Community Pharmacy Hepatitis C Antibody Testing Service

Overview

This Guidelines summary provides details on the NHS hepatitis C antibody testing service, including the aims, prerequisites, duration, availability, and provision of the service in community pharmacy.

This service has been extended for another year, until 31 March 2023.

This summary does not include information on records and data sharing, governance, reporting and monitoring, or payment. For the complete set of recommendations, refer to the full guideline.

Reflecting on your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Service Description

• The community pharmacy hepatitis C antibody testing service is an advanced service commissioned under the NHS Community Pharmacy Contractual Framework
• People who inject drugs (PWID) who are not engaged in community drug and alcohol treatment services will be offered the opportunity to receive a hepatitis C virus (HCV) test from a community pharmacy of their choice—subject to the pharmacy being registered to provide the service
• Where the test produces a positive result, the PWID will be referred for appropriate further testing and treatment via the relevant Operational Delivery Network (ODN).

Aims and Intended Service Outcomes

• The aim of this service is to increase levels of testing for HCV amongst PWID who are not engaged in community drug and alcohol treatment services to:
  • increase the number of diagnoses of HCV infection
  • permit effective interventions to lessen the burden of illness to the individual
  • decrease long-term costs of treatment
  • decrease onward transmission of HCV.

Prerequisites for Service Provision

• Prior to provision of the service, the pharmacy contractor must:
  • be satisfactorily complying with their obligations under Schedule 4 of the Pharmaceutical Services Regulations in respect of the provision of essential services and an acceptable system of clinical governance
  • notify NHS England and NHS Improvement that they intend to provide the service by completion of an electronic registration through the NHS Business Services Authority Manage Your Service (MYS) platform
  • be satisfied that all pharmacy staff involved in the provision of the service are competent to do so
• Pharmacy staff providing the service must have access to the pharmacy’s shared NHSmail and the Hepatitis C IT Registry, provided by NHS England and NHS Improvement
• Pharmacies must have a consultation room, where the point-of-care-tests (POCTs) will be undertaken, which complies with the following minimum requirements:
  • the consultation room must be clearly designated as an area for confidential consultations
  • it must be distinct from the general public areas of the pharmacy premises
  • it must be a room where both the person receiving services and the pharmacist or pharmacy technician providing those services are able to sit down together and talk at normal speaking volumes without being overheard by any other person (including pharmacy staff), other than a person whose presence the individual receiving the test requests or consents to (such as a carer or chaperone)
  • it must be a room where infection control measures can be maintained
  • handwashing facilities must be available in the room or nearby
• The pharmacy contractor must have a standard operating procedure (SOP) in place for this service, which includes procedures to ensure health and safety and infection control procedures are maintained in line with relevant guidelines
• Where the service is being provided during the COVID-19 pandemic, members of staff performing the test must wear a fluid-resistant (type IIR) surgical mask to protect both parties and any other personal protective equipment recommended at that time by PHE for any direct care of possible and confirmed COVID-19 cases in primary care. All staff involved in the provision of this service should ensure they are familiar with and adhere to the SOP
• The pharmacy contractor must ensure that pharmacists, pharmacy technicians, and their teams providing the service are competent to do so
• The core training requirement for any staff providing the service is to watch the NHS England and NHS Improvement training video and to ensure they are familiar with the manufacturer’s instructions on how to use the POCT
• The pharmacy contractor must ensure that staff are appropriately trained and made aware of the risks associated with the handling and disposal of clinical waste and that correct procedures are used to minimise those risks
• A needlestick injury procedure must be in place. The pharmacy contractor must ensure that staff involved in the provision of this service are advised that as there is a small risk that they could come into contact with blood-borne viruses; they should therefore consider being vaccinated against hepatitis B and be advised of the risks should they decide not to be vaccinated.

Service Duration

• As the National Hepatitis C Programme is an elimination exercise, the service will be time limited. In the first instance it will run until 31 March 2022
• Prior to 31 March 2022, a review will be undertaken to ascertain whether the service is effective in testing this difficult-to-reach patient cohort and successfully directing those PWID who test positive towards further polymerase chain reaction testing and treatment. The review will be informed by PHE observational data and the NHS England and NHS Improvement registry. If the efficacy of the service model is suitably demonstrated, the service may be extended into 2022/2023
• In line with the objectives of the Hepatitis C Programme Board, the service will not continue after 31 March 2025.

Service Availability

• The pharmacy contractor should seek to ensure that the service is available throughout the pharmacy’s contracted opening hours. If they are also commissioned to deliver a Needle and Syringe Programme (NSP) service, it will be particularly important to ensure that the testing service is offered at a time that PWID visit to exchange their injecting equipment
• The pharmacy’s NHS website profile should be edited to indicate that a blood-borne virus testing service is provided. If the pharmacy temporarily or permanently ceases to provide the service, they should, as soon as possible, update their NHS website profile to reflect that the service is no longer available
• The pharmacy contractor must ensure the service is accessible, appropriate, and sensitive to the needs of all service users. No eligible PWID should be excluded or experience particular difficulty in accessing and effectively using this service due to their race, gender, disability, sexual orientation, religion or belief, gender reassignment, marriage or civil partnership status, pregnancy or maternity, or age
• The pharmacy contractor can refuse to provide the service to an eligible PWID if the PWID or any other person accompanying the PWID, threatens violence or commits or threatens to commit a criminal offence
• If the pharmacy contractor wishes to stop providing the service, they must notify NHS England and NHS Improvement that they are no longer going to provide the service via the MYS platform, giving at least 1 month’s notice prior to cessation of the service, to ensure that accurate payments can be made.

Service Provision

For guidance on records and data sharing, governance, reporting and monitoring, payment, related forms (consent, clinical record, ODN referral, and notification to general practice), and information to be recorded on the Hepatitis C IT registry, refer to the full guideline.