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CABINET – 15 JANUARY 2014
ARRANGEMENT FOR THE AUTHORISING OF PATIENT GROUP
DIRECTIONS FOR THE USE OF AZITHROMYCIN IN CHLAMYDIA
SCREENING – URGENT ACTION BY THE CHIEF EXECUTIVE
REPORT OF THE CHIEF EXECUTIVE
Purpose of the Report
The purpose of this report is to inform the Cabinet of the urgent action taken by the Chief Executive, following consultation with the Leader, to delegate authority to allow the Director of Public Health to authorise the Patient Group Directions (PGDs) for the use of Azithromycin in Chlamydia screening.
It is recommended that the urgent action taken by the Chief Executive, as now reported, be noted.
Reasons for Recommendations
The County Council’s General Scheme of Delegation requires that any urgent action taken by the Chief Executive between meetings is reported to the next appropriate meeting of the body concerned.
Timetable for Decisions (including Scrutiny)
Consideration is currently being given to the establishment of a scheme of delegation to the Director of Public Health, similar to those of other Chief Officers, to avoid the need for various operational and technical decisions to be taken by the Cabinet itself. It is hoped that such a scheme will be available for consideration at the Cabinet’s next meeting.
In this particular case an urgent decision was required which could not be left until such a scheme has been prepared and, indeed, could not await this meeting of the Cabinet.
Policy Framework and Previous Decisions
Local Authorities acquired new statutory responsibilities on 1st April 2013 under the Health and Social Care Act 2012 to carry out public health functions.
The County Council, through the Director of Public Health, commissions Chlamydia screening for its population. Screening (via urine sampling) is carried out in a variety of settings including in primary care. People who test positive i.e. have evidence of Chlamydia infection are recommended to take a course of antibiotics (Azithromycin). When screening takes place in GP practices, a PGD has been developed to enable practice nurses to supply Azithromycin to those patients who test positive.
The County Council commissions both Chlamydia screening and integrated sexual health services in Leicestershire. Delayed treatment of patients who are Chlamydia positive could potentially be more expensive in the longer term due to the subsequent need to treat more severe disease and due to the increased risk of spread of untreated infection.
The Director of Corporate Resources has been consulted on the resource implications of this report.
Circulation under Local Issues Alert Procedure
None. Officers to contact
Patient Group Directions (PGDs) are documents permitting the supply of prescription-only medicines (POMs) to groups of patients, without individual prescriptions. In practice this means that a PGD, signed by a doctor and agreed by a pharmacist, can act as a direction to a nurse to supply and/or administer prescription-only medicines to patients using their own assessment of patient need, without necessarily referring back to a doctor for an individual prescription.
The County Council is now responsible for commissioning Chlamydia screening for its population. Screening (via urine sampling) is carried out in a variety of settings including in primary care. People who test positive i.e. have evidence of Chlamydia infection are recommended to take a course of antibiotics (Azithromycin). When screening takes place in GP practices, a PGD has been developed to enable practice nurses to quickly supply Azithromycin to those patients who test positive.
Ratification of PGDs for Azithromycin:
PGDs must be reviewed periodically and the local PGD for Azithromycin which was originally developed by Leicestershire and Rutland Primary Care Trust has now passed the point where it needs to be reviewed and re-ratified. PGDs must be developed and signed by a suitably trained doctor and pharmacist. The County Council does not employ any pharmacists. Both local Clinical Commissioning Groups (West Leicestershire and East Leicestershire and Rutland) have developed and signed a new PGD for Azithromycin in line with NICE guidelines. As commissioner, the County Council’s Director of Public Health (DPH) (or clinical governance lead) is legally able to counter sign this PGD in order for Azithromycin to be used in GP practices in Leicestershire for patients who test positive for Chlamydia.
There was a degree of urgency in authorising the delegation of this responsibility. Until there was a current PGD in place, practice nurses were unable to use this PGD. This could have lead to a delay in commencing curative treatment (and a real risk of non-treatment) because of significant geographical, time and cost barriers. This could have had clinical consequences in terms of spread of infection and other complications from sub-optimal treatment e.g. subsequent infertility.
The Cabinet has yet to determine a scheme of delegation to the Director of Public Health. Until that is done matters such as this will have to be determined by the Cabinet itself. However, in this particular case it was considered that the matter was so urgent it could not await the next meeting and the decision was therefore taken by the Chief Executive under the powers he has to take decisions on matters of urgency between meetings.
Relevant Impact Assessments
Equal Opportunities Implications
The action taken is aimed at providing appropriate services to the diverse communities across the City, County and Rutland. Evidence shows that individuals from socially excluded backgrounds are more at risk of developing Chlamydia infection and are at more likely to be disadvantaged by delays in treatment.
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