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Why pharmacists should be involved

The community pharmacist is a trusted source of information and advice for their patients. This is particularly important for those issues which can have high media attention e.g. introduction of a new vaccine or an outbreak of an infectious disease.

Further information and advice can be found in the Health Protection Topics section of this website.  Examples of topics included are:-

Infection Control

Knowledge of infection control principles is important to protect yourself and your patients.

And

Immunisation and Storage of Vaccines

Advice on safe storage of vaccines which must be stored in the ‘cold chain’ between  2oC and 8oC at all times.

Communicable Disease, Outbreak Control and  Emergency Planning

Pharmacists can recognise symptoms of a notifiable disease in order to appropriately refer patients

Understand how an outbreak is being managed to be able to offer appropriate advice and reassurance to the public.

Maintain Business Continuity Plans to ensure minimal impact on the delivery of patient care in the event of an emergency situation.

Screening for Health Protection  

Pharmacists can encourage uptake of screening programmes against several cancers e.g. cervical, breast cancer and  bowel. More information may be found on the Screening – Health topics – Public Health Scotland website.   

For any enquiries regarding health protection please contact:

PharmacyPublicHealth@ggc.scot.nhs.uk

Blood Borne Virus

Three blood borne viruses are the main cause for concern in Scotland, Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C.

There is an effective vaccine only for Hepatitis B.  However, there are few effective treatments for Hepatitis C and HIV.  

More information

Key points for community pharmacy

 Some pharmacies may

  • Offer support for dried blood spot testing for Hepatitis C and HIV.
  • Dispense antiviral medicines for Hepatitis C.
  • Provide ‘Injecting Equipment’ to prevent spread of disease.
Communicable Disease

Public Health Protection Unit – NHSGGC in NHSGGC has a key role in monitoring and responding to the incidence of notifiable diseases e.g. meningitis.

For more information visit

 Key points for community pharmacy

  • Recognise and refer patients with symptoms suggesting a serious or notifiable disease to the GP or acute services as necessary.
  • Compliance with prophylactic therapy e.g. tuberculosi
Community Pharmacy & Infection Control

The NHS GGC Community Pharmacy Infection Control Guidelines  provide basic advice.

To reduce the incidence of infection due to antimicrobial resistance in the population, NHSGGC has launched https://clinicalguidelines.nhsggc.org.uk/adult-infection-management/ to be followed in primary care and the prescribing support team has developed a non-prescription pad to encourage patients to seek non antibiotic remedies for viral infections.

More Information

 Key points for community pharmacy

  • Provide antibiotic stewardship.
  • Offer advice to patients on appropriate infection control techniques to reduce spread of disease such as norovirus or influenza.
Health Screening

The NHS GGC Public Health Screening Unit is responsible for a range of health screening programmes.

  Key points for community pharmacy

  • Encourage patients to participate in screening programmes.
Immunisation Programmes

Immunisation is one of the most effective health interventions.

There are several formal immunisation progammes in the UK. They are Childhood, Adult and Seasonal Influenza.

More Information

 Key points for community pharmacy

  • Encourage patients to engage with national and childhood programmes.  

 Some pharmacies may

  • Offer travel and influenza vaccination clinics.
Outbreak Control

Public Health Specialists from NHS GGC Public Health Protection Unit – NHSGGC are involved in identifying and managing outbreaks of disease. They will liaise with infection control teams for example in the case of a norovirus outbreak in an institution or with local authorities if an outbreak is linked to a food supplier in an E. coli outbreak. 

Chemical Biological Radiological and Nuclear (CBRN) outbreaks

Local authorities and health boards are required to have plans in place to manage accidental events such as major oil or chemical spills or deliberate terrorist acts. A specialist on line training module is available from TOXBASE

More Information

  Key points for community pharmacy

  • Provide reassurance to patients.
  • Keep Business Continuity Plans up to date.
Patient Group Directions (PGDs)

Patient Group Directions (PGDs) are legal documents that enable suitably qualified healthcare professionals to administer and supply medicines (P or POM) in a defined clinical situation where the patient may not be individually identified before presenting for treatment. The individual using the PGD must have signed and been authorised to use the PGD prior to administering or supplying any medicines named in the document.

NHS GGC uses PGDs to allow nursing staff and Health Visitors to administer vaccines for the routine child immunisation programme and travel in specialist clinics. 

More Information

  • Information about working under PGDs National health Education Scotland NES

 Key points for community pharmacy

  • Community pharmacy PGDs authorised for use in NHS GGC may be obtained from the Community Pharmacy Development team or GGC PGD administration at Clarkston Court, 56 Busby Road, Clarkston, Glasgow G76 7AT
    Telephone No. 0141 232 1728.
Seasonal Influenza

Individuals are most likely to catch influenza in the winter months. The season runs from October to the end of February occasionally into March, peaking in December/January.

