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APPENDIX A
SERVICE SPECIFICATION
Service Specification No.
3
Service
Participation in the R U Clear chlamydia and gonorrhoea
screening programme (Pharmacies) SCREENING ONLY
Authority Lead
Jon Dunn, Public Health Manager, Manchester City Council
Provider Lead
Period
1 June 2015 to 31 March 2015
Date of Review
1 January 2016
60
1. Population Needs
1. NATIONAL AND LOCAL CONTEXT
1.1 NATIONAL CONTEXT
1.1.1 Overview of commissioning responsibilities
a. Local authorities have the lead for improving health and for coordinating efforts to protect public
health. Public health teams within local authorities are responsible for commissioning and
funding a number of mandated services and other services to improve the health and wellbeing
of local populations.
b. Local authorities are mandated to commission and fund comprehensive, open-access HIV/STI
testing services, STI treatment services (excluding HIV treatment) and contraception services
for the benefit of all persons of all ages present in their area. NHS England is responsible for
commissioning and funding HIV treatment services. Clinical Commissioning Groups are now
responsible for funding abortion services; vasectomies and sterilisation procedures; and for the
promotion of opportunistic STI testing and treatment within general practice.
1.1.2 National Chlamydia Screening Programme (NCSP)
a. Genital chlamydia infection is the most commonly diagnosed bacterial sexually transmitted
infection in the UK. Prevalence of the infection is highest in sexually active women aged 16-19
and men aged 20-24. Untreated infection can have serious long-term consequences including
pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Chlamydia often has
no symptoms and opportunistic screening of asymptomatic young people is considered the
best approach for detecting and treating this infection.
b. The National Chlamydia Screening Programme (NCSP) in England was established in 2003.
The programme aims to prevent and control chlamydia through early detection and treatment of
asymptomatic infection, so reducing onward transmission and the consequences of untreated
infection.
c. The Department of Health considers that general practices and pharmacies have an important
role in screening for chlamydia, treatment and partner notification. Embedding the offer of an
opportunistic screen in core services including general practices and community contraception
and sexual health services is recommended practice and the approach that is considered the
most viable option for further extending the reach of local programmes.
1.1.3 Public Health Outcomes Framework
a. The Public Health Outcomes Framework sets out a vision for public health, desired outcomes
and the indicators that will be used to monitor how well public health is being improved and
protected. The Framework includes three indicators relating to sexual health:
o
Indicator 2.04: Under-18 conception rate
o
Indicator 3.02: Chlamydia diagnosis rates among young adults aged 15-24s
o
Indicator 3.04: % of persons presenting with HIV at a late stage of infection
b. Local areas are tasked to continue to work to reduce the number of under-18 conceptions, to
prevent and control the transmission of chlamydia, and to promote and increase uptake of HIV
testing in order to reduce the number of patients entering HIV treatment services at a late stage
of infection. Participation in the R U Clear chlamydia and gonorrhoea screening programme is
expected to contribute to increasing the number of access points for asymptomatic young
people aged 15-24 to obtain an opportunistic screen.
c. Public Health England recommends that local areas should be working towards achieving a
chlamydia diagnosis rate of at least 2,300 per 100,000 young people aged 15-24. Modelling
suggests that achieving a diagnosis rate of >2,300 will contribute to further reducing the
prevalence of chlamydia.
1.2 LOCAL CONTEXT
1.2.1 Overview of sexual health data for Manchester
a. Improving the sexual health and wellbeing of the population is one of the public health priorities
for Manchester. Sexual ill-health is a particular issue for Manchester with high rates of sexually
transmitted infections including HIV and high rates of unintended conceptions.
b. Manchester has the highest incidence of HIV outside of London and the South East. 230
residents entered HIV treatment services in 2012; the overall number of residents accessing
HIV treatment reached 2,086 at the end of 2012. 1,083 (52%) residents had contracted HIV
through sex between men and 896 (43%) residents through heterosexual sex.
c. Diagnoses of common sexually transmitted infections including chlamydia, gonorrhoea, genital
herpes and genital warts are also increasing. GUM clinics diagnosed 1,537 cases of chlamydia,
711 cases of gonorrhoea, 469 cases of genital herpes (first episode) and 1,106 cases of genital
warts (first episode) to patients recorded as residents of Manchester in 2012. 1,685 cases of
chlamydia were diagnosed in contraception clinics and other settings in 2012.
d. Rates of most sexually transmitted infections are highest amongst young people aged 16-24;
rates of selected sexually transmitted infections are also high amongst men who have sex with
men and women and men from black African and black Caribbean communities living in the
UK.
e. Uptake of contraception amongst residents is good. Residents can obtain contraception from
general practices and from contraception and sexual health clinics. Palatine contraception and
sexual health service reported 46,000 clinic attendances in 2012/13, up from 43,800 in
2011/12. Brook in Manchester recorded 12,900 clinic attendances in 2012/13, up from 10,000
in 2011/12.
f.
