SERVICE LEVEL AGREEMENT FOR THE PROVISION OF PHARMACY SERVICES
Between XXXXXXXXXXX TRUST & XXXXXXXXXXXXX PHARMACY
SPECIFICATION OF WORK
This service agreement relates to all pharmaceutical support received by XXXXXXX MENTAL HEALTH TRUST from the Pharmacy Directorate, XXXXXXXXX Hospital NHS Trust.
1. OBJECTIVES OF THE SERVICE
The objectives of the service is to deliver a comprehensive, efficient, professional and cost effective service aimed at meeting the requirement of all staff and clients of XXXXXXXXXXX Mental Health Trust.
2. SCOPE OF THE SERVICE
The main components of the pharmacy service will be:
- Clinical pharmacy services including designated Clinical Pharmacist to the Mental Health Unit.
- Dispensing including specialist monitoring
- Therapeutic drug monitoring
- Drug Information
- Clinical trial administration and supply
- Formulary management
- Drug procurement and distribution
- Financial management information
- Residency service
The department is staffed by a team of pharmacist, technician and support staff.
3. PROVISION OF SERVICE
3.1 PROCUREMENT AND STORAGE OF DRUGS
3.1.1 Procurement of all medicines will be in accordance with the Trust's Standing Financial Instructions. All drugs will be purchased by the pharmacy department using the pharmacy computer system. Drug contracts will be negotiated through the Regional Pharmacy Network, Inner London Purchasing Consortium, along with locally negotiated contracts with manufacturers and wholesalers. All price reductions negotiated will be passed onto the Mental Health Trust.
3.1.2 Drugs will be supplied at hospital cost price including VAT with no on-cost.
3.1.3 All drugs will be stored under appropriate conditions according to legal requirements and suppliers recommendations. Continuous monitoring of storage conditions will be carried out.
3.2 SUPPLY OF DRUGS
3.2.1 All prescriptions will be dispensed for in-patients,outpatients and day patients in accordance with a legal prescription. All dispensed medication labels will satisfy the labelling requirements of the Medicine Act (1968) and the guidance issued by the Royal Pharmaceutical Society of Great Britain. The supply period for all individually dispensed inpatients items will be tailored to the requirements of the individual ward. The supply duration for any patients on leave will be specified at the time. Currently within XXXXXXXX NHS Trust, all outpatients receive two weeks supply of medication and all patients discharged from the wards, receive one week. Unless specified, the same will apply to patients from the XXXXXXXXXX Mental Health Trust.
3.2.2 All inpatient dispensed items will be delivered twice daily to the XXXXX Unit by the Pharmacy Porter at scheduled delivery times. Any supplies required between these times will be collected by the ward staff. All ward staff must carry security identification when collecting drugs.
Note: Separate delivery arrangements will be required for XXXXXXUNIT and financial details must be agreed with the Directorate of Support Services at XXXXXXXX
3.2.3 Stock drugs will be supplied through the technician topping-up service on a specified day (days will differ between wards). Drugs will be supplied against an agreed stock list compiled by Pharmacy and the Ward Manager. As part of the topping up service, technicians will check expiry dates of products held on wards and ensure all drugs are being stored at the correct conditions. Stock will be delivered on the same day as ordered and ward staff will be responsible for receipt and putting away of the stock. (Initially, it is intended that the majority of wards will be topped-up weekly).
3.2.4 Stock drugs ordered through the technician topping up service will be delivered to the XXXXXXUNIT by the Pharmacy Porter. As above, separate delivery arrangements will be required for XXXXXX UNIT. Ordering of drug items outside of the top-up service (ad-hoc) will be the responsibility of the ward staff using the appropriate stationary.
3.2.5 Stock lists will be reviewed regularly with the Ward Manager and changes made to reflect fluctuations in demands and changes in practice.
3.2.6 Items not covered by the stock system are controlled drugs: These are issued against individually signed requisitions in accordance with the "Misuse of drugs Regulations".
3.2.7 All drugs requiring special monitoring are supplied in accordance with Manufacturer and Product Licence requirements eg. Clozapine.
