Report of Director of Public Health

Councillor Williams (Portfolio Holder for Adults and Health), Bethan Hopcraft (Strategy and Commissioning Officer) and Steve Oakley (Head of Contracting and Procurement), presented the report, which sought approval to procure a community pharmacy-supervised consumption scheme for opioid substitution therapy (OST), commencing 01 April 2022 for an initial period of 5 years, with an option to extend for up to a further two 2-year periods.

During discussion, Ms Hopcraft gave the following additional information:

(i)  a GP prescription is taken by the patient to a pharmacy and they monitor the dose, with the vast majority of pharmacies across the city offering the service, although some prefer not to be part of the scheme;

(ii)  there are all types of pharmacies involved, from small, independents to branches owned by national and international companies, which gives patients the option to go anywhere in the city;

(iii)  pharmacies submit invoices for work undertaken and those are dealt with by Public Health.

Resolved to

(1)  approve the expenditure of up to £2,589,517 of Public Health monies associated with procuring a community pharmacy-supervised consumption scheme and provision of take-home naloxone scheme commencing 01 April 2022 for a period of 5 years, with an option to extend for a further two 2-year periods;

(2)  delegate authority to both the Director of Public Health and the Director of Commissioning and Procurement to approve the outcomes of the supervised consumption accreditation process and award the contracts.

Reasons for recommendations

The current contracts held with 31 providers across 50 bases for this service are due to expire on 31 March 2022. Approval is sought for the use of funding to enable new contracts to be established for the continuation of a supervised consumption scheme within the City for an initial 5-year term with the opportunity to extend for two further two-year periods (subject to successful performance and continuing requirement for this provision. Without securing new contracts, there will be serious consequences for not only our drug-using population, but also a potential increase in crime (through diverted medications, among other crimes), and accidental poisonings of children and vulnerable adults.

Due to the potentially chaotic nature of the lives of people using this provision, there is an increased risk of overdose due to people potentially using more than their prescribed dose. Nottingham City is dedicated to improving health outcomes for citizens and by re-procuring this provision, the risk of overdose from prescribed and non-prescribed opioids reduces among our drug-using population. Similarly, methadone poisonings account for over half of all poisonings in children under four, and the provision of this scheme will contribute to the reduction in risk of accidental poisonings in children. In addition, this provision will reduce the likelihood of diversion of potentially dangerous controlled medications.

Encouraging daily contact with a qualified health professional will improve the likelihood of any additional health concerns being identified and treated. Throughout their treatment journey, service users can build relationships with their pharmacist which often supports their recovery and other areas of their lives.

The length of the contract to be procured will reduce the processing costs associated with applications and will allow for providers to focus on service delivery, provide stability, and reduce mobilisation and exit time. The providers will be subject to regular financial and contractual audits and any potential extensions will be informed by these audits. Contracts will be issued with a 6-month break clause to allow for flexibility should the need arise to defund this provision.

An open accreditation is recommended for this service to enable any newly qualified pharmacists, or newly owned pharmacies who pass the accreditation process to deliver the scheme during the long contract period. Using a competitive tender process would limit the market, and an open accreditation has proven successful in the past in allowing flexibility for primary care providers (i.e. pharmacies and GPs) to deliver this provision without adding administrative burden to officers within Nottingham City Council, and providers of this service.

The provision is funded entirely through the Public Health ring-fenced grant, and as such is subject to requirements of this grant. Specifically, it is required for the local authority to provide “an accessible drug and alcohol treatment and recovery system that includes a full range of NICE-compliant drug and alcohol interventions to treat both alcohol and drug dependence and to reduce harm, based on local authority prevalence, need and current outcomes”. As stated, NICE guidelines state that provision of supervised consumption, where appropriate and required, is effective in reducing the potential harm caused by overdose, accidental poisoning and diversion of medications.

Other options considered

Do nothing and let the service provision end on 31 March 2022. This is not a viable option because there is a clear need for this service in the city to continue to ensure the continuity of positive outcomes for people who use opioids. Discontinuation of this service could result in an increase in overdose, accidental poisoning, and diversion of controlled medication. All of these aspects would increase the burden on other departments and organisations, such as HM Coroner’s Office, Nottinghamshire Police, Community Protection and local businesses, to name a few.

In line with Public Health grant requirements as laid out in Public Health Grant Conditions and Mandated Functions in England, a local authority must, as a condition in using the grant, “have regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services”. The supervised consumption scheme will allow Nottingham City to provide an evidence-based treatment system which aligns with the needs of the drug-using population.