Public Health Services Contract

2015/16

PUBLIC HEALTH SERVICES CONTRACT

Appendix A

Waveney Stop Smoking Specification

1 Introduction

3.1 The service will be aimed at smokers who are motivated to quit who do not have any medical conditions that require a medical assessment prior to the commencement of NRT.

3.2.1 From April 1 2015, Public Health Suffolk will be introducing a web-based database (PharmOutcomes) which will replace the paper system used for dispensing and smoking cessation monitoring. Pharmacies will be allocated an exclusive username, password and passcode for this database and they will be able to access this at any time to input client data and other relevant information.

3.2.2 Data-inputting under the new system will be carried out in ‘real time’, meaning that information will be registered instantaneously.

3.2.3 Pharmacies can still request paperwork from PharmOutcomes website under the ‘help tab’ if they are unable to complete 1:1 appointments in front of a computer, however, it will be the pharmacy’s responsibility to upload that data to the system at the earliest available opportunity.

3.2.4 Public Health Suffolk recommends that all smoking cessation-trained staff access the new database at the earliest possible opportunity to familiarize themselves with the system.

3.2.5 It is the responsibility of the pharmacy to ensure that its IT systems can accommodate the PharmOutcomes Health database and that the relevant security measures have been undertaken.

3.2.6 Further information can be found on the PharmOutcomes system available online at:

https://pharmoutcomes.org/pharmoutcomes/help/home

3.3 Individuals Unsuitable for Support in Community Pharmacy

The following circumstances make an individual unsuitable for stop smoking support in Community Pharmacy:

·  Dependent smokers recently discharged from hospital following admission due to myocardial infarction, severe dysrhythmia or CVA and who are considered to be haemodynamically unstable.

·  Under 12 years of age.

·  Smokers wishing to pursue a gradual cessation or temporary abstinence (please refer to Specialist Service for advice and support).

3.4 The service will consist of:

An initial assessment

·  If the individual is ready to quit a quit date will be set.

·  If the individual is not ready to quit give leaflet ‘Go it Alone/Get Support’ and advise individual to return when ready.

·  If the individual is ready to quit but unsuitable for support in community pharmacy refer to alternative service (local GP practice clinic or specialist service).

·  It is necessary for the individuals motivation to take a Carbon Monoxide (CO) reading at the initial assessment and record this.

3.5 Supply of NRT

·  Assessment of individual NRT requirements and suitable product and dose (Appendix 1).

·  Once suitable product is selected the individual must be given clear instructions on appropriate use.

·  1 week’s supply of NRT may be given to the individual.

3.6 Supply of NRT on recommendation of a level 3 Smoking Cessation Advisor

·  Supply of appropriate NRT product in accordance with the directions of the level 3 advisor.

·  Normally 2 weeks at a time and maximum 4 weeks at a time.

3.7 On-going support

·  The individual must be given advice on quitting and a copy of the leaflet “It’s so much easier since I quit” – Your guide to quitting for good with Smokefree. For supply discuss with the Stop Smoking Service.

·  The individual must be offered a weekly appointment for the first 4-weeks after the quit date – this will enable on-going support and encouragement to be given, ensure compliance to treatment and enable weekly supply of NRT.

·  Complete quitting must be encouraged, cutting down is not appropriate – refer to training manual.

·  Once the individual has been quit for 4-weeks future support and supply of NRT can be negotiated with the individual with no more than 2-weeks supply given at one time.

·  A CO reading should be taken at each contact, and definitely at 4-weeks quit.

Provided the individual stays quit a maximum of 12 weeks supply of NRT can be provided, maximum 2-weeks supply at any one time.

3.8 Relapse Prevention

·  Individuals who have successfully quit at 12 weeks sometimes do not feel able to stop NRT use. They should be encouraged to cease regular use but if complete abstinence from NRT is not possible continued NRT use is preferable to a return to smoking, but cannot be funded under this service. The individual may purchase the required product.

·  It is good practice to offer a few words of encouragement if the individual continues to visit the pharmacy after the formal stop smoking service support has ended.

·  It is expected that approximately 50% of those who set a quit date will be quit at 4-weeks.

3.9 Pregnancy

3.8.1 NRT is not contraindicated in pregnancy. The decision to use NRT should be made on a risk-benefit assessment as early on in the pregnancy as possible with the aim of discontinuing use as soon as possible.

3.8.2 Smoking during pregnancy is associated with risks such as intra-uterine growth retardation, premature birth or stillbirth. Stopping smoking is the single most effective intervention for improving the health of both pregnant smoker and her baby. The earlier abstinence is achieved the better.

