ࡱ>  .bjbjcTcT 4p>>x&8K| 1&S:0000000$/35\0040]]]d0]0]]r,&.r)-t000 1--6-6(&.&.&-6L.(]00] 1-6 :  LOCAL ENHANCED SERVICE SPECIFICATION FOR OPPORTUNISTIC CHLAMYDIA SCREENING IN GENERAL PRACTICE 1 INTRODUCTION 1.1 The purpose of this specification is to outline the local enhanced service (LES) to be provided by General Practice in offering opportunistic Chlamydia screening to the target population of young people aged 15 24 years, as defined by the National Chlamydia Screening Programme (NCSP). 2 BACKGROUND 2.1 Genital Chlamydia trachomatis is the most common sexually transmitted infection (STI) in England. The prevalence of Chlamydia is highest amongst sexually active young men and women, especially those aged 15 24 years and it is estimated that one in twelve will have the infection. The majority of people will be asymptomatic and therefore many will remain undiagnosed. If left untreated, the Chlamydia infection may have serious long-term consequences including pelvic inflammatory disease, ectopic pregnancy and infertility in women, and epididimo-orchitis and infertility in men. 2.2 The NCSP was established in 2003 with the objective of controlling Chlamydia through the early detection and treatment of asymptomatic infection to prevent the development of sequelae and to reduce onward transmission. The programme offers opportunistic screening to all sexually active people aged 15 24 years in a variety of health and non-health care settings outside Genito-urinary Medicine (GUM) clinics. For the purposes of this specification (and the national programme), the age-range of 15-24 encompasses young people aged between 15 and up to their 25th birthday. The NCSP advocates that all sexually active young people aged 15 24 years should be offered opportunistic screening for Chlamydia, and that healthcare professionals should always consider Chlamydia screening when consulted for any reason by this age group. It is recommended that sexually active young people aged 15 24 years are screened annually and after every new sexual partner. 2.3 The situation in Somerset reflects the national picture of continually rising STIs, particularly Chlamydia amongst young people. The Somerset Chlamydia Screening Programme was established in 2007 and has steadily built a sustainable programme across a range of settings. In 2008/9 there were 9754 people aged 15 24 years who were screened for Chlamydia in Somerset (15.8% of the 15 24 year old population), with 8.8% of them testing positive. GPs in Somerset have played an active role in the programme contributing 23% of all screens in 2008/9. 3 AIM AND OBJECTIVES OF THE SOMERSET CHLAMYDIA SCREENING PROGRAMME 3.1 The Chlamydia Screening Programme (CSP) in Somerset aims to increase opportunistic screening for the Chlamydia infection amongst all sexually active men and women aged 15 24 years. It aims to do this through: increased access to Chlamydia screening in a range of settings in Somerset, particularly for those young people who do not typically use sexual health services increased opportunistic screening of asymptomatic patients consulting for unrelated conditions in General Practice increased awareness and understanding of Chlamydia and opportunities for screening amongst all young people increased awareness and understanding of Chlamydia and availability of screening amongst all staff working with young people in health and non healthcare settings reducing the stigma associated with Chlamydia and increasing the acceptability of screening increased early detection and treatment of Chlamydia and reducing onward transmission promoting positive sexual health, linking with sexual health promotion initiatives in Somerset to provide a holistic service for young people 4 SERVICE OUTLINE 4.1 The aim of this Local Enhanced Service (LES) is to increase the uptake of opportunistic Chlamydia screening by young people through General Practice and to reduce the positivity rates of Chlamydia infection with the 15 24 year old age group. 4.2 All General Practices in Somerset have been supportive of the Somerset Chlamydia Screening Programme. This LES is intended to build on this support and improve uptake of Chlamydia screening by young people aged 15-24 through General Practice. All General Practices are invited to participate in this LES. The LES will initially be in place until 31 March 2011 at which point it will be reviewed. 