The proportion of women opting for long-acting reversible contraception is increasing. 5,152
(28%) females attending for contraception and recorded as a first contact opted for a longacting method at Palatine clinics in 2012/13, up from 4,576 (26%) in 2011/12. 702 females
attending for contraception and recorded as a first contact opted for a long-acting method at
Brook in 2012/13, up from 646 (19%) in 2011/12. In 2011/12, 3,450 patients received a longacting method of contraception from their general practice.
g. The rate of abortions among female residents aged 15-44 has been falling since the late 2000s,
down from 24 per 1,000 in 2008 to 21 per 1,000 in 2011. The abortion rate for Manchester is
higher than the rate for England but is comparable to other core cities. 2,964 abortions were
performed to women resident in Manchester in 2011. 987 (33%) procedures were performed
for young women aged 20 – 24; 749 (25%) for women aged 25 – 29; 406 (14%) for women
aged 30 – 34; and 332 (11%) for women aged 35 and over. 490 (17%) procedures were
performed for young women in their teens.
h. The under-18 conception rate for Manchester peaked in 2005. The rate stood at 52.2 per 1,000
in 2011 compared to 71.9 per 1,000 in 2005 (-27%); there were 411 under-18 conceptions in
2011 compared to 591 in 2005 (-30%). However, Manchester continues to have one of the
highest under-18 conception rates in England and in parts of east and north Manchester more
than one in ten young women conceive before reaching the age of 18.
1.2.2 R U Clear chlamydia and gonorrhoea screening programme
a. R U Clear is the chlamydia and gonorrhoea screening programme for Greater Manchester. R U
Clear processes screens for chlamydia and gonorrhoea, manages results, undertakes partner
notification activities, and arranges treatment.
2. Outcomes
2.0 EXPECTED OUTCOMES
2.1 Direct influence on outcomes
a. Participation in the R U Clear chlamydia and gonorrhoea screening programme is expected to
contribute to:
1. Increasing the number of asymptomatic young people accepting an opportunistic screen for
chlamydia and gonorrhoea from pharmacies in Manchester.
2. Improving knowledge and understanding of chlamydia and gonorrhoea amongst young men
and women through the provision of information, advice and guidance.
3. Improving knowledge and understanding of the risks associated with unprotected sex
through the provision of information, advice and guidance.
4. Improving awareness of the importance of regular screening for chlamydia amongst young
women and men through the provision of information, advice and guidance.
2.2 Indirect influence on outcomes
a. Participation in the R U Clear chlamydia and gonorrhoea screening programme is expected to
contribute to achieving:
1. Reducing the prevalence of chlamydia and gonorrhoea amongst young women and men
through the prompt detection and treatment of asymptomatic infection.
2. Reducing the transmission of chlamydia and gonorrhoea amongst young people through
the promotion of safer sex practices.
3. Preventing the consequences of untreated infection.
3. Scope
3.1 AIMS AND OBJECTIVES
3.1.1 Aims
a. The overall aim is to embed the offer of an opportunistic screen for chlamydia and gonorrhoea
for asymptomatic young people aged 16-24 within pharmacies located in Manchester. This will
contribute to local efforts to prevent and control transmission through prompt detection and
treatment of asymptomatic infection.
3.1.2 Objectives
a. Contractors participating in the R U Clear chlamydia and gonorrhoea screening programme will:
1. Promote the R U Clear chlamydia and gonorrhoea screening programme and communicate
the importance of regular screening to young people (16-24s) accessing services from the
pharmacy.
2. Issue R U Clear chlamydia and gonorrhoea home screening kits to young people (16-24s)
accessing services from the pharmacy, as and when appropriate.
3. Ensure that clients accepting a R U Clear chlamydia and gonorrhoea home screening kit
are provided with information, advice and guidance about how to take and return the
sample.
4. Ensure that clients accepting a R U Clear chlamydia and gonorrhoea home screening kit
are provided with information, advice and guidance about sexually transmitted infections
including chlamydia and gonorrhoea.