3.8.3 Ideally smoking cessation during pregnancy should be achieved without NRT. However for women unable to quit on their own, NRT may be recommended to assist a quit attempt.

3.8.4 Nicotine passes to the fetus affecting breathing movements and has a dose-dependent effect on placental/fetal circulation. However the risk of using NRT to the fetus is lower than that expected with tobacco smoking, due to lower maximal plasma nicotine concentration and no additional exposure to polycyclic hydrocarbons and carbon monoxide.

3.8.5 Intermittent dosing products may be preferable as these usually provide a lower daily dose of nicotine than patches. However, patches may be preferred if the woman is suffering from nausea during pregnancy. If patches are used they should be removed before going to bed.

3.8.6 At present the Stop Smoking Service does not recommend the routine supply of Nasal Spray or 24 hour patches to pregnant smokers.

3.10 Lactation

3.9.1 NRT is not contraindicated in lactation. Nicotine from smoking and NRT is found in breast milk. However the amount of nicotine the infant is exposed to is relatively small and less hazardous than the second-hand smoke they would otherwise be exposed to.

3.9.2 Using intermittent dose NRT preparations, compared with patches, may minimize the amount of nicotine in the breast milk as the time between administrations of NRT and feeding can be more easily prolonged.

4 Re-imbursement

4.1 With regard to the supply of NRT on recommendation of a Level 3 Smoking Cessation Advisor, each product dispensed will be subject to a £1 supply fee.

4.2 It is not permitted for providers to subcontract service provision to other parties and any claims made on this basis will not be paid.

4.3 To safeguard the service against the possibility of fraudulent claims, all claims submitted to the PharmOutcomes website by the Pharmacy will be the responsibility of the Pharmacy Manager to ensure are correct.

4.4 All forms must be submitted on PharmOutcomes monthly in line with the data deadline (Appendix 3).

4.5 For each successful quit achieved by the in-house Level 2 service, a fee of £50 will be paid. This will be split into two elements: £20 for setting a quit date and £30 for a successful, validated, 4-week quit, as identified by the return of the service monitoring form.

4.6 Late quarterly returns will receive only £20 per quit (£10 for each element) and no payment will be given for monitoring forms received after the end of year return date.

4.7 NRT supplied directly to the patient as part of the 1:1 support will be reimbursed at cost price plus VAT minus any prescription charge collected. Payment to community pharmacies will be made by Suffolk County Council in the second month after data submission

5 Dates for Data Submission 2015-16

5.1 Stop Smoking data is reported by the Stop Smoking Service on a monthly and quarterly basis. Because data can only be submitted for the quarter in which the quit date was set, adherence to the reporting deadlines is very important.

5.2 The attached ‘Dates for Data Submission table’ identifies the date by which PharmOutcomes monitoring forms must be completed (Appendix 3).

5.3 The dates in bold signify the end of the reporting period for the previous quarter. Payments for forms received after the quarter deadline will be made at a reduced rate.

5.4 The attached Dates for Data Submission table (Appendix 3) shows the latest date for returning monitoring forms for inclusion in the data return (Appendix 4). The 15th of May 2016 is a particularly important deadline as any data received after this date cannot be included as it is the year end. Therefore any forms received after the 15th May 2016 will not qualify for payment.

5.5 Please note that the PharmOutcomes forms should be completed on a regular weekly basis as the 4-week follow up is completed and not stored until the deadline.

5.6  Activity received after the last date in the year cannot be used and will therefore not qualify for payment at all.

6 Obligations of the Pharmacy and Suffolk County Council

6.1 Carry out the service in such a manner in which it meets professional obligations as detailed in the Royal Pharmaceutical Society of GB Guidance on Child Protection (August 2007 or any updated versions).

6.2 Carry out the service in such a manner in which it meets professional obligations as detailed in the Royal Pharmaceutical Society of GB Guidance on the Protection of Vulnerable Adults (August 2007 or any updated versions).

7 Standard of Service

7.1 The Contractor shall comply with the Care Quality Commission standards for clinical quality and safety to enable it as a provider of health and adult social care to comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 and the Care Quality Commission (Registration) Regulations 2009.

7.2 This service specification applies from 1 April 2015 to 31 March 2016; its contents may be adjusted as a result of practical experience and consultation.

Product information ref Stop Smoking

Appendix 1 – Product information ref stop smoking

Appendix 2 - Monitoring form guidance

Appendix 3 – Dates for Data Submission table