4.3 In order to deliver on this LES, practices will be required to: offer an opportunistic screening test to all sexually active 15-24 years old men and women presenting at the practice, utilising every opportunity to offer screening (such as health checks, contraceptive consultations, pregnancy testing and travel vaccinations) set up a computer prompt to flag up when a young person aged 15-24 years is attending for a consultation, as a reminder to offer an opportunistic screen promote the Somerset Chlamydia screening programme by displaying posters and leaflets in the waiting area and/or toilets display kits so they are available for patients to pick up from waiting area/toilets keep a supply of kits in all clinical rooms promote arrangements for return of samples, such as return to reception or a labelled box for returned samples ensure that patients have the Chlamydia patient information leaflet, are aware of the instructions for screening and the need to complete and return the NCSP test forms identify a member of staff to act as link person to champion the programme, ensuring the promotional material and kits are displayed and that kits are ordered when needed offer sexual health advice and condoms (available free from Health Promotion Resource Service) offer an access point for the courier system for completed screening kits, including those from non NHS designations, and ensure specimens are sent to the microbiology laboratory offer a collection point for supplies ordered by non NHS partners as negotiated practices will be expected to continue to provide assessment, treatment and referral for index cases that are ineligible for treatment through the screening programme due to pregnancy. continue to use existing microbiology forms for diagnostic (symptomatic) tests in every age group and for asymptomatic individuals who are outside the programme age range. Results, treatment and advise on contacts of positive cases for the above tests remains the responsibility of the initiating clinician 5 SUPPORT FROM THE SOMERSET CHLAMYDIA SCREENING TEAM 5.1 The Somerset Chlamydia Screening Team will provide the following support to practices: provision of resources to enable the practice to promote Chlamydia screening, such as posters, leaflets, display boxes provision of DIY screening kits, both blue (urine for men and women) and pink (swab for women only) results notification, arrangement for treatment for all positive cases, partner notification and additional sexual health advice. Results are confidential between the patient and the Chlamydia Screening Office. Results will not be shared with the clients registered general practice unless this is agreed with client and the back of the Chlamydia screening form ticked data collection and reporting on Chlamydia screening in each General Practice offer support and advice to practice staff, training on Chlamydia screening and talking with young people about sexual health and newsletters sharing good practice 5.2 The Somerset Chlamydia Screening Team can be contacted on: Sara Dove, Chlamydia Screening Service Manager,  HYPERLINK "mailto:Sara.Dove@somerset.nhs.uk" Sara.Dove@somerset.nhs.uk Kerry McCullough, Clinical Lead  HYPERLINK "mailto:Kerry.McCullough@somerset.nhs.uk" Kerry.McCullough@somerset.nhs.uk Tel: 01749 836704 5.3 In addition to this, condoms to promote sexual health with young people (and other sexual health promotion material) can be obtained from the Health Promotion Resource Service by contacting Susan Parsons on  HYPERLINK "mailto:susan.parsons@somerset.nhs.uk" susan.parsons@somerset.nhs.uk or 01823 287822. 6 ELIGIBILITY 6.1 This LES covers the opportunistic screening of sexually active 15-24 year olds for Chlamydia. The following are ineligible for this purpose: diagnostic Chlamydia screening for all age groups where a patient presents as symptomatic Chlamydia screening of anyone outside the 15-24 year age range results, treatment and advise on contacts of positive cases for the above tests remains the responsibility of the initiating clinician 7 RENUMERATION 7.1 In recognition of the contribution that practices are already making towards the Chlamydia Screening Programme, each practice delivering this LES will receive a retainer fee of 150. 7.2 In addition to this, a payment per screen based on the percentage of the practices registered population of 15-24 year olds will be paid as follows: Payment based on screens per percentage of registered 15-24 year old population Retainer fee for each practice150Per screen for first 0-5%2Per screen for next 5.1-10%3Per screen for next 10.1-15% maximum5 7.3 Payments for each practice will be made after each quarter and will be based on the numbers of eligible registered patients that successfully returned a screen to the NCSP, using data collected through Somersets Chlamydia Screening database with verification through the NCSP. 7.4 Practices will be provided with performance information from each quarter, including where applicable the number of ineligible screens. 8 ANNUAL REVIEW / MONITORING 8.1 This LES will be reviewed prior to 31 March 2011 and a decision made on its effectiveness and whether appropriate to continue. 8.2 Quarterly data will be sent to each practice and the Chlamydia Screening Team will offer support visits if appropriate.     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