Positive results from chlamydia screening

The concept of chlamydia screening in pharmacies is gaining momentum. The pharmacy White Paper “Pharmacy in England — building on strengths, delivering the future”, published earlier this month, stated that later in 2008, the Government will release a national template for primary care organisations outlining how to commission chlamydia screening services to community pharmacies.

Where to start

As part of the National Chlamydia Screening Programme, primary care organisations are now assessed by the Healthcare Commission on the percentage of 16–24 year olds in their area that are screened for infection.

It is in the PCO’s interest to develop a chlamydia screening service that is easily accessible to the public.

Raj Nutan, pharmacy business manager at the National Pharmacy Association, suggests that pharmacists who would like to offer such a service should contact their PCO or local pharmaceutical committee. The NPA offers assistance to any pharmacies or LPCs that want to bid for a PCO-commissioned service.

Alternatively, if a pharmacist believes the local population would be happy to pay to be tested, the NPA offers an “off the shelf” testing kit. This product may increase in popularity if azithromycin becomes available without prescription — as is planned for later this year.

How the service works

A pilot scheme run by Lambeth and Southwark primary care trusts, which started in August 2005, was England’s first to evaluate the feasibility of testing for and treating chlamydia in community pharmacies. The success of the pilot has led to the service being commissioned widely from pharmacies across the two PCTs.

Screening kits are currently offered at 36 of the 61 pharmacies in the area, and so far six pharmacists have been trained to supply treatment.

New Park Pharmacy, Clapham Park, London, was one of the sites used for the Lambeth and Southwark pilot. During the first phase of the pilot, service users were required to have a consultation with the pharmacist before receiving the kit.

Rimal Patel, a community pharmacist at the pharmacy, believes that offering initial counselling to users increases the likelihood that they will complete the test.

However, Jo Holmes, head of primary care delivery and development at Southwark PCT, says that after analysis of the results of the pilot, the initial consultation proved not to be financially or operationally sustainable, due to the extra demand placed on pharmacists time.

“Also, young people have told us they don’t want to be waiting around in the pharmacy for too long to obtain a test,” she adds.

Service fees and time taken

During the Lambeth and Southwark pilot, a time and motion study was conducted to calculate the appropriate fee for the commissioned service. Pharmacies are now paid £1 for issuing each test and £8 for supplying treatment to each infected patient.

When the test is given out as part of an emergency hormonal contraception (EHC) consultation, the pharmacy receives £18 (increased from the standard rate of £15.45 for an EHC consultation).

Southwark PCT started its chlamydia screening service in February. During the first month, 100 test kits were issued. Provisional numbers for March indicate an improvement and Ms Holmes expects numbers to increase further.

“Like all new services, delivering it will get easier with practice — the development of EHC supports this,” she says.

During the pilot, 83 tests were performed in three sites over a three month period, and 9.5 per cent of those tested were shown to be infected.

Set up and running costs

If a service is commissioned, the cost of the tests is paid for by the PCO. Pharmacists will need training to develop the necessary competencies to run the service. Currently, PCOs that have commissioned the service to pharmacies will provide the necessary training, and some offer to reimburse locum costs while the pharmacist attends the course.

Pharmacies that choose to offer a private service will need to obtain a supply of testing kits and make arrangements with an accredited laboratory that can carry out the required tests. The NPA recommends Gordon Laboratories Group.

Other PCTs that have commissioned a service from community pharmacies are City & Hackney PCT, London, and Hull PCT. City & Hackney pay pharmacies £1,000 per year to offer it (to cover the cost of training, auditing, collecting data and signposting), and a reimbursement of £5 to cover the cost of each test issued.

If any patient requires a consultation to receive treatment, the pharmacy is paid £15 (or £20 if the patient is under 18 years old) and reimbursed with £8.95 to cover the cost of azithromycin.

At Hull PCT, pharmacies are paid £70 to set up the service, and £4 for each test that is issued (test kits are supplied for free by the PCT).

Benefits of the service

When all overheads are covered by the PCO, the service generates profit for community pharmacies. It also increases the footfall of young people into your pharmacy, who may purchase other goods, says Ms Holmes.

A survey conducted as part of the Lambeth and Southwark pilot revealed that 11 per cent of young people who used the service also purchased goods that they had not intended to buy before they entered the store.

Along with screening, issuing treatment generates turnover and improves a pharmacy’s enhanced services portfolio, so pharmacy proprietors should be keen to deliver the treatment service as well. Ms Holmes suggests that the best way to do this is promote the service heavily and get as many people screened as possible.

“The more testing kits you give out, the more people will be screened,” she says. “If we see a pharmacy is issuing a large number of tests, we are more likely to offer to train them for the treatment service.”

In the areas that need it, the service also offers community pharmacies a chance to strengthen their relationship with the PCO. “Offering chlamydia screening doesn’t sound as grand as running diabetes screening or asthma clinics,” says Mr Patel, “however, if it meets a local need, then it is well worth doing.”