3.2 SERVICE DESCRIPTION
a. Manchester City Council is commissioning and funding the Contractor to offer chlamydia
screening and treatment services as described in this specification. This section details:
o
Specific requirements relating to participation in the R U Clear chlamydia and gonorrhoea
screening programme (Component A - see section 3.2.1)
o
General requirements relating to the provision of all services detailed in this specification
(see section 3.2.2)
3.2.1 Opportunistic screening of asymptomatic young people for chlamydia and gonorrhoea
(Component A)
a. Manchester City Council is commissioning and funding the Contractor to participate in the R U
Clear chlamydia and gonorrhoea screening programme in line with the requirements set out in
this specification. R U Clear is the opportunistic screening programme for asymptomatic young
people aged 16-24 living in Greater Manchester.
b. The Contractor shall arrange for trained pharmacists / counter staff to issue R U Clear
chlamydia and gonorrhoea home screening kits to asymptomatic young people aged 16-24
attending the pharmacy.
c. Pharmacists / counter staff should assess the appropriateness of offering a R U Clear
chlamydia and gonorrhoea home screening kit. It could be appropriate to issue a home
screening kit for instance if:
o
Young person attends the pharmacy for emergency hormonal contraception
o
Young person attends the pharmacy and asks for information, advice or guidance about
contraception or sexually transmitted infections.
d. Pharmacists / counter staff should ensure that clients accepting a R U Clear chlamydia and
gonorrhoea home screening kit are provided with information, advice and guidance about how
to take and return the test.
e. Pharmacists / counter staff should ensure that clients accepting a R U Clear chlamydia and
gonorrhoea home screening kit are provided with information, advice and guidance about
sexually transmitted infections including chlamydia and gonorrhoea. Symptomatic young
people should be referred to STI testing / treatment services.
f.
The Contractor must ensure that pharmacists / counter staff are competent and trained in the
operation of this service.
g. The Contractor is required to ensure that pharmacists / counter staff have the skills to consult
with clients in a sensitive and appropriate manner.
3.2.2 General requirements
a. The Contractor is required to ensure that consultations occur in a designated room or area. The
designated room or area should meet the relevant guidelines and should allow for the
conversation between the client and the pharmacist / member of staff to remain confidential.
b. Manchester City Council requires the Contractor to log the distribution of R U Clear chlamydia
and gonorrhoea home screening kits (Component A) using Pharmoutcomes. The Contractor
will need to record the unique identification number on the screening kit as well as their site
reference number. Pharmoutcomes will be used for the purposes of audit and for generating
and submitting invoices.
c. The Contractor is required to adhere to national and local guidelines for offering sexual health
advice and treatment to young people aged under-19 including the requirement to assess
Fraser competence.
d. The Contractor will ensure compliance with local policies and procedures for safeguarding
children and vulnerable adults including the Greater Manchester protocol for working with
sexually active young people (See Section 4)
e. Manchester City Council will promote contraception and sexual health services and access
points via the sexual health website for Manchester and other channels.
f.
Manchester City Council will ensure that the Contractor has information about local
contraception and sexual health services to aid pharmacists to make accurate and appropriate
referrals.
g. Manchester City Council will arrange at least one service monitoring meeting per annum
3.2.3 Requirements of the R U Clear chlamydia and gonorrhoea screening programme
a. Manchester City Council commissions and funds CMFT to manage the R U Clear chlamydia
and gonorrhoea screening programme. R U Clear is responsible for working with partners to
deliver screening and treatment activities including:
i)
Supporting screening sites through the provision of consumables including home screening
kits.
ii) Delivering a results management service and to arrange treatment for index cases and their
partners in line with NCSP guidelines
iii) Delivering partner notification activities in line with NCSP guidelines
iv) Providing on-site training and support for providers offering chlamydia screening
v) Providing on-site training and support for providers offering treatment of chlamydia
vi) Producing and distribute promotional materials – e.g. poster and leaflets
3.3 CLINICAL GOVERNANCE
3.3.1 General
a. The Contractor is responsible for ensuring that sufficient arrangements for clinical governance
are in place to allow for the provision of safe, effective services delivered to a high standard.