3.3 CLINICAL PHARMACY SERVICE
Clinical pharmacy services are integral to this agreement:
3.3.1 A Pharmacist will visit each ward daily at a pre-set time to review patient's drugs charts and provide advice and information to all ward staff and patients. The Specialist Pharmacist will visit XXXXX UNIT fortnightly.
3.3.2 Prescriptions will be monitored to ensure the appropriateness of the formulation, route and dosage, any drug interactions and adverse drug reactions, along with ensuring compliance with accepted practice and safe systems of work.
3.3.3 Any non-stock items required for individual patients will be supplied as part of the ward pharmacy service. These will be delivered to all wards in the XXXXXXX Unit by the Pharmacy Porter at the scheduled delivery times. It is the responsibility of the ward staff to order and collect any items which are required urgently and therefore cannot wait until the Pharmacist's next visit.
3.3.4 The Ward Pharmacist will act as the point of contact for the ward.
3.4 SPECIALIST CLINICAL SERVICES
3.4.1 As part of the agreement the pharmacy department will appoint a designated Senior Clinical Pharmacist to provide a Specialist Clinical Service to the Mental Health Unit.
This will encompass:
- Specialist input into ICU.
- Support and advice on psychiatric and non-psychiatric medical interventions as required.
- Advice to the nursing staff regarding patient counselling.
- Development and Implementation of policies and procedures involving medicines.
- Active participation in the Drug and Therapeutics Committee.
- Provision of Formulary advice and information.
- Specialist advice on drug usage and expenditure.
- Regular financial reporting and analysis.
- Regular meetings with clinical and non-clinical staff to discuss drug usage and expenditure.
- Actively work with the Mental Health Trust to seek ways to control and reduce drug expenditure.
- Production and distribution of patient information leaflets.
- Participation in clinical audit at a frequency to be agreed.
- Provision of active and passive drug information including the production of newsletters/bulletins.
- Teaching of ward based staff on drug related matters.
- Participation in the discharge planning process.
3.4.2 The Specialist Pharmacist will be the main point of contact for all clinical matters. However, there will be direct access to the pharmacy-based Drug Information Services as required.
3.5 DRUG INFORMATION
3.5.1 The pharmacy will provide a prompt and comprehensive response to requests for information on medicines from all healthcare professionals with the Trust. This information will be active or passive as appropriate and will be accurate, evaluated and unbiased. All Pharmacists working in the Drug Information Centre are trained in basic enquiry answering skills and provide requested information in accordance with the UK Drug Information Pharmacist Group (DIPG) Guidelines.
3.6 THERAPEUTIC DRUG MONITORING
Pharmacists will monitor, advise on sampling times and interpret blood concentration of identified groups of drugs. Currently, Pharmacy offers this service for Phenytoin, Carbamazepine, Sodium Valporate, Phenobarbitone, Theophylline/Aminophylline. This service is also provided to GP's who are provided with a written report.
3.7 SPECIALIST MONITORING SERVICE
Pharmacy will monitor, co-ordinate and liaise with medical and nursing staff regarding blood testing for patients on Clozapine. This includes follow up to ensure appropriate results received, record-keeping and supplies system, along with trouble-shooting for discharge patients/community. This part of the service will be costed per patient and will not be part of the overall variance triggers built into the service agreement. The service agreement is based on a service up to 25 patients beyond this, additional charges will be made at a rate of £250 per patient.
3.8 RESIDENCY SERVICE
There is a Pharmacist on-call outside of normal pharmacy working hours, all requests for emergency supply of drugs must be directed through the Resident. The Resident is available through Switchboard and at all times for any advice or information required.
