Pharmacy First
Delivery of Smoking Cessation Support
Local Scheme 3
July 2008
Service Level Agreement
Services covered:Provision of Smoking Cessation Support
Duration of Agreement: …………..
Commissioner No:Insert name, address and contact telephone for PCT
Commissioner contact:Insert name
Provider:Insert name, address and contact telephone number for pharmacy
Provider Contact:Insert name
SectionContents
1Duration of Agreement
2Service Description
3Aims and Intended Service Outcomes
4Service Outline
5Service Funding
6Termination of Agreement
7Health and Safety
8Training and Development
9Confidentiality
10Indemnity
11Complaints
This Service Level Agreement (SLA) is for (insert name and address of pharmacy) to provide smoking cessation support from the pharmacy.
- Duration of Agreement
This agreement will run on a twelve monthly rolling contract and will be reviewed periodically. At least 1 months notice must be given by either party to terminate or change this SLA. The PCT will review the number of smoking cessation returns and assess the feasibility of maintaining the pharmacy on the scheme. However if it is evident that the scheme is not being accessed by the public, then the PCT reserves the right to terminate our participation in the scheme.
Service providers are required to agree with the PCT this specification at the start of the year.
- Service Description
Evidence shows that:
- 26% of the UK population currently smoke (2) (ONS 2002)
- Smoking Kills over 120,000 people in the UK per year (3)
- Smoking is associated with a wide range of health problems
- Treating smoking-related illness costs the NHS £1.7 billion annually (3)
- Smoking is the single greatest cause of preventable illness and premature death in the UK (3) Smoking Kills
- Seven out of ten adult smokers say they would like to give up, but due to the addictive nature of nicotine, most find it hard to quit (3)
- For smokers who give up, the chances of getting a serious or fatal disease are greatly reduced. (3)
- Face to face intensive behavioural support from a trained specialist leads to 3-10 out of 100 moderate to heavy smokers stopping smoking (4)
- Intensive behavioural support plus Nicotine Replacement Therapy, Bupropion (4) (5) or Varenicline (6), leads to 13-19 out of 100 moderate to heavy smokers stopping smoking.
Community pharmacists have an increasingly important role in smoking cessation, and are well placed to offer support for customers who want to stop smoking and do not require the more intensive support offered by the specialist smoking service. This service offers the customers of the pharmacy the opportunity for an assessment of their nicotine dependency and, where appropriate, free smoking cessation support and access to pharmacotherapy for smoking cessation through local protocols or a referral to Leeds NHS Stop Smoking Service.
As part of the service the pharmacy will display a range of leaflets and posters to promote the range of smoking cessation services available to customers in Leeds.
- Aims and Objectives
This Service Level Agreement for Smoking Cessation aims to improve, in line with NICE and Department of Health guidance, the quality of care provided to patients who smoke and want to stop. Leeds PCT and service providers within a range of settings will jointly achieve this.
‘All … health professionals … should refer people who smoke to an intensive support service (for example, NHS Stop Smoking Services). If the individual is unwilling or unable to accept this referral, practitioners with suitable training should offer a prescription of pharmacotherapy in line with NICE technology appraisal guidance no. 39, and additional support’.(1)
- To improve access for people to smoking cessation support
- To increase the number of people having a successful quit attempt
- To increase service user satisfaction
- To offer service user’s choice.
Intended Service Outcomes
- Smoking cessation support in community pharmacies is acceptable to service users
- 4 week quit rates meet those targets set by the Department of Health
- Service users are highly satisfied with the service
- The pharmacy may reach service users that would not access support from another service provider
- Service Outline
Smoking cessation work in Leeds is currently delivered on a tiered service model which has proved an effective way of addressing health inequalities. Specialist services are commissioned from PCT care services directorate and, although the servicess caters for all smokers across the city, they are particularly focused on providing services within the 10% SOAs where prevalence is highest and nicotine dependency greatest. Elsewhere less intensive services, designed for less dependant smokers, are provided through a locally enhanced service with primary care and a service level agreement with community pharmacists. These services are delivered by an appropriately trained and registered smoking advisor.
Service providers with an SLA will:
Ensure smokers who wish to stop smoking are initially assessed for nicotine dependency (see appendix 1). For those smokers demonstrating high levels of dependency an offer of referral to specialist stop smoking services will be made.