Seasonal influenza can affect anyone. It is an acute viral infection of the respiratory tract. There are three types of influenza virus: A, B and C. Influenza A and influenza B are responsible for most clinical illness.

It is difficult for an individual to develop long term immunity to influenza as the make up of the viral strains change slightly on a regular basis. So vaccination against seasonal influenza has to be undertaken annually.

More Information

The government resource Immunisation against infectious disease – ‘The Green Book’

In the United Kingdom immunisation for influenza for certain groups including ‘at risk’ patients is provided on the NHS and in Scotland the Chief Medical Officer (CMO) will send a letter detailing which groups are eligible for vaccination. Letters from the CMO are available here. 

Egg allergy isn’t always an absolute contraindication for receiving flu vaccine. The British Society for Allergy and Clinical Immunology website advises on managing individuals with egg allergy

An e learning course for healthcare professionals undertaking immunisation is available. Registration is required to undertake this course.

NHS Inform has key patient information on all types of immunisation

NHS GGC: Immunisation – NHSGGC

 Key points for community pharmacy

  • Encourage at risk patients to attend for vaccination
  • Advise on management of symptoms
  • Some pharmacies offer private flu vaccination clinics
Sexual Health

Sandyford co-ordinates a wide range of sexual health services in NHS GGC.

The Free Condoms web-site provides, support for practitioners involved in condom distribution, information on how to sign up as a distribution point, where to find condom distribution points and general advice on condom use and products offered

It is important that pharmacists and their staff understand what they should do if they have any concerns about a child and sexual health issues. Access information at NHS GGC Child Protection Unit’s website 

More Information

  Key points for community pharmacy

  • Be able to recognise and differentiate between symptoms of sexually transmitted diseases.
  • Refer all men consulting with symptoms of discharge or thrush infections to Sandyford or their GP.
  • Be aware that there is no charge for vaccine supplied by a Sandyford Clinic.
  • Supply of emergency hormonal contraception or bridging contraception under PGD.
Substance Misuse

Pharmacists play an important part in providing information and advice about substances liable to misuse controlling the availability of medicines, and the associated risks and in providing harm reduction programmes e.g. methadone and the supply of injection equipment.  

More Information

 Key points for community pharmacy

  • Give advice on wound care and management, safer injecting practices and remind clients of the importance of safe disposal of syringes.
  • Know which pharmacies are ‘Injecting Equipment Providers’
  • Be able to sign post clients to other services as necessary.
  • Know how to deal with needle stick injuries
Travel

Two websites are highly recommended for those living in Scotland seeking travel health guidance. Fit for Travel which gives the most up to date information for the public and the professional site TRAVAX.

Access to TRAVAX requires registration but it is free for Community Pharmacists in Scotland to register.

More Information

Key points for community pharmacy

  • Provide patients with pre-travel advice.
  • Encourage the use of sunscreen with a minimum SPF15. 
  • Advise on the carriage and storage of medicines abroad e.g. insulin. 
Vaccine Storage

NHS GGC Guidelines on Vaccine Storage and Handling are available in the NHSGGC Guidelines Repository

More Information

 Key points for community pharmacy

  • Remind patients collecting travel vaccine of the storage requirements. It is preferable that they collect vaccine immediately before their appointment for administration.

For queries about the service please contact the Queen Elizabeth University Hospital Biochemistry Department on 0141 354 9060.

About the service

The Scottish Biologic Drug Monitoring Service is delivered by the Biochemistry Dept. within the Lab Medicine Building on the Queen Elizabeth University Hospital site, Glasgow.

The service currently delivers Infliximab and Adalimumab levels and their respective total anti-drug antibodies (ADA) for optimising care predominantly in gastroenterology patients with inflammatory bowel disease. The service attained UKAS accreditation (2019) and is working with IMMQAS and others to improve the EQA understanding for drug and ADA assays. The service uses both WHO standards for drug levels and a patient pool sample for ADA assay to monitor performance. It is involved in sample exchange with other laboratories.

The service employs a reflex ADA testing strategy based on drug level result. When a drug level result is within or higher than the therapeutic target range, and when ADA level has previously been undetectable, reflex ADA testing is not routinely performed. Since the introduction of reflex ADA testing approximately 50% adalimumab samples and 37% infliximab samples have not had a reflex ADA test performed.

