Supervised Consumption Service Level Agreement

between

North Yorkshire and York Primary Care Trust

(on behalf of North Yorkshire and City of York Drug and Alcohol Action Teams)

and

Chemist Name

[insert today’s date]

1 Updated May 2010

Services Covered Supervision of the consumption of substitute medications prescribed (under NHS prescriptions) to those who have drug-related problems, including dependent opiod users as well as those who present with additional polydrug use or concurrent use of, for example, benzodiazepines.

Duration of Agreement 1 March 2008 to 31 March 2009

Commissioner North Yorkshire Substance Misuse Team, on behalf of North Yorkshire and York Primary Care TrustThe HamletHornbeam ParkHarrogate HG2 8RE

01423 815150

Commissioner’s Angela Dixon Representative Commissioning Manager – Substance Misuse

North Yorkshire Substance Misuse TeamNHS North Yorkshire and YorkStation Road Business ParkStation RoadThirskYO7 1PZ

01845 573934

Provider Chemist Name StreetTownCountyPostcode

Telephone Number

Provider’s ……………………………………………………………..Representative (Provider - please complete)

2 Updated May 2010

CONTENTS

Paragraph

1 Introduction

2 Strategic Objectives

3 Aims, Objectives, Principles and Standards

4 Service Management

5 Service Provision

6 Provider’s Obligations

7 Commissioner’s Obligations

8 Quality of Service

9 Performance Standards

10 Service Management

11 Service Development

12 Monitoring of Service

13 Risk Management

14 Service User – Eligibility

15 Service User – Exclusion

16 Interagency Working

17 Method of Payment

18 Termination

19 Appendices

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1 INTRODUCTION

1.1 This document sets out a service specification for a Community Pharmacy (the ‘Provider’) providing a supervised consumption service (the ‘Service’). The Service will be provided to drug users who are prescribed methadone, Subutex® or Suboxone® in the City of York or North Yorkshire DAAT areas. The Service will encompass supervised support and advice to service users in a safe environment.

1.2 The commissioning body that is responsible for the Service is North Yorkshire and York Primary Care Trust (the ‘Commissioner’). The commissioning of the service, on behalf of the PCT, is undertaken by North Yorkshire and City of York Drug and Alcohol Action Teams.

1.3 The Service will be delivered by the ‘Provider’ in accordance with these specifications and the Pharmacy Based Management of Substances for Drug Users, Operational Guidelines – attached at Appendix 1 (‘the Guidelines’). Any such revision or re-issue or subsequent version may be disclosed to the Provider by the Commissioner from time to time.

1.4 Any contractual agreement undertaken between the Commissioner and the Provider assumes the Provider’s compliance with obligations and responsibilities as set out by the Royal Pharmaceutical Society of Great Britain (RPSGB) and the National Treatment Agency. In addition, any locally set clinical governance and quality standards as agreed between the Provider and Commissioner are to be adhered to.

1.5 This Service Level Agreement will, as required, be subject to review and amendment.

1.6 For the purposes of this Service Level Agreement, supervised consumption means the observed consumption by the pharmacist/staff of service users prescribed substitute medications for opiates where supervision has been requested by the prescriber. The practice is designed to support drug users to stop or stabilise their opiate use thus enabling them to develop their personal goals.

2 STRATEGIC OBJECTIVES

2.1 The Commissioner is committed to purchasing services which fulfil the requirements of the National Drugs Strategy, whilst meeting local need. Key aims of service commissioning are to:

discourage people from misusing drugs and enable those who wish to stop to do so;

ensure that communities have access to accurate information about the risks of drug misuse;

increase the safety of communities from drug related crime; reduce the harm drug misuse causes to individuals and to communities; reduce the accessibility and availability of drugs to young people;

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protect communities from the health risks, and other damage associated with drug misuse, including the spread of communicable disease such as HIV, or Hepatitis.