Should the smoker demonstrate low levels of dependency following assessment; the service provider may opt to deliver in house smoking cessation support in line with the guidance stated below. They will ensure this service is delivered by a member of staff who has undertaken training (normally 2.5 days) to provide support to clients who want to stop smoking and are registered as an advisor with Leeds NHS Stop Smoking Service.
Ensure patients are offered access to the choice of the full range of smoking cessation treatments (Nicotine Replacement Therapy, Varenicline, Bupropion) as appropriate, and utilise local protocols to obtain treatment.
Following referral, a patients will be offered a range of smoking cessation support e.g. drop in clinic, group programme, 1:1 support normally within 2 weeks of accessing the service. Most programmes run for 7 weeks although ongoing support may be provided if needed.
Once attending a clinic, patients will be assessed and a recommendation for treatment will be provided for the patient to take to their GP or, in the case of nicotine replacement therapy, a voucher will be issued which maybe exchanged at a pharmacy registered on the NRT access scheme. Once attending a support programme the clients are supported though the preparation phase of quitting and the initial stages of quitting until they have been successfully able to quit smoking for a period of 4 weeks. In addition, the specialist service follows up clients at 52 weeks following their quit day. Progress is monitored throughout via recording expired carbon monoxide readings using a carbon monoxide monitor.
Services are provided across the city and run through the day including evenings.
In addition to the generic service, the service employs specialist advisors to support pregnant women.
This Service Level Agreement will fund:
- Service providers who offer in-house smoking cessation services in line with the minimum standards for smoking cessation services (see Appendix 2) set out by the DH (7,8,9). Service providers will return the required minimum data sets on a monthly basis and within a specified deadline, to smoking services, in time for inclusion in the monthly report for the DH.
It is expected the following specification will be fulfilled by service providers:
a)An advisor offering smoking cessation support will have received appropriate training for their role, and be registered with Leeds NHS Stop Smoking Service as an accredited advisor. (Level1)
b)In addition they will attend at least one networking/update session held by the service throughout the year to ensure skills and knowledge are kept up to date. This will be monitored by Leeds NHS Stop Smoking Service
c)The service provider will respect client confidentiality at all times and conduct appointments in an appropriate location.
d)The in house service provided will be delivered to Department of Health specification for the provision of stop smoking support. (see Appendix 2). This will be monitored by Leeds NHS Stop Smoking Service
e)In line with NICE guidance, the service provider will ensure the full range of smoking cessation treatments are offered to clients who want to stop smoking (5,6)
f)The service provider will adhere to local protocols and procedures regarding the provision of stop smoking services and treatments
g)It is expected that the service provider will promote all available NHS Stop Smoking Services, including the specialist service for those smokers demonstrating high levels of dependency.
h)Ensure changes at the provider organisation are communicated to Leeds NHS Stop Smoking Service (this would include change of ownership, contact details or if accredited advisor leaving the branch)
To assist service providers, Leeds NHS Stop Smoking Service will provide the following:
I.All resources and training required to support the registered advisor deliver one to one smoking cessation advice including provision of update sessions.
II.Assistance to service providers in developing strategies and establishing in house services if requested.
III.Feedback to service providers where requested
IV.All resources required to promote available smoking services including the opportunity to directly supply a range of nicotine replacement therapy (patches, inhalator, lozenge, gum, nasal spray and microtab) via the pharmacy access scheme
- Service Funding
Activity data will be provided to the PCT as detailed elsewhere in this specification in order for the PCT to monitor, evaluate and review performance with regard to agreed service specifications.
In 2008/09 service providers will receive a £30 payment for each patient who stops smoking at 4 weeks following their quit day, as defined by the Department of Health criteria (9).
This will be paid twice yearly in arrears on return of the minimum data set to Leeds NHS Stop Smoking Service. To ensure services are in line with Department of Health requirements, all minimum data sets will be returned to the service within 2 weeks of recording the 4 week outcome following each quit day set.
- Termination of Agreement
Should either party wish to terminate the agreement, one months notice will be given in writing
- Health and Safety
The pharmacy will be responsible for the provision and maintenance of a safe and suitable environment for clients and will comply with all relevant statutory requirements, legislation, Department of Health guidance and professional Codes of practice and all Health and Safety regulations.