There may be some clinical scenarios where ADA titres are desirable even when drug level results are therapeutic. Requests for additional ADA testing should be indicated clearly at the time of test request or can be arranged by contacting the lab directly.

During 2019 there were 2821 Infliximab and 2920 Adalimumab samples analysed from health boards across Scotland.

TDM tests should be requested according to local biochemistry/immunology laboratory requirements. The previously used paper request forms are no longer required. Local teams are encouraged to collate data related to TDM use and outcomes as this may be required to sustain future rounds of service funding.

Specific Rheumatology guidance

Specific Gastroenterology guidance

Vedolizumab drug level and antibody testing

Vedolizumab drug level testing is now available. The utility of testing drug and anti-drug antibodies for vedolizumab has yet to be fully ascertained. Target drug levels for vedolizumab have not been clearly established. The current evidence is covered in these articles:

Vedolizumab testing is not part of the nationally commissioned TDM service. The cost per sample is £20.

In order to gather clinical data regarding the benefits of vedolizumab drug level testing, please complete and enclose a completed request form with each sample. This information will be used to try and secure UKAS accreditation for vedolizumab drug level testing. Vedolizumab Request Audit Form.

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Clyde Biochemistry Laboratories (those based at Royal Alexandra Hospital, Inverclyde Royal Hospital and Vale of Leven Hospital) has been accredited with UKAS to standard ISO 15189:2012 for much of our test repertoire. The certificate of accreditation is available online.

The scope of our accreditation includes the majority of the tests performed by our laboratories, with a small number of tests not falling within our accreditation status (for example, no fluid analyses (on fluids other than CSF, urine or blood / serum / plasma) are accredited) – see the link above for details of our accredited scope.

Specialist services including Protein Electrophoresis and less often requested endocrine assays are based at RAH. 

All routine GP work within the Clyde Sector is also based at RAH.

Please accept our apologies for the behaviour of links on this webpage. This is due to a global setting which is outwith the Biochemistry Department’s control.

Clyde Biochemistry Document Library
Service Hours

Routine operating hours

  • Monday to Friday, 8.30am to 5.00pm
  • Saturday and Sunday, 8.30am to 12.00pm (Inverclyde Royal Hospital) and 9.00am to 12.00pm (Royal Alexandra Hospital) 
  • There is a 24hr emergency service for urgent samples outwith these hours
Contact Details

Royal Alexandra Hospital (RAH)

  • Address: Corsebar Road, Paisley, Renfrewshire PA2 9PN
  • Telephone: 0141 314 6157 extention 06157

Inverclyde Royal Hospital (IRH)

  • Address: Larkfield Road, Greenock PA16 0XN
  • Telephone: 01475 504827 extention 04827 – Emergency requests extention 04213

Vale of Leven Hospital (VOL)

  • Main Street, Alexandria G83 0UA
  • Telephone: 01389 817568 extention 87568

POCT issues / Cryoglobulin testing 

For routine issues with gas analysers or blood glucose meters and to arrange training / barcode for meters please email:

Cryoglobulin testing can also be arranged via this email address.

Clinical Advice

Both Primary and Secondary care professionals served by the Clyde Biochemistry Laboratory can obtain clinical advice by email:

Feedback

We are committed to providing a quality service to users. If you wish to provide feedback on the Clyde Glasgow Biochemistry service, please contact our Quality Manager by emailing Pamela.craig@ggc.scot.nhs.uk.

Handbooks and Manuals
Laboratory Newsletter

The most recent laboratory newsletter is available below:

Previous issues of the newsletter are stored in the Clyde Biochemistry Document Library:

Clyde Biochemistry Document Library
Memos

Primary Care

Secondary Care

Previous memos can be found in the Clyde Biochemistry Document Library, linked above.

Hosted Resources – Detect Lung Cancer Ealry

This page is currently under review and will be updated imminently to reflect the HFEAs most recent data.

Prior to starting treatment

When we receive a referral letter from your doctor, we will send you a letter of acknowledgment requesting some important information regarding your partner. When we are able to offer you an outpatient appointment, we will write to you and give you:

  • a date and time approximately 4-6 weeks later for you both to attend for your first appointment at ACS

Since the results of your partner’s semen test will influence which treatment is most suitable for you, it is most important that your partner has had a sample analysed prior to your appointment. This should be arranged with his General Practitioner. Please note that:

  • if, despite this request, your partner does NOT supply a semen sample as instructed, your first visit to ACS will be cancelled and you must contact us to arrange another appointment.
Your first visit

At your first consultation (which will take about 30 minutes) you will meet with a Specialist Fertility Nurse or a Doctor. They will go through a detailed medical history with you both. You will also have your height and weight measured (to calculate your BMI), carbon monoxide screening (to check if you smoke) and you may also need an ultrasound scan of your ovaries.

