Community pharmacists in Sheffield have always been involved in treatment of drug users. The first pharmacy based needle exchange scheme is thought to have started in Sheffield in 1988 and by the early 90s quite a well developed system involving 15 community pharmacies was in place. At this time, treatment was mainly via the secondary care service along with a small dedicated band of general practitioners. The secondary care service appeared under funded with a long waiting list and this was not helped by the rather bizarre way that the pharmacist fees were being charged back to secondary care providers, but not attributed to prescriptions generated by GPs. With the fees being linked to each supply this made a big difference to treatment costs and also encouraged the prescribing of larger quantities.

To overcome this problem, Sheffield Local Pharmaceutical Committee, at a meeting with Sheffield Health Authority around 1994, put forward a suggestion that a service for treatment of drug users should built along a similar model to the evening deputising service, whereby prescriptions were written on behalf of GPs and costs would then be charged back to the patient’s GP. At that time it was claimed that this system was not possible, however, within a few years the Primary Care Drug Dependency Clinic (PCDDC) was able to be set up along similar lines to those suggested.

During this period there had been recognition for the need for supervised methadone consumption and a number of pharmacies agreed to undertake this task on an individual basis as no funding was available.

With the advent of the PCDDC the need for a more formalised system became apparent. Sheffield Health Authority, via the Director of Pharmaceutical Public Health, Mick Down, was able to identify the necessary funding and a pilot scheme was introduced in 1999 with the full service, to start in January 2000, put out to tender.

Associated Chemists (Wicker) Ltd, a consortium owned central late night pharmacy, was the successful applicant. The scheme proposed was for a “shared care” model to be open to all pharmacies in the city. To encourage participation, Associated Chemists agreed to undertake daily supervised supply during the patient’s “stabilisation” period, after which, with agreement, they could be transferred to a participating pharmacy of their choice. The pharmacist would be reassured that should any problems arise, the patient could be transferred back to the central pharmacy. This degree of support has enabled 43 of Sheffield’s 106 (40.5%) to register and take part in the scheme. Registration involves other obligations on the pharmacy concerned such as close liaison with prescribers over missed doses, registering each patient, accepting back used needles & syringes, timely return of forms etc.

The original scheme anticipated around 300 patients with 100 receiving supervised supplies. This was quickly exceeded and by June 2002 there were almost 900 registered of which 46% receive supervised doses. The needle exchange part of the scheme is now concentrated in 5 pharmacies and they undertake around 4,500 transactions per month.

Payment is based on a Service Level Agreement with a fixed amount paid out each month. This means that the budget cannot overspend but the amount paid to each pharmacy for each registered patient varies from month to month. A weighting system is used to take account of different levels of input necessary for “take out” methadone, supervised methadone and supervised buprenorphine.

Regular meetings of the CPSDU pharmacy staff take place and a monthly newsletter (“At the Sharp End”) is distributed along with the monthly cheques.

Associated Chemists supply all participants with a range of suitable forms including “The Rules” for those registered. Downloadable forms (Word Format) can be found in this section.

The scheme appears to have been a success with pharmacists, prescribers and patients. In February 2008 over 1750 patients were registered and 82 pharmacies.

Martin Bennett
BPharm, MRPharmS, FIPharmM
Managing Director

If you require more information on this scheme please get in touch either by phone on 0114 272 7676 or e-mail us at pharmacy@wicker.co.uk.