- Training and development
Any pharmacy staff offering smoking cessation support must have attended both Level 1 and Level 2 smoking cessation training and be registered with Leeds NHS Stop Smoking Service and will therefore be adequately trained regarding the delivery of smoking cessation support. In addition they will attend at least one networking/update session held by the service throughout the year to ensure skills and knowledge are kept up to date. This will be monitored by Leeds NHS Stop Smoking Service
- Confidentiality
All parties agree that access to any information relating to individual service users treated under the terms of this SLA will be restricted to authorised personnel and that information will not be disclosed to a third party. The parties will comply with the Data Protection Act, Caldicott guidelines and other legislation covering access to confidential client information.
- Indemnity
This agreement does not abrogate the pharmacy or pharmacist from any of their professional duties or obligations and the PCT cannot be held liable for any action or inaction by a pharmacy or pharmacist under the auspices of this agreement that may lead to client harm.
- Complaints
The pharmacy will effectively manage any complaints or incidents, keeping a record for audit purposes.
(i)AUTHORISATION
For and on behalf of PCT (Commissioner)Signed______
Job title:
Name:
Date______ / For and on behalf of Pharmacy (Provider)
Signed______
Job title:
Name:
Date______
Appendix 1
Defining Brief Intervention:
The essential features of individual smoking cessation advice in primary care are:
Ask about smoking at every appropriate opportunity and record smoking status
Brief advice - advise all smokers to stop and of the stop smoking support available
Confidence – Instil confidence in the smoker to have a quit attemptthe smoker to stop
Direct – Recommend attendance at smoking services; provide literature and following assessment for nicotine dependency, as defined below, initiate a referral to an appropriate level of service
Assessment:
All smokers who wish to be referred for smoking cessation support should be initially assessed for dependency. A brief two question assessment can be used using appropriate open questions:
- Does the smoker smoke the first cigarette of the day within 15 minutes of waking?
- Has the smoker had a serious (supported) quit attempt within the last 12 months?
Should the smoker answer yes to both questions refer to the Specialist Stop Smoking Service (details as follows)
Method of referral / Comment- Phone
- 0800 169 4219
- Fax
- 0113 203 3416
- Referral sheet
- Available from Leeds NHS Stop Smoking Service
- Send to:
Stockdale House
Victoria Road
Leeds
LS6 1PF
Should the smoker answer no to one or both questions refer to own service provider.
All training and materials to support brief interventions are available from Leeds NHS Stop Smoking Service and can be obtained by phoning 0113 203 3446.
Appendix 2
Criteria for the provision of stop smoking support
- An advisor will offer weekly support for at least the week before a client’s quit day and the subsequent four weeks. This may not necessarily be taken up by the client, but should be available. The support could be offered by telephone where appropriate.
- Follow up at 4 weeks following the quit day will be attempted for all clients. It is important that the follow up should be carried out promptly.
- At the 4 week follow up, clients should be seen in person. If the client does not attend a follow up appointment, up to 3 attempts will be made to reach the client by telephone; any client not contacted after 3 attempts will be classed as ‘lost to follow-up’. If telephone follow up is not an option, then a letter should be sent to the client inviting them to contact the advisor to confirm their smoking status. Any client not responding to the letter should be classed as ‘lost to follow-up’.
- A client will be counted as having successfully stopped smoking if he/she has been completely abstinent from smoking for a period of 2 weeks since 2 weeks after the quit date (i.e. weeks 3 and 4 following the quit day). The rationale behind this definition is to allow a period of ‘grace’ in recognition of the fact that some smokers initially struggle but then are successful in their quit attempt. (See appendix 3)
- In line with best practice, all advisors will attempt, wherever possible to confirm the smoking status of all clients self-reporting as having quit smoking at 4 weeks, by the use of a carbon monoxide monitor. Whether validation was attempted, and, if attempted, the result should be recorded for monitoring purposes.
- The advisor will complete the client record card (provided by Leeds NHS Stop Smoking Service) fully and accurately and return to the service following completion of the 4 week follow-up. Completion will be monitored by Leeds NHS Stop Smoking Service.
Appendix 3
Definition of a four week quit
A successful quit is counted when a client, at 4 weeks following the quit date, has been totally abstinent since two weeks after the quit day for a period of 2 weeks.
References