3.9 PHARMACY OPENING HOURS
Monday - Friday 9.00am - 6.30pm
Saturday 9.30am - 1.00pm
Sunday 10.00am - 12.30pm
4. LEVEL OF SERVICE
The service will be provided to the following annual levels of activity:
| Inpatient/TTO Dispensed Items | 9335 |
| Stock Items | 6212 |
| Outpatient Dispensed Items | 12328 |
| Clozapine Dispensing | 25 patients |
| Compliance Aid Filling | 120 |
| Drug Information Enquiries | 60 |
| Therapeutic Drug Monitoring Requests | 240 |
| Ward Visits | 1820 |
| Purchasing/Stores to a level of expenditure of | £XXXXXXX* |
| Specialist Clinical Pharmacist | 0.8 WTE |
*Predicted 97/98 XXXXXXXXXXX Mental Health]
Trust drug expenditure
Costs of Purchasing/Stores staff time - based on £XXXXXXX as a percentage of overall drug purchases for the two Trusts.
5. ADJUSTMENTS
A cost adjustment will be made if activity rises 5% above these levels or 10% below the levels.
6. QUALITY OF SERVICE
6.1 The skill mix of staff will reflect the professional and technical service provided. All members of staff will be suitably qualified to ensure that the tasks assigned are within their capabilities. All members of staff will receive suitable training for all areas of work undertaken. All activities will be undertaken in accordance with local Standard Operating Procedures.
6.2 All Pharmacists are registered with the Royal Pharmaceutical Society of Great Britain and are trained to at least Postgraduate Certificate level in Clinical Pharmacy.
6.3 Career and personal development is actively encouraged within the Directorate, along with training provided to meet individual needs.
6.4 The standards of pharmaceutical service will be in accordance with the Royal Pharmaceutical Society's Code of Ethics, NHS Terms of Service and the Regional Pharmaceutical Officer's "Standards for Pharmaceutical Services in Health Authorities, Units and Trusts in England" and will be reviewed in light of any future national guidelines.
6.5 The Clinical Pharmacy Standards for Mental Health documents produced by the South East Thames Psychiatric Pharmacy Network will form the basis for defining local standards.
6.6 The department has been approved as a clinical pharmacy academic practice unit for the School of Pharmacy at XXXXXXXXX University.
7. MONITORING OF SERVICE
Monitoring of the service will be a dual responsibility between XXXXXXX Mental Health Trust and the Directorate of Pharmacy, XXXXXX Hospital. The aspects of the service that will be monitored and the methods by which this will be achieved and reported will be agreed between both parties. The contract will be reviewed annually and the value will be adjusted to reflect changes in activity along with any external factors affecting costs such as inflation and pay awards.
Material increases or decreases in the appropriate value of overheads as apportionments are revised in line with 'Costing of Contracting' will also be actioned.
8. COST OF SERVICE
| The cost for the level shown | = £XXXXXX | Direct Pharmacy Cost |
| = £XXXXX | Trust Overhead Costs | |
| TOTAL COST FOR THIS AGREEMENT: | £XXXXXXX |
9. SIGNATURES TO THE AGREEMENT:
Director of Pharmacy
On behalf of XXXXXX NHS Trust
On behalf of XXXXXXXXXXX
Mental Health Trust
Notes:
The Trust did not fund specifics such as ward round attendance, medication histories etc, despite seeing the UKPPG clinical pharmacy standards and support from consultants. Consequently pharmacy managers aren't happy to supply these services. The pharmacy is paid by workload (supply and some clinical eg drug information, TDM, ward visits). If the workload goes 5% over at the end of the year, extra charges are added. This is useful in that money matches workload even if it is retrospective. If pharmacy hear that a new unit is opening before the end of the financial year we put in a bid to provide services based on estimated workload. It also means we get additional funding for clozapine patients as they are specifically mentioned in the SLA. Most of our extra money comes from this. When the SLA was written (1997) we had 25 clozapine patients, now we have 65 - so thats an extra £10,000. The only dedicated member of staff to mental health is me (0.8 wte), so even if eg ward round attendance were included in the SLA, more dedicated staff would be needed. The mental health trust do not monitor the SLA because they don't have anyone to do it. I fact they decided 2 years ago that they were paying too much for pharmacy services (they contract from several trusts) & employed an independent pharmacist to review the service, only to be told that they should be paying a lot more!
10.4.00