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Address ................................................. ................................................. ................................................. Post Code ........................... Phone ............................. Fax ......................... Email Address ........................................... Contact Person ........................................ This agreement is between the above pharmacy (The Pharmacy) and the Service Provider for the above scheme - Associated Chemists (Wicker) Ltd of 61 - 71 Wicker, Sheffield S3 8HT Tel 0114 2727 7676 Fax 0114 272 6431 Email: martin@wicker.co.uk Contact: Martin Bennett Services to be provided (please tick): Supervised administration of oral methadone (Supervised Administration) Support to users collecting their dispensed prescriptions for methadone and other drugs used in the management of drug misuse (Prescription Support) Syringe and needle exchange scheme for injecting drug users (Injecting Support) (a) Advice on harm reduction methods and (b) supply of condoms (Health Promotion) The Pharmacy will provide the above services : For Elements 1,2 & 4a - to people with a drug dependency receiving prescriptions for methadone and other drugs used in the management of drug misuse generated by a Sheffield prescriber. For Element 3 - to any Drug User who self refers to the service. For all elements the user must agree to: Abide by the “rules” of the scheme For Elements 1 & 2, agree to a relaxation in the “confidentiality rules” by signing the Client Registration Form to allow the pharmacy to share certain information with the prescribing team, with the Service Provider and with any other pharmacy that the patient may transfer to. I have read the attached criteria that apply to joining this scheme. The named pharmacist for this pharmacy is .......................................... Please list any relevant courses / distance learning undertaken: Signed Signed .......................................... .................................................... on behalf of the pharmacy on behalf of the Service Provider Print Name..................................... ..................................................... Date ...................................... ..................................................... This agreement is not valid until signed by both parties. Information: Pharmacy Registration The following criteria will apply to pharmacies wishing to participate in the scheme: Pharmacies participating in the scheme must be “registered” by signing the Registration Agreement. This document must be signed by both the pharmacy & the service provider before any fees become applicable. Participation in the Supervised Administration & Prescription Support will be made available to all Sheffield pharmacy contractors who wish to be involved and who are willing to operate within the standards set for the scheme and agree to accept up to 8 patients on Prescription Support (of which up to 4 may be on Supervised Administration). Pharmacies may accept more than this number if they so wish. The suggested figures allow for patients to be allocated a collection “time slot” so that the pharmacy generally only has to deal with one methadone patient per hour. It is felt that with the level of back up from the Service Provider this degree of activity should be within the capabilities of a majority of pharmacy contractors in Sheffield Participation in the full Injecting Support Scheme will not be compulsory, but a pharmacy within the methadone scheme will be asked to consider providing needle exchange facilities and, as a minimum, should agree to sell syringes, needles, condoms and sharps containers where requested. In addition they must have facilities to accept used sharps returned in small sharps containers - a suitable sharps container + a collection service is available via Sheffield Health. Pharmacies providing Supervised Administration & Prescription Support should, where possible, provide an area for medication to be consumed out of view of other members of the public. It is recognised that this objective is, to some extent, a long-term aim and will be dependent on grants being made available via the PCTs. Each pharmacy contractor who wishes to take part in the scheme should name the pharmacist responsible for providing the service and liaising with the Service Provider. It is desirable that the pharmacist nominated should be undertaking or have completed the CPPE distance learning package on substance misuse or a similar course. All pharmacies involved must operate a non-discrimination and equal access policy. The participating pharmacy must agree to complete and return the necessary paperwork (forms will be provided) in a timely manner in order to meet the deadlines set. These include: Pharmacy Registration to take part in the scheme Client Registration for new clients Recording of missed doses. Recording of number of current clients supervised, number of clients collecting and their prescriber, on a monthly basis (Recording Forms will be provided). Return of the above information to Associated Chemists (Wicker) Ltd by the 5th working day of the following month. The participating pharmacy must agree to contact the prescribing team by phone or fax in any of the following circumstances ( A suitable FaxForm will be provided): Following 3 sequential failures to collect medication. Evidence of increasing health, emotional or other problems Breach of the “contract” to which the service user has agreed Any other occasion when the pharmacist is concerned about the user’s well being. The participating pharmacy should make available information/ leaflets supplied via other agencies on drug abuse topics particularly covering harm reduction, availability of Needle Exchange and self help groups. Eventually it is hoped to develop a “Newsletter” for use by the group. (Health Promotion) Where necessary, the participating pharmacy should refer clients to other suitable services that work with drug users. Advice and counselling will be provided to all users of the service (Health Promotion). Where a