3 AIMS AND OBJECTIVES OF THE SERVICE

3.1 To ensure compliance with the service user’s agreed care plan, by: dispensing prescribed medication in specified instalments; ensuring each supervised dose is correctly administered to the patient for

whom it was intended (doses may be dispensed for the patient to take away to cover days when the pharmacy is closed);

liaising with the prescriber, named keyworker and others directly involved in the care of the patient (where the patient has given their written permission);

monitoring the patient’s response to prescribed treatment; for example, if there are signs of overdose, especially at times when doses are changed, during titration of doses,

if the patient appears intoxicated or when the patient has missed doses, and, if necessary, withholding

treatment if this is in the interest of patient safety, liaising with the prescriber or named keyworker, as appropriate;

improving retention in drug treatment; improving drug treatment delivery and completion.

3.2To reduce the risk to local communities of:

overuse or underuse of medicines; diversion of prescribed medicines onto the illicit drugs market; accidental exposure to the dispensed medicines.

4 SERVICE MANAGEMENT

4.1 At the commencement date and throughout the term of the Agreement, the Provider shall appoint a Representative, who shall:

oversee and co-ordinate the Service on behalf of the Provider; liaise with and act as the contact point for the Commissioner’s

Representative; ensure that the terms and conditions of this Agreement are met.

This Representative must be informed to the Commissioner’s Representative by completing and submitting Appendix 3.

For all changes, further forms must be submitted.

4.2 At the commencement date and throughout the term of the Agreement, the Commissioner will appoint a Representative who shall: manage the Agreement; liaise with the Provider’s Representative.

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The Provider must be informed, in writing, of any changes to the Commissioning Representative.

5 SERVICE PROVISION

5.1 The Provider will facilitate:

the service user’s access to a user-friendly, non-judgmental, patient-centred and confidential service.

the service user’s access to a point for the collection and consumption of substitute medications for opiates.

the service user’s access to information and advice on minimising harm, general health and health promotion.

service user’s access to referral to other health and social care professionals where appropriate.

5.2 The Provider will promote safe practice to the user. Pharmacists or other appropriately trained staff should provide direct input wherever possible to promote harm reduction. Interventions should include a clear health promotion element.

5.3 The Provider will input into the care planning for service users as requested by the service user’s prescriber or key worker.

5.4 Providers will support the service user’s key worker, responsible for co-ordinating care, by monitoring continuity of care and contributing to the aim of maximising retention of service users in treatment.

5.5 The Provider is not limited to the number of service users they take on at any one time as long as they can fulfil their obligations of providing a quality service to service users, in line with this Agreement and the Guidance.

6 PROVIDER’S OBLIGATIONS

6.1 The Provider will ensure the pharmacy environment and protocols are in such a condition as to be able to:

facilitate a quiet, discreet and confidential area where consumption of substitute medications for opiates and other health care interventions can take place;

ensure capacity to provide information and leaflets supplied via other relevant agencies and shared care partners;

ensure that standard operational procedures facilitate a ‘speedy’ service that limits waiting time for service users;

access to records and documents containing information relating to service users will be restricted to authorised personnel and that information will not be disclosed to a third party. The Provider will ensure compliance with the Data Protection Act, Caldicot and other

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legislation covering access to confidential service user information. Pharmacists will only share information with other health care professionals and agencies in line with any agreed information sharing protocols.

6.2 The Provider will ensure that all pharmacists, locums or other staff involved in delivering this scheme will:

treat all service users with dignity and respect and value their rights to confidentiality;

work in partnership with key stakeholders in the ‘shared care scheme’, i.e. the service user, prescriber or key worker;

provide appropriate health information and referral to other services when required;

commit to reasonable training and service development initiatives as set out in this Agreement;

support the Pharmacist and Provider’s Representative in providing the service.

6.3 The Provider will ensure compliance with all legal and professional requirements.

6.4 The Provider will ensure that substitute medications are only dispensed if the conditions outlined in Appendix 1 apply.

6.5 Care Management

Providers who provide both needle exchange and supervised consumption services will include the supervised consumption service as part of the ‘shared care management system’ within the terms of this contract, but will work to a separate SLA and Guidelines for the needle exchange services.