We require all patients starting a cycle of treatment to have 2 MMR (Measles, Mumps & Rubella) vaccinations. If you have already provided us with paperwork to confirm this, you do not need to do so in subsequent cycles. If you need to check if you have had 2 MMR vaccines please check with your GP in the first instance.

Please note that to be eligible for treatment offered by ACS you must meet the following criteria (the first two apply to the female partner only):

  • eligible patients must be screened before the female partner’s 42nd birthday
  • the female partner must have a BMI above 18.5 and below 30. Couples should be aware that a normal BMI is best for both partners.
  • both partners must be non-smoking (nicotine free) for at least three months before treatment and couples must continue to be non-smoking during treatment. This includes patches, gum and e cigarettes
  • couples where only one partner has legal parenthood of a child (or a biological child) can access NHS funded treatment as long as all other access criteria are met in full
  • same sex couples will not be eligible if they already have a child in the home and both have
    consented to legal parenthood of that child.
  • neither partner to have undergone voluntary sterilisation or who have undertaken reversal of sterilisation
  • couples must have been cohabiting in a stable relationship for a minimum of two years
  • both partners must abstain from illegal and abusive substances
  • both partners must be Methadone free for at least one year prior to treatment
  • neither partner should drink alcohol prior to or during the period of treatment
Possible investigations

Provided you are eligible for treatment at ACS, the most likely outcome of your first visit is that we will be able to recommend a treatment appropriate for you. Should you decide to proceed with that treatment, your name will be placed on the appropriate waiting list.
However, sometimes it will be necessary for you to make several visits to ACS before we can recommend a treatment appropriate for you. Here are some examples of reasons why that might be the case:

  • blood tests need to be carried out but cannot be done during your first visit as they need to be taken at a particular time in your menstrual cycle.
  • an x-ray  or scan needs to be carried out to see whether your fallopian tubes are blocked.
  • your partner needs to provide another semen sample to confirm the results from his first sample.
  • your BMI needs to be reduced to less than 30 or increased to greater than 18.5
Reaching the top of the waiting list

When your name reaches the top of the treatment waiting list (which may take up to 12 months from the date of your referral to ACS), we will send you a letter giving you your next two appointment dates.

The first of these appointments (ART appointment) will be dated 4 to 6 weeks after the date of the letter you received, and the second appointment (Post Screen appointment) 2 to 3 weeks after that.

ART Appointment

At the ART appointment (which takes about 30 minutes to complete) You will meet with a Specialist Fertility Nurse who will:

  • take samples for tests that are required (e.g. high vaginal swab, Anti Mullerian Home etc.)
  • give you some registration forms to complete prior to your next appointment.
  • you will also be given some Human Fertilisation and Embryology Authority consent forms. It is important that you and your partner read over these forms and discuss the relevant issues that require consent, such as using your eggs and sperm to create embryos for treatment, freezing embryos, research and training. All of these issues can be discussed further with the specialist fertility nurse at your next appointment should you have any questions.
Post Screen Appointment

At the Post Screen appointment (which takes about 1 hour to complete) You will meet with a Specialist Fertility Nurse who will:

  • review your medical history
  • discuss your test results
  • discuss in detail your recommended treatment cycle
  • complete your consent forms (both treatment and HFEA)
  • review the forms that you have completed
  • discuss arrangements for you to start treatment

Depending on when you have your period, your treatment will begin 5 to 8 weeks later.

Please visit NHS Inform for the most recent advice on the coronavirus (COVID-19) vaccine and pregnancy. Here you will find information specific to those in the process of having fertility treatment.

Update Friday 11th March 2022

On the 7th January 2022 it was nationally agreed that fertility treatment for unvaccinated women would be deferred with immediate effect. This recommendation was reviewed, as planned, alongside emerging evidence of risk and the prevailing levels of COVID-19, during January and February 2022.

Data from PHS demonstrates that both COVID-19 cases and hospitalisations are stabilising, and a reduced proportion of cases are resulting in hospitalisations, following the emergence of Omicron as the dominant variant. While data specifically on pregnant women is very limited, the available data on unvaccinated individuals suggests that the risk of severe disease requiring hospital or critical care admission has reduced over the last four to six weeks. Therefore, it has been determined that fertility treatment for unvaccinated patients will no longer be deferred.

