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Expanding Needle and Syringe Provision (NSP) in the Community: How Hepatitis C Trust Peers Are Making a Difference
The Hepatitis C Trust have generously offered to deliver NSP to people in the community through their peers and Inclusion’s community drug and alcohol treatment services (part of Midlands Partnership University NHS Foundation Trust) were keen to take them up on their offer.
Needle and Syringe Provision (NSP) is a vital harm reduction service for people who inject drugs. Traditionally delivered through drug treatment services and community pharmacies, NSP plays a key role in preventing the spread of blood-borne viruses and reducing injecting-related harm. However, as access through community pharmacies declines and service models evolve, it’s time to think differently.
Why Peer-Led NSP Matters
To truly reach those who need sterile injecting equipment, we must diversify how NSP is delivered. While on-site NSP in drug treatment services and community pharmacies remain essential, alternative methods—such as online ordering, vending machines, stand-alone services, and peer distribution—are increasingly important.
Here’s why Hepatitis C Trust peers are uniquely positioned to support NSP delivery:
Widening Access: With fewer community pharmacies offering NSP and challenging geographies, many people are left without easy access to sterile equipment. Peer-led provision helps fill this gap.
“Partnership working has driven NHS England’s progress towards hepatitis C elimination. Our lived-experience peers are already reaching underserved communities and supporting thousands into life-saving treatment. However, our work has also highlighted gaps in prevention and harm reduction efforts that risk widening inequalities for people who use drugs. Our partnership with NHS Inclusion Services will strengthen joined-up pathways, ensure delivery of peer led needle and syringe provision, enable equitable access to essential harm reduction services, helping protect communities and keep elimination on track.”
Danny Morris, Midlands & West Regional Manager for The Hepatitis C Trust
Community Connection: Hepatitis C Trust peers already engage with individuals through hepatitis C testing and outreach. They often meet people who need NSP but either aren’t, or struggle to access traditional services.
Hepatitis C Elimination: Strengthening NSP coverage is critical to achieving hepatitis C elimination in England. Peers can offer harm reduction advice alongside equipment distribution.
“If we have any hope of achieving our ambition of eliminating hepatitis C as a public health threat, and of sustaining it, we must address how we reduce transmission. This requires us to take an honest look at what we need to improve, and using the resources that are available to us. People who use drugs deserve to have accessible NSP that meets their needs.”
Deanne Burch, Programme Lead for Hep C U Later (an NHS Addictions Provider Alliance initiative)
Collaborative Systems Working: Sharing resources between services creates a more cohesive and responsive offer for people who use drugs.
“Staffordshire drug and alcohol services are being delivered through a s75 agreement, which has a hard-wired system approach to supporting people who use drugs and alcohol through collaboration, integration and partnership. I have also had the pleasure of working with the HepC Trust in the past and I have encountered the quality and passion of their staff, including volunteers. Hence, it felt like a natural fit for us in Staffordshire to develop a partnership with the Hep C Trust and we look forward to realising the undoubted benefits for reducing harm, preventing BBV spread and enabling people to access treatment and recovery, where required and desired.”
Jon Shorrock, Partnership Lead, Inclusion Staffordshire (Part of Midlands Partnership University NHS Foundation Trust)
Reducing Harm: Increasing access to sterile equipment helps lower the risk of infections and injuries caused by reusing or sharing injecting equipment
Challenges and How We Overcame Them
Implementing peer-led NSP wasn’t without its hurdles. But through collaboration and flexibility, solutions were found:
Governance and Assurance: A multi-agency meeting brought together the governance lead, pharmacy lead, Hep C U Later, and the Hepatitis C Trust to explore needs and agree on solutions. A Memorandum of Understanding (MOU) was signed to formalise the partnership and underpin the expectations between the two organisations.
“Bringing together two organisation’s governance requirements can be challenging, but with clear communication and the commitment to work together to provide this additional resource to our communities has meant that a meaningful, safe and collaborative MOU has been reached which meets both organisation’s requirements.”
Karen Marsh, Head of Quality and Governance, Inclusion (Part of Midlands Partnership University NHS Foundation Trust)
Training: Hepatitis C Trust peers were required to complete the Exchange Supplies Level 2 Needle Exchange Training to ensure safe and informed delivery which all of their peers undergo already as part of the Hepatitis C Trust’s training strategy.
Information Governance: To protect privacy and reduce the need for more complex governance arrangement and agreements, only non-personal data (e.g. number of needles/syringes distributed) is shared between from the Hepatitis C Trust and drug treatment services.
Storage and Safety: Water for injection must be stored below 25°C. A simple temperature monitoring sheet was introduced, with equipment ideally distributed and returned on the same day.
“As part of our commitment to safe and effective service delivery, all medicines used in the peer-led NSP distribution initiative will be stored at ambient temperature, in line with both manufacturer recommendations and Trust policy. To maintain quality and reduce waste, stock levels will be kept lean, with close monitoring of turnover and strict rotation to ensure older stock is used first. Any issues—such as temperature excursions or risks identified during assessments—will be promptly escalated to the Inclusion Pharmacy Lead for expert guidance and resolution.”
Denis Kanu, Lead Pharmacist, Inclusion (Part of Midlands Partnership University NHS Foundation Trust)
What’s Next?
The success of peer-led NSP has opened dialogue for further collaboration:
Naloxone Distribution: The drug treatment service is exploring how peers can support overdose awareness and prevention by distributing naloxone and delivering training. It is recognised that this may have more challenges to overcome due to the recording and information requirements and the current policies in place around dispensing.
Strengthening Partnerships: A governance meeting is being planned to bring together all of the providers who are collaborating with the Hepatitis C Trust on NSP peer distribution to share learning, and resolve distribution challenges. This could lead to even closer ways of working that benefit people who use drugs.
Ongoing Review: Regular evaluations will ensure the Hepatitis C Trust’s peer NSP model continues to meet community needs and improve over time, as well as providing a vital space for the drug treatment service to hear feedback from people accessing NSP.
Training Opportunities: Hepatitis C Trust peers will be offered further training from the drug treatment service to support both their development and the wider workforce.