6.6 Training

The following are training and competencies that the Provider will need to develop within the pharmacy, in order to comply with all requirements for offering a supervised consumption service. All pharmacists must have an appropriate level of competency to undertake this Service.

6.6.1 The Provider ensures that at least one pharmacist, based at the location detailed on page 2 of this Agreement, involved in the delivery of the Service, completes the ‘Substance Use and Misuse’ (or successor) distance learning package, available from the Centre for Postgraduate Pharmaceutical Education. This individual must be made known to the Commissioner.

6.6.2 If the Provider does not have a pharmacist with this training upon signing of this Agreement, the Provider is expected to ensure completion of the training within six months. The Commissioner’s

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Representative must be informed once the qualification has been awarded and a copy of the certificate sent to them.

6.6.3 The Provider ensures that its Representative and one other member of staff attends one DAAT-led annual training and development event per year to promote the service locally and update knowledge and skills.

6.6.4 Providers must ensure that staff are trained to provide the appropriate level of service. Pharmacists and their staff will adhere to the standards and practice guidance set out by the RPSGB for the provision of service to drug misusers.

6.6.5 The Provider will ensure that Pharmacists respond to all reasonable training requirements, as reasonably required, from time to time by the Commissioner.

6.7 Competencies

6.7.1 Information Management

Establish and maintain appropriate information related to drug treatment services and other relevant local services.

Correctly process documentation for the supervised consumption scheme.

Provide appropriate records for audit and evaluation.

6.7.2 Communication

Elicit key information for the dispensing of substitute medications for opiates by use of appropriate questions.

Provide information and advice in a manner appropriate to the needs of the service user.

Behave in a manner that instils confidence of others involved in the service, especially the service user.

Support, collaborate with, delegate to and supervise other staff in an appropriate manner for the provision of the Service,

Use knowledge and skills effectively to facilitate learning of other staff in relation to the Service.

6.7.3 Personal Skills Development

Recognise personal and professional limitations in regards to the Service.

Identify priorities for staff training and development for the Service Record learning activities in relation to the Service.

7 COMMISSIONER’S OBLIGATIONS

7.1 The Commissioner will facilitate at least one contractors’ meeting per year to promote service development and update the knowledge of pharmacy staff

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and to assist with the Provider’s training and development with regards to the Service.

7.2 The Commissioner will provide a framework for the monitoring and recording of relevant service information for the purposes of audit and the claiming of payment.

7.3 The Commissioner will provide details of relevant referral points and pathways, in line with Models of Care, which pharmacy staff can use to signpost service users who require further assistance.

7.4 The Commissioner will obtain or produce health promotion material relevant to the service users and make this available to Providers.

7.5 The Commissioner’s Representative will keep an up-to-date and comprehensive list of pharmacies providing the Service. This is in line with financial governance and an important tool for the planning of drug misuse services.

8 QUALITY OF SERVICE

8.1 The Commissioner will expect evidence of the Provider’s full compliance with:

the New Contract for Community Pharmacy 2004; the Commissioner’s clinical governance and quality standards

arrangements; other reasonable future arrangements deemed necessary as and

when required.

8.2 All clinical governance, reported incidents and service user safety standards in regards to this enhanced service will be monitored and audited on an annual basis by the Commissioner.

8.3 The Provider will ensure and provide evidence that the Commissioner is indemnified against any claim arising from a service user, or any person acting on behalf of the service user, during the provision of the Service.

8.4 The Provider will provide and maintain a safe and suitable environment for Service Users and comply with all relevant statutory requirements, legislation, Department of Health Guidance and professional codes of practice and all health and safety regulations.

8.5 The Provider will effectively manage any complaints or incidents within the complaints procedure protocols and guidelines.

9 PERFORMANCE STANDARDS

9.1 The Provider ensures the pharmacy has appropriate health promotion material available for the user group and displays and promotes its uptake.

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9.2 The Provider reviews its standard operating procedures in line with the Commissioner’s requirements as negotiated with the Local Pharmaceutical Committee, on behalf of the Provider.

9.3 The Provider adopts and implements the DAAT’s Models of Care assessment and screening tools and referral and care pathways for the service users.