prescription calls for methadone to be consumed in the pharmacy, the prescribed quantity should be provided to the client in a properly labelled container, with the top removed prior to handing over. The client should drink this in front of the pharmacist. Water should be available for the client to drink if required. Any significant comments or observations should be noted and fed back to the prescriber where this is necessary. Any difficult incidents that may occur should be reported back to the Service Provider. The Service Provider will supply: A range of back up services to include Registration forms for clients Recording charts Pre-paid envelopes, “Methadone Files” A passport photo service Information on how to operate the system. Placement of clients with other pharmacies where their has been a breach of rules. Sheffield Health will provide: Supplies of equipment for the Needle Exchange Sharps containers Collection of full sharps containers Payment There is a fixed annual sum allocated for these services for Sheffield. For 2002/2003 this is Ѓ100,690 for Elements 1 & 2 and Ѓ74,309 for element 3 (Element 4 to be included in these figures). The figures include an element of VAT as agreed with Customs & Excise. The two budgets are entirely separate. A management fee is top sliced from these amounts to cover the administration, forms , leaflets etc. The remainder is then be divided by twelve to give a monthly allocation. Activity during that month will be divided into this amount to provide a fee per client (or fee per transaction for the Needle Exchange) and this amount paid back to the participating pharmacy. Returns from pharmacies to the service provider should be made within 5 working days of the month end to enable payment to be paid by the last day of the following month. There is also a “low volume” provision, which limits the amount paid out if the number of clients registered throughout Sheffield drops below 185, however, this is unlikely to occur! A weighting will be applied so that “Prescription Support” clients who take away medication will count as one fee unit, “supervised” methadone clients will count as 3 fee units and supervised buprenorphine patients count as 5 fee units. Example of pay for - Elements 1 & 2 ( Supervised Administratio & Prescription Support): Month12Funds available4,1674,167Total registered at all pharmacies300400Total Supervised Total Non-supervised100 x 3 = 300 units 200 x 1 = 200 units150 x 3 = 450 250 x 1 = 250Total Fee Units for Month500700Monthly fee/unit8.335.95Number Registered at Pharmacy A4 supervised = 12 units 6 non = 6 units Total = 18 units5 supervised = 15 units 7 non = 7 units Total = 22 fee unitsTotaly pay to A18 x 8.33 = 149.9422 x 5.95 = 130.9 The grand total paid to all Sheffield contractors will be the same each month (provided we exceed 185 clients). The total paid to each individual contractor will depend on their activity, on the mix of supervised to non- supervised and on the total activity for Sheffield as a whole. Element 3 - Injecting Support: In order to maximise pharmacy recruitment to Injecting Support, we are willing to look at various levels of involvement. This could lead to different pharmacies offering: Full Scheme Limited supply (say to “regulars only”) Sale (as opposed to free supply) of injecting equipment Strict exchange - one for one only policy All pharmacies involved would, as an absolute minimum, have to supply sharps containers and accept “returns” and to have a written handout setting out the service that they provide. Drug users would be able to “vote with their feet” as to whether or not they wished to avail themselves of the lower levels of service. Other points to note include: Modified recording sheets and monthly returns would be necessary in order to standardise the recording format with that used by the Rockingham Drugs Project and to enable the Service Provider to undertake computer analysis of the returns. Additional recording forms - necessary in order to keep track of the Health Authority’s stock of Injecting Equipment. All forms to be returned to the Service Provider in a timely manner in order to facilitate data entry, payment and computer analysis of supplies. The service to be provided in a discreet manner. However, those clients who fail to keep to the rules may be refused supply. The pharmacist will ensure that, where appropriate, users of the service are referred to other services that work with drug users. In particular clients should be referred , where appropriate to services where they can access screening and vaccination (specifically to include Hepatitis B&C & HIV screening). (Health Promotion) The pharmacy will carry information leaflets on harm reduction, injecting techniques and information on self help and support services. (Health Promotion) supplied by the Service Provider and others Co-ordinated Pharmacy Services for Drug Users Copyright Associated Chemists (Wicker) Ltd Page page \* MERGEFORMATe ЅРAЄ|.І ЇŽђѓєћќ§ж#ф#ў#џ#я$F%G%S%b%c%h%i%n%н&у&ь&ј&љ&џ& ' ''1(O(P(•) ********$*%*&***.*3*4*5*6*:*;*?*F*G*H*J*Ÿ.А.:/K/y/Ї/Ј/и/й/э/ю/я/ё/ѓ/є/§§§§§§§§§§§§§§§§§§њњ§§§§§§§§§§§§§§§§§§§§§§§§§§њјјјuU^UH3XYZЁуMtКѕі/01;<cdЌA’фх9 ќќњњњњњњњњњњњњњњњњњеееењњњЏ%Sh˜ўh 4џhŸ$Sh˜ўh  4h.SS9 \ t u Л М   S e о 1 Ѓ   T w Э Ю žŒcЈѓййжжжжжждддддбббджЋЋЋЋЋ%Sh˜ўh 4џhŸSSS%Sh˜ўК  4h.ѓFњ+Pk | W’б"PЧи01ST|}ййГГГГГйГГГГŽŽŽŽŽŒŒŒŒŒS$Sh˜ўh 4џhŸ%Sh˜ўК  4h.%Sh˜ўh 4џhŸ}œЎУж№mnŽМЮѓєќ§џ#$э$ю$я$G%H%N%P%R%S%c%i%o%кккккккзззкккзззееееееевЮЮВвЮЮSИlЙО(Яžm SSSS$Sh˜ўh 4џhŸo%p%“%—%›%œ%­%Т%ж%ъ%ј%&&!&%&)&*&;&@&E&F&f&~&Ž&Ÿ&З&Ч&м&н&э&љ&' ''урммуййммммуйммурммурммммммурммммMSSSИlЙО(Яžm !'''0(1(P(Q(§(ў( )2)j)”)•)M*N*ж*з*ѕ*і*х+усссссооИИИИооооооо’%Sh˜ўh 4џhw%Sh˜ўŸ  4h.SSSИlЙО(Яžm х+[,э,j-В.y/Ї/Ј/г/ё/ђ/ѓ/є/йййййбЯбЬЯЯйSSž<#%Sh˜ўh 4џhw TK @ёџ Normala $@$ Heading 1]c&@"& Heading 2xU]c$@2$ Heading 3xUc">@т"Title>№]c0pўOВpOutline (Not Indented)GK˜ўh 4h.hclўOТlOutline (Indented)GL˜ўh 4h.hc&ўOв& Table Text McfўOтf Number ListGN˜ўh 4h.hc,ўOђ,First Line IndentOаcbўObBullet 2GP˜ўh 4џhvhcbўObBullet 1GQ˜ўh 4џhŸhc ўO" Body SingleRc ўO2 Default TextScє,0џџџџ/yzє/9 ѓ}o%'х+є/ !STimes New Roman Symbol &ArialWingdings&Arial Black_tvz!џ "€аL) L) ƒMartin Bennett