Community Pharmacy Injecting Equipment Provision -new service 2017- Elizabeth Hutchings - Substance Misuse Pharmacist

Programme: Introduction to the new service specification Any questions? Water for injections. Any more questions?

Thank you For coming tonight Conducting 18,500 transactions last year Distributing 331,000 syringes last year 78% of syringes supplied in Fife come from the 19 IEP pharmacies A big thank you to everyone who has come to this event for Injecting Equipment Providing pharmacies Your work is appreciated by the Blood Borne Virus and Public Health teams and quite possibly taken for granted – but without you we would be hard pushed, in fact it would be impossible to deliver this scale of a harm reduction service across Fife. With an estimated number of 2,900 injecting drug users in Fife the rate of syringes distributed stand at about 145 per person per year – second highest in Scotland (rates ranging from an estimated 164 per user to 29 per user) The last briefing from the Needle Exchange Survey Initiative (researchers visited some pharmacies in Fife) indicated that Hep C rates across Scotland have risen since the last survey conducted in 2011/12 and Glasgow has reported 90 new cases of HIV since 2015 when they could have expected around 20.

Background to the service update Hep C Action Plan: 2010 Guidelines Emma’s visit: 2015 survey and observation of current practice Service Specification: no review since set up in 2008 Time for an update:- Back in 2010, as one of the actions of the Hepatitis C Action Plan, the Guidelines for services providing Injecting Equipment were published. The guidelines recognised the advantages of using community pharmacies – a “local” service with longer opening hours, access to a healthcare professional, less stigmatising and more anonymous service but also recognised that pharmacies are busy places and there is often not the time or space to provide in-depth advice and education to injectors and that pharmacy staff need training and support to deliver the service. During the summer of 2015 Emma Hamilton - National Training and Development Officer for the Scottish Drug Forum visited every IEP pharmacy in Fife and produced a report on her findings. Emma completed a survey at each pharmacy asking questions about the support the service needed, training requirements, what happens in practice, staff confidence in providing the service and the equipment provided. Emma concluded, and indeed staff highlighted, that there are a range of training needs which need to be met in order for you to feel confident to deliver harm reduction support but there are challenges in attending or completing training. What staff felt they did well was the informal rapport they had with clients, non-judgemental, discreet, quick, confidential service and taking time to listen. However, staff did recognise that they do not give out information on harm reduction, signpost to other services, and don’t spend enough time asking questions of their clients. The existing Service Specification was drawn up in 2008 – when NHS Fife Addiction Services managed Fife’s Harm Reduction Service and was badly in need of updating. The new service specification is based on a proposed national service specification and I hope will bring some clarity to exactly what is expected from a pharmacy based Injecting Equipment Provider.

The main differences: £500 retainer and £2.00 transaction fee Staff available for training One “peer review” session Four topics annually Better use of NEO Transaction data Client details The new service specification and remuneration package was discussed and agreed by the Community Pharmacy Fife committee just before April 2017 The combination of a slight decrease in transaction fees (from £2.17 to £2.00 per transaction) together with a small uplift in the total amount of money available for fees means that a £500 retainer fee is available to all contractors. This means that (using transaction figures last year) no contractor should receive less for the service than they did – and some will receive quite a bit more. HOWEVER, each contractor is expected to allow staff to attend training that is provided by or on behalf of NHS Fife – this is one training session and we shall aim to hold one in this format as a “peer review” session each year to which at least one member of staff is expected to attend. Other training will be provided either at your pharmacy or online. 2. An aspiration that data is transferred to Neo at the time of transaction. There are many reasons, problems and barriers for not using Neo in real time but this is the most accurate and time efficient way of collecting data

Other bits and pieces: Provision of information on BBVs, safer injecting practices, overdose prevention, naloxone, wound management, sexual health etc. Signposting to other services. Access to the Minor Ailment Service A rather daunting list and that’s not going to be addressed all at once but step by step all the information you need will be available on the community pharmacy website and will either be accompanied by training or there will be a back up resource of information leaflets that you will be expected to have available when the need arises.

The support team: Ordering equipment – Sheila Dall Data collection – Karen Welsh Training – Helen Coulter Stock control – Ashley Paterson Anything else – Liz Hutchings Addaction: Gareth Balmer Chris Davison Please read your emails! There are now seven people you can contact on various aspects of IEP: Sheila for stock ordering – has asked me to point out an error in the service specification section 3.2 says that any order placed as directed by fax will usually be delivered to the pharmacy the next working day – Sheila is unable to process all orders on the day come in so your order may be with you in 2 or 3 days – it should definitely be less than a week. Karen is taking over the collection of transaction numbers from neo – a reminder that all transactions for the preceding month should be on neo by the 7th day of the following month in order for you to be paid for them. Helen will be in charge of training and will be calling in to your pharmacy probably about 4 times a year for support and training. Ashley – who already provides assistance with the Sharps Service will add Injecting Equipment stock control to her portfolio Me for anything else and don’t forget Gareth and Chris from Addaction for specialist advice. All contact details will be on the usual website. Please read and respond to emails as it will be our main way of communication via the pharmacies nhs net account. In addition each pharmacy has an IEP champion identified two years ago – please confirm the name or nominate someone else and let us know the best email address to use for that person. Emails will be marked in capitals INJECTING EQUIPMENT NEWS for easy identification.

Training resources:

10 modules in addition to these three: Preparation, cooking up and injecting, consequences of injecting, Blood borne viruses, overdose and naloxone, Steroids and image enhancing drugs and new psychoactive Substances Some modules take just 5 minutes – all have the option of completing a test which will be for your use alone. Access details will be added to the Community Pharmacy website. There is also a section in the NES Pharmacy Distance Learning Pack – “Substance use and pharmaceutical care”

And finally – we will be running a programme of structured interventions to address the information part of the service specification. The programme will be on a two yearly rota which can be developed and adapted and new subjects introduced as we go along. Each subject will run for 3 months and during that three months we would like you to complete what is in effect a brief intervention with each of your clients. Helen is there to help with any training needs – each subject will be accompanied by material and training – either online or in your pharmacies and we will be recording , on neo when I have worked out how, which clients have received the intervention (so that you are not repeating it unnecessarily) and so that we can record the number that are carried out.