9.4The Provider complies with the monitoring and administration requirements, keeping accurate records and forwarding them quarterly to the Commissioner:

numbers in treatment per month and quarter; number of visits per individual registered for treatment, per month; numbers not complying with supervised administration scheme; information and advice offered; untoward incidents.

9.5 The Provider ensures training standards are maintained as stipulated in this Agreement.

9.6 The Provider participates in an annual Commissioner organised clinical governance, service and contract review as deemed necessary.

9.7 The Provider annually facilitates service user feedback and uses it to improve service delivery where appropriate

10 SERVICE MANAGEMENT

10.1 Core opening hours will be those normally operated by the Pharmacy. Any specific requirements must be arranged and agreed with the service user and marked down on the service user/pharmacists agreement.

11 SERVICE DEVELOPMENT

11.1 Service developments will be negotiated on an annual basis. Any generic changes will be put to the Local Pharmaceutical Committee prior to implementation.

12 MONITORING OF SERVICE

12.1 Monitoring is an integral part of the Agreement and negotiations regarding continuation or termination of the Agreement.

12.2 The Provider complies with the monitoring and administration requirements, keeping accurate records and forwarding them quarterly to the Commissioner:

numbers in treatment per month and quarter, including service user’s initial, date of birth and postcode;

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number of visits per individual registered for treatment, per month, including dates of all supervisions;

numbers not complying with supervised administration scheme; information and advice offered; untoward incidents.

12.3 Monitoring Meeting

The Commissioner’s Representative, or designated officer, will visit the Provider at least once every two years, for a formal monitoring meeting, to last no longer then one hour.

The visit will be arranged with a minimum of four week’s notice, at a mutually agreed date and time.

The Provider representative will have to complete a monitoring proforma and submit this at least two weeks prior to the scheduled visit. The proforma will be no longer than two pages and will include collation of service users’ views on the service provided.

Following the formal monitoring the Provider will receive two copies of the notes of the meeting, identifying areas for support and/or follow up. Both copies should be signed and one returned to the Commissioner’s Representative. A copy of the signed notes of the meeting will be forwarded to the Local Pharmaceutical Committee and the Primary Care Contracting Team.

13 RISK MANAGEMENT

13.1 The Provider will inform the Commissioner within one working day of serious untoward incidents.

14 SERVICE USER ELIGIBILITY FOR THE SERVICE

Eligibility for the Service will be as follows:

14.1 Normally - For service users 18 years and over who are assessed as requiring methadone/buprenorphine substitute prescribing by GPs or locally commissioned specialist drug treatment services.

14.2 Rarely - Young people from 16 to 18 years old, generally regarded as competent to consent to treatment and assessed as requiring methadone/buprenorphine substitute prescribing by GPs or locally commissioned specialist drug treatment services.

14.3 Exceptionally - Young people under 16 years old, assessed as requiring methadone/buprenorphine substitute prescribing by the specialist prescribing service, who has been deemed capable of managing the treatment regimen by the prescribing doctor in consultation with the young persons’ specialist service.

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14.4 The Provider must ensure that the planning and delivery of the Service is directed towards meeting the needs of all diverse populations. All aspects of the Service will be sensitive to the individual needs of Service Users. Their cultural, religious and linguistic needs should be recognised and met, utilising resources and specific services for support where appropriate.

15 SERVICE USER EXCLUSION

15.1 Pharmacists may refuse to serve Service Users. Service Users may be excluded if they pose a serious risk to staff, other service users and members of the public. As with any other customer the police may be called.

16 INTERAGENCY WORKING

16.1 Liaison with Substance Use Specific Services

The Provider will demonstrate appropriate working arrangements with specialist substance treatment providers.

16.2 Liaison with Non-substance Misuse Key Stakeholders

For the Service to operate effectively it is essential that good working relationships are developed and maintained, particularly with prescribing GPs, but also with other complementary service providers, including local agencies such as community health and social care agencies.

17 METHOD OF PAYMENT

17.1 Payments to the Provider will be made in accordance with the payments detailed in Appendix 2. The payments will be subject to such amendments as are agreed from time to time. All changes will be notified in writing and must be appended to this Agreement.

