Freelance Needle Exchange Ltd
Background
There is very strong evidence that the HIV virus can be spread by the sharing of used syringes. In an effort to reduce the spread of HIV, the Government established a pilot syringe and needle exchange scheme in 1987. Syringe exchange is a facility where drug injectors can obtain sterile needles and syringes and return used injecting equipment. This service is free to the client, and available on a regular and reliable basis at a known location. Today, pharmacy-based schemes are quite widespread and a recent Advisory Council on the Misuse of Drugs report, recommended that pharmacists should increase their level of involvement in such schemes.

The Pilot Schemes in North & North East Lincolnshire
Needle and syringe exchange services have been available in North East Lincolnshire since May 1992 following the development of a scheme in Grimsby and Immingham, which operated mainly through community pharmacies but also through a drug treatment centres and a street agency. In November 1992 a further scheme was opened, operating from five community pharmacies in Scunthorpe and the surrounding district. Equipment was initially available only in pre-packs containing syringes, needles, swabs, sin-bins and condoms. The schemes were funded as pilot projects from the HIV/AIDS budgets of the district health authorities in Grimsby & Scunthorpe, which in 1993 merged to become United Health.

Continuation of the schemes beyond the pilot phase was made subject to their evaluation and studies of the schemes were commissioned by Grimsby Health Authority in October 1992 and the new joint authority in July 1993 and were completed and published in January and October 1993 respectively.

United Health (now known as South Humber Health Authority) took the decision to purchase a needle exchange scheme for the whole of South Humberside on a single contract and put the services out to tender late in 1993.
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The Formation of Freelance and brief history
The Freelance Group was formed to bid for the operation of the needle exchange scheme during the Summer of 1993. The group consisted of the community pharmacists already involved in the two health authority schemes. It was led by Tim Cottingham, Colin Keenan and Rod Tucker, whose pharmacies were the most active in the area, and had developed a wide interest in substance misuse. In amalgamating the schemes, the directors could apply good examples of practice from one site or area to the whole scheme. Because the Freelance Group was to be managed by pharmacists in regular day to day contact with clients, the process of development of the service would be more responsive to clients needs.

United Health awarded Freelance the contract and the new amalgamated South Humberside service became operational from the 1st January 1994 with 13 sites. The aims and objectives of the Freelance Group as set out in the bid for the contract with United Health and were:

  1. To allow the drug injecting population who live within the Grimsby, Scunthorpe and Goole areas, full and free access to clean needles and syringes through community pharmacies and other suitable sites.
  2. To encourage the return of contaminated injecting equipment from users of the scheme for safe disposal
  3. To co-operate with and promote the counseling and support roles of the local voluntary drug agencies and to refer clients to these services if required.

After one of the founder members resigned from Freelance due to pressure of work, the remaining directors took legal advice. The result of this was the formation of a limited company, Freelance Needle Exchange Ltd, with Tim Cottingham & Rod Tucker as directors in May 1995. This company was principally so as to fully separate the service from the directors ordinary work and protect the service.

In April 1996, with boundary changes, the site in Goole fell within the area of responsibility of East Riding Heath Authority. Despite this, Freelance were able to renewed the contract with the new Health Authority. The company registered for VAT in September 1996.

Since April 1997, Freelance Needle Exchange has a three year rolling contract to provide needle exchange services to clients within the South Humber Health Authority area.
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Some Pictures of our service - all pictures are copyright Freelance Needle Exchange 1997

Picture Picture
Exchange room
Cottingham
Chemists		 Assorted sin-bins
Picture Picture
Typical exchange
pack		 An exchange
taking place


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An brief overview of the role of Freelance Needle Exchange Ltd The Freelance Needle Exchange is an organization formed specifically to manage the Grimsby and Scunthorpe needle exchanges. The directors quickly identified their responsibilities to many specific groups and organizations.