The Contractor is required to adhere to Department of Health guidance including:
i)
To establish and maintain links with reproductive and sexual health services.
ii) To have processes and procedures in place for reporting incidents including serious
untoward incidents (SUIs). The Contractor is required to inform the Director of Public Health
on incidents and near misses as well as reports on complaints and complements and other
patient feedback.
b. The Contractor is required to ensure that all staff involved in the provision of R U Clear home
screening kits (Component A) have received appropriate training.
c. The Contractor will ensure that a Standard Operating Procedure is in place for each of the
components described in this specification.
d. Manchester City Council reserves the right to liaise with NHS England and / or CCGs to check
that the Contractor is eligible and competent to provide pharmacy services
3.3.2 Clinical skills and competencies
a. The Contractor is required to ensure that all staff (pharmacists and counter staff) involved in
the distribution of R U Clear home screening kits have received on-site training from R U Clear
(CMFT)
b. The Contractor is also required to ensure that each pharmacist / counter staff member involved
in the distribution of R U Clear home screening kits has had a Criminal Records Bureau (CRB)
/ Disclosure and Barring Service (DBS) enhanced check.
3.3.3 Care pathways and protocols
a. The Contractor is required to support the development and implementation of care pathways
and protocols relating to the provision of chlamydia screening and/or treatment of chlamydia.
3.4 POPULATION
a. Manchester City Council is responsible for commissioning and funding contraception and sexual
health services for residents of Manchester.
b. This service is not restricted to residents of Manchester. However, the Contractor is required to
ensure that, for all clients attending to collect R U Clear chlamydia and gonorrhoea screening
kits that full postcode data is collected and recorded to allow the Council to cross-charge for
services provided for residents of other local authorities.
3.5 INCLUSION AND EXCLUSION CRITERIA
3.5.1 Opportunistic chlamydia and gonorrhoea screening for asymptomatic young people
1. Inclusion criteria
a. The Contractor is permitted to offer R U Clear screening kits to:
2.
o Asymptomatic young people aged 16-24 living in Greater Manchester.
Exclusion criteria
a. The Contractor is required to exclude:
o
Symptomatic young people
o
Young people aged 15 and under
o
Adults aged 25 and over
o
Young people not resident in Greater Manchester
b. The Contractor should refer excluded clients, as appropriate, to other services including:
o Symptomatic young people should be referred / signposted to STI testing services.
o Young people aged under-16 should be referred / signposted to STI testing services.
o Adults aged 25 and over should be signposted to STI testing services
o Young people not resident in Greater Manchester should be signposted to STI testing
services in their own area of residence.
3.6 REFERRALS
a. The Contractor is required to accept self-referrals from clients attending to collect an R U Clear
home screening kit
3.7 INTERDEPENDENCIES WITH OTHER SERVICES
a. The following interdependencies have been identified:
1. R U Clear (Central Manchester Foundation Trust) – for the provision of R U Clear chlamydia
and gonorrhoea home screening kits.
2. R U Clear (Central Manchester Foundation Trust) – for the referral of clients for treatment for
chlamydia.
4. Applicable Service Standards
General
A Framework for Sexual Health Improvement in England’, Department of Health, 2013
Sexual Health: Clinical Governance – Key principles to assist service commissioners and
providers to operate clinical governance systems in sexual health services’, Department of
Health, 2013
Emergency contraception
Clinical Guidance: Emergency contraception’, Faculty of Sexual and Reproductive
Healthcare, 2012
Chlamydia screening and treatment
Integrating the National Chlamydia Screening Programme within local sexual health
economies: Guidance for commissioners and public health professionals’, Department of
Health, 2012
Development of specifications for the commissioning of chlamydia screening in general
practice and community pharmacy’, Department of Health, 2010
NHS Community Pharmacy Contractual Framework Enhanced Service: Chlamydia testing
and treatment’, Department of Health, 2010
CPPE Self-Declaration of Competence
https://www.cppe.ac.uk/services/docs/Chlamydia%20testing%20and%20treatment.pdf
https://www.cppe.ac.uk/services/docs/emergency%20contraception.pdf
Protocol for working with sexually active young people
http://greatermanchesterscb.proceduresonline.com/chapters/p_work_sexually_act_yp.html
5. Location of Provider Premises
The Contractor is required to deliver the services detailed in this specification from:
Faith Pharmacy
59 Booth Street West
Hulme
Manchester
M15 6PQ
6. Required Insurances
Please refer to Section B; General Terms and Conditions of the Contract, Clause B27: Insurances
for details of the required levels on insurances.
7. Fees to be paid
Distribution of R U Clear chlamydia and gonorrhoea screening kits
A1
Issue of an R U Clear home screening kit
£2 per kit
Manchester City Council reserves the right to revise fees.
All contractors must submit an invoice and audit data in a timely manner. Payments
will not be made if audit data is not submitted. Any invoice which relates to work
completed more than four months ago will not be paid