17.2 Payment for the Service will be made in accordance with this Agreement and paid monthly on receipt of the appropriately completed paperwork.

17.3 Payments can only be made to pharmacies who have signed up to this supervised consumption scheme and have agreed to provide the Service, outlined in this Agreement.

18 TERMINATION

18.1 If the Service is not provided in accordance with the standards set out in this Agreement, the Commissioner may, by written notice, require the Provider to remedy any failure.

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18.2 If the Provider:

is in material and/or persistent breach of SLA standards; has committed any offence under the Prevention of Corruption Acts; has given any undisclosed or illicit fee, or reward, to any elected member

or officer of the Commissioners in order to gain an unfair advantage; becomes bankrupt, makes an arrangement with its creditors or other

arrangement under the Insolvency Act 1986; has an administrative receiver or liquidator appointed or has a winding up

order made;

the Commissioner may terminate the SLA immediately.

18.3 This Agreement may be subject to termination should the funding from the Commissioners cease.

18.4 At least three months notice must be given by either party to terminate or change this Service Level Agreement. The Commissioner retains the right to withdraw the scheme at any time if it is deemed unsuccessful.

19 APPENDICES

1 Pharmacy Based Management of Substances for Drug Users – Operational Guidelines 2008

2 Payment Model3 Notification of Provider Representation Form

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20 SIGNATORIES

The Commissioners and the Provider agree that the Provider shall deliver the services in accordance with the clauses contained within this Agreement.

Signed by North Yorkshire and York Primary Care Trust.

Signed & Dated

1 February 2008

Name Melanie Bradbury

Position Assistant Director of Vulnerable People and Third Sector Commissioning

For the Provider

Signed & Dated

Name

Position

This Agreement is Dated [insert today’s date].

Please sign, date and keep one copy of this contract for your files. Sign, date and use your pharmacy stamp and post to:

Angela Dixon, Commissioning Manager – Substance Misuse, North Yorkshire and City of York Drug and Alcohol Action Teams, NHS North Yorkshire and York, Station Road Business Park, Station Road, Thirsk, YO7 1PZ

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APPENDIX 1

PHARMACY BASED MANAGEMENT OF SUBSTANCES FOR DRUG USERS - OPERATIONAL GUIDELINES

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APPENDIX 2

PAYMENTS MODEL

1 Per Supervision

The current scale of payments to pharmacies engaged in this scheme is:

Methadone £1.50 per supervised consumption. Subutex/Suboxone £2.45 per supervised consumption.

2 Retainer

There is no retainer paid for this Service.

3 Claims

In order for payments to be processed, claim forms with a covering invoice should be sent to the DAAT, at the address on page 2 of this Agreement.

All invoices must include:

the reference ‘5NV PAYABLES 6675 XXNORTHYORKSDAAT’. The name, address and telephone number of the pharmacy making the

claim; VAT number if applicable; the word ‘INVOICE’; date of the invoice; invoice number unique to your pharmacy; date(s) or time period to which the claim relates; a brief description of services claimed for.

Only original copies of invoices will be paid and should ideally be printed off on pharmacy letter head.

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APPENDIX 3

PROVIDER DETAILS

1) The owner / manager is a National Pharmacy Association member:-

Owner/ Manager* ……………………………………………………………..(Insert name)* delete as appropriate

NPA Member? Yes No

2) The pharmacy is open for ( 5 ) ( 6 ) ( 7 )* days a week. *Circle correct figure

3) I ………………………………………………, the Provider’s Nominated Representative, will claim the fees appropriate to this number of days opening - following supervised consumption, in line with this Agreement.

Signed & Dated

Pharmacy Name

Pharmacy Address

Tel Number

Pharmacy Stamp

Please provide details of those Pharmacist(s) that will provide the Service. Copies of CPPE certificates should be sent to the contact address on page 2 of this Agreement.

Name(s) of Pharmacist(s)

CPPE Qualification(please tick)

CPPE to be completed within 6 months (please tick and include

deadline)

17 Updated May 2010