The JCVI (Joint Committee on Vaccination and Immunisation) advice on vaccinating pregnant women, namely that pregnant women should now be considered as a clinical risk group and part of priority group 6 within the vaccination programme remains the same. Therefore, we will continue to fully inform patients, prior to their treatment, of the evidence concerning the safety of vaccines in those planning pregnancy, undergoing fertility treatment and the pregnant population in respect of maternal and perinatal outcomes, including evidence for continued vaccine effectiveness against symptomatic COVID-19 disease. Furthermore, we will continue to advise patients at the start of the fertility pathway, and at every opportunity thereafter (making every contact count) about the risks of non-vaccination.

In line with the reviews recommendations, we will also ask patients to sign an informed consent form acknowledging that they are aware of the risks prior to treatment, similar to other aspects of the fertility pathway.

The COVID-19 vaccines are safe and effective and there is no evidence to suggest that the COVID-19 vaccines will affect fertility in women or men.

More information is available on the NHS Inform website.

Update Thursday 23rd December 2021

The Scottish Intensive Care Society Report, published on 13 October, highlighted that of the 89 COVID-19 positive pregnant women who were admitted to critical care between December 2020 and end September 2021, 88 were unvaccinated, 1 was partially vaccinated, and none were fully vaccinated. Wave 3 has seen increased numbers of pregnant women being admitted to hospital with moderate to severe COVID-19 symptoms requiring critical care, with clinicians reporting a particular peak in September.

On 16 December, the Scottish Government, Chief Medical Officer, Dr Gregor Smith wrote to NHS Chief Executives highlighting recent updates to the Joint Committee on Vaccination and Immunisation advice on vaccinating pregnant women, namely that pregnant women should now be considered as a clinical risk group and part of priority group 6 within the vaccination programme.

In addition to this, the latest evidence from the UK Obstetric Surveillance System (UKOSS) and the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) shows that unvaccinated pregnant women and their babies have died after admission to hospital with Covid-19 and 98 % of pregnant women in ICU with Covid-19 are unvaccinated. We also know that of all the women who have died during pregnancy or up to 6 weeks after birth, 88% of them were unvaccinated. 

In light of the above evidence, the speed at which the Omicron variant is spreading through communities and the safety of pregnant women and their babies, it has been nationally agreed that fertility treatment for unvaccinated women will be deferred with immediate effect. We will review this decision during February 2022 or earlier if appropriate. Older women who have their treatment deferred, will have the deferral time added back on to their fertility journey to ensure that they do not lose out on eligibility for treatment due to their age.

Women who are within 12 weeks of having their second Covid vaccine dose or who have had their booster will continue their treatment as normal. For those who have recently had or are about to receive their booster vaccination, treatment can begin 10 days after the booster vaccination has been received. Positions on waiting lists will not be penalised if extra time is needed for vaccination.

Further information regarding the Omicron variant will continue to become available and any changes to current guidance will be communicated as soon as it becomes available.

For further information regarding covid vaccination in pregnancy and breastfeeding, please see the following link:

FAQ following update on 23rd December 2021
1. How long the treatment will be deferred / postponed?

Treatment will be deferred until February 2022 at which point the advice will be reviewed to determine if treatment can recommence of whether further deferral will be required.

2. If the risks are in pregnancy, why does my partner status matter?

If your partner gets infected you will be exposed to risk of infection. If you are a confirmed contact you will then need to isolate and will be unable to attend for monitoring/ treatment.

3. It is our personal choice to get vaccinate. Why are you forcing us to get vaccinated?
  • It is still your personal choice as to whether to have the vaccine, all we are saying is that we cannot proceed with treatment without evidence of vaccination due to the risks involved.
  • JCVI (Joint Committee on Vaccination and Immunisation) has put pregnant women in high risk category.
  • RCOG (Royal College of Obstetricians and Gynaecologists), RCM (Royal College of Midwives), Scottish Government all are advising vaccination, including boosters for pregnant women.
4. Is it for all fertility treatment or only IVF?

The guidance relates to all fertility treatment and not IVF alone.

5. I am self-funding, why does policy apply to me?

As this is based on clear clinical advice around the risks for this group of women and the decision is based on protecting this group, this policy applies to all patients having treatment in Centres, not just NHS patients.

6. Will I have to provide evidence?

Yes. Please download the app. This will be checked when you come in to the centre.

7. If I wait, I will be more than 40. This will compromise my funding status

No this will not compromise your funding status. All patients having treatment deferred will have the deferral time added back on to their treatment journey to ensure that no patient loses out on treatment due to their age.

8. Can I go through stimulation and freeze embryos?

The same concerns around infection during treatment and subsequent cancellation of the cycle prior to egg collection apply.

9. Will there be further deferral?

We don’t know at this stage. The available data will be reviewed in February.