  1. Clients - To provide full and free access to injecting equipment and to provide a method of safe disposal. To provide concise and practical advice and information on harm reduction and to be able to refer clients onto other agencies and services. To provide a totally confidential service. To produce an occasional newsletter on safer drug use, current problems and sexual health.
  2. Pharmacists - To provide an easy and safe system of syringe exchange which avoids disruption to the smooth running of the pharmacy. Easy lines of communication to deal with acute problems. Training and support services. Appropriate payment for services. Advice is also freely available community pharmacists with substance misuse queries who do not participate in needle exchange.
  3. The Public - To tackle the problems of discarded needles and syringes. To promote the positive role of the scheme in providing assistance to a group at high risk of contracting HIV and other infectious diseases.
  4. The Purchaser - All of the above. But also specifically to provide accurate information on the service provided. To produce a clear picture of the client group, their age, sex, drugs of choice etc. Also to stay within the allotted budget.
  5. Treatment - Provide accurate information on the extent of injecting and the relative Agencies use of substances. To refer clients for evaluation and treatment. To offer advice on issues of mutual interest. To distribute literature on specific local topics.
  6. Others - Freelance provides suppliers with accurate projections of equipment needs so as to minimize waste.

Whilst Freelance Needle Exchange are ultimately responsible for the purchase and distribution of equipment, safe disposal of collected clinical waste, data collection and analysis, the way that each site pharmacists operate their exchange is within their own professional control. This allows them to offer a service within the constraints of their pharmacies and tailored to the needs of their particular clients. The Freelance Guide contains all the information required for the safe operation of needle exchange as well as detailing the returns policy, confidentially, protocol for dealing with under 16's, health and safety policy and a concise guide for visiting locum pharmacists. Memos and newsletters are also circulated to all sites as they are required.

All injecting equipment provided to clients are made to comply or exceed British Standards. The vast majority of the pre-packed and loose equipment is supplied directly to sites from both the Grimsby and Scunthorpe NHS Hospitals Trusts. These suppliers are contractually responsible for the quality of this equipment. No one should believe the often held view that needle exchanges supply only equipment rejected by the hospital service.

The larger sites began to offer a wider range of loose equipment in addition to pre-packs. The largest sites provided a full pick and mix service with a range of disposal bins.

Pharmacists record transaction information during each client visit on a duplicate form. The transaction sheets are sent to Freelance on a monthly basis in order to asses the uptake of the scheme and also to calculate payment to the pharmacists. Total transaction figures are then sent when collated to South Humber Health Authority followed by a full report every year.

The collection and safe disposal of clinical waste is contracted to the Support Services Department of East Riding Health Authority.
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Current performance indicators

The needle exchange scheme operates through 17 sites, 14 of these are community pharmacies. The remaining three sites are clinics of South Back Consortium Healthcare, a drugs treatment agency which is part of Scunthorpe Community NHS Trust.

During 1996/7, 12,471 client visits were made, 172,251 syringes were issued with an estimated 135,459 (78.6%) returned.

To the end of 1996, 1640 clients had registered with the service although 218 of these are re-registrations with an average age of 26 years old.
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Independent Evaluations In the early part of 1995 an independent evaluation of the Freelance Scheme was carried by Hamer and Connell. Below is a quote from this evaluation

"Freelance has not only consolidated needle exchange services in South Humberside but it has taken them forward, building an organization capable of a diverse and reflexive response to the needs of injecting drug users. That the exchange schemes are well used has never been in doubt but Freelance has actively developed the user base and is new well placed to deliver services to an expanding population."

which concluded that

"the scheme can be considered to have been a remarkable success".

In addition, in June 1995, a Drug Advisory Service report on services for problem drug users in the health district listed the Freelance scheme under "commendable features, exceptional and applicable elsewhere".
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Current Activities

We are involved in piloting a supervised methadone consumption programme which has recently commenced. In the new year we will involve ourselves in needs assessment work by a broad client surveys) to make any necessary improvements in the provision of services to the clients. It has been 18 months since this was last carried out and a number of new clients have joined the scheme. Certain sites that have access to a separate exchange area are now offering a wide variety of condoms. Uptake of condoms has increased dramatically and wider availability from more sites is planned