Level 2 Intermediate Service Provision in Pharmacy

April 2010

SMOKING CESSATION IN HERTFORDSHIRE 2010/11

Level 2 Intermediate Service Provision in Pharmacy

Local Enhanced Service

Role of Hertfordshire Stop Smoking Service

Hertfordshire Stop Smoking Service aims to help smokers quit by working in partnership to deliver a high quality service, contributing to the reduction of smoking prevalence and improving health and wellbeing in Hertfordshire

To enhance the quality and effectiveness of Level 2 Intermediate stop smoking services provided in a GP practice Pharmacy or other healthcare professionals, by ensuring that a high quality standard of training has been received by those providing the intervention to patients.

To ensure more intensive support is offered to support smokers with more complex needs by referral to the Hertfordshire Stop Smoking Service

To ensure that robust data is collected to provide accurate and timely measurement of outcomes at surgery, PBC, and PCT levels and to remunerate appropriately

To provide ongoing supportand mentoringfor all providers to ensure quality of service, to maximise quit rates and achieve 4 week quit targets

April 2010

Level 2 Intermediate Stop Smoking Service

SERVICE SPECIFICATION

Pharmacy Settings

Provide one or more Stop Smoking Adviser(s) who has been trained to Level 2 standards and registered with HSSS

Level 2 training comprises
2 day initial training with mandatory annual update training in subsequent years for service providers
Advisers who have been trained to the standards of the Health Development Agency or National Standard for Smoking Cessation Training in other Trusts and can provide validation, can offer the service in Hertfordshire subject to attending update training
In house programmes will be evaluated for accreditation pending guidance regarding National Standard for Smoking Cessation Training. Until this is available, each application will be dealt with on an individual basis
Advisers who wish to offer a Pregnancy Service are invited to attend HSSS Smoking in Pregnancy Training (1/2 day)

All front line staff not providing a service to be trained in Brief Intervention for Smoking Advice according to Department of Health recommendations ’30 seconds to save a life’, Ask, Advise, Act

Ensure that the service is promoted to maximise engagement and referral into own service

Return to HSSS accurately completed Monitoring forms for all clients by the end of the month following the quit attempt either using the reply paid envelopes supplied, or by entry on-line through Quit Manager. Incomplete or inaccurate forms may be returned which will delay payment

Provide 1:1 or group interventions and follow the recommended course of treatment according to Department of Health Guidance (see Appendix 1)

Provide dedicated clinic time to enable the course of treatment to be phased according to Department of Health Guidelines and at a time convenient to patients (see Appendix 1)

All motivated quitters should be given the optimum chance of success in any given quit attempt. NRT, Champix (varenicline) and Zyban (buproprion) should all be made widely available as a first line treatment (where clinically appropriate) in combination with intensive behavioural support. Please refer to NICE and local Guidance for full information

Minimise ‘Lost to Follow Up’ patients by contacting them at least 3 times to encourage them back into the programme

Achieve a minimum 4 week Quit Rate of 35% (minimum standard set by the Department of Health below which HSSS must exception report to the Department of Health)

Achieve two week maximum wait time to first appointment for every client

Ensure there is sufficient clinic provision and qualified advisers available to meet pharmacy Smoking Cessation Targets and ensure there are no gaps in service provision

April 2010

Local Enhanced Service

PAYMENTS 2010/11

Pharmacy Providers

£70 per successful 4 week quitter to be paid monthlyon receipt of accurately completed Monitoring Forms either by post or on line through Quit Manager

£30 per unsuccessful quit attemptor lost to follow up to be paid quarterly on receipt of accurately completed Monitoring Forms, provided that a Quit Rate of at least 34.5% has been achieved.

Quit Rates of 34.4% and belowno payment for No Quits and Lost to Follow Up as this falls below the minimum standard set out in the Service Specifications

Achievement of Quarterly Quit Targets An additional payment of £30 per successful quitter will be made quarterly to pharmacies achieving 100% or more of quarterly targets to be paid following receipt of all Monitoring Forms after the end of each quarter

Pregnancy Service

In recognition that significantly more time may be required to support a pregnant smoker to quit

£100 per successful quitter will be paid monthly on receipt of accurately completed Monitoring Forms indicating the pregnant status of the client, either by post or on line through Quit Manager

Pharmacy Targets

Quarterly pharmacy targets have been calculated using average monthly dispensing activity Jan 09 – Dec 09

1 quitter per750 items dispensed per calendar month*

* based on average items dispensed per calendar month (Jan 09 – Dec 09)

Payments to Pharmacies Providing NRT Products

Pharmacists working under the NRT Protocol (2010) will receive £2.00for each supply of NRT provided (usually 2 weeks)
Pharmacists working under the NRT Protocol (2010) will receive the cost for each item of NRT listed in BNF
Pharmacists supplying NRT may return an invoice for the supply of NRT on a monthly basis to HSSS on the correct approved NRT Invoice

April 2010

Hertfordshire Smoking Cessation Local Enhanced Service

Service Level Agreement April 1st 2010 to March 31st 2011

This document constitutes the agreement between the provider and NHS Hertfordshire in regards to the Local Enhanced Service (LES) for Smoking Cessation.

The provider is required to sign and to agree to the terms as set out in this LES for the delivery of smoking cessation services for the period April 1st 2010 to March 31st 2011.

IMPORTANT Payments for claims will commence only once this SLA has been received by the PBC Support Team, NHS Hertfordshire, Charter House, Welwyn Garden City, AL8 6JL. Fax 01707 361240

Signature on behalf of the Provider (Community Pharmacy)

Pharmacy ……………………………F Code………..

Address……………………………………………

………………………………………………………

Name of Signatory…………………………………..

Job title ……………………………………………….

Signature
Date

2. Signature on behalf of NHS Hertfordshire

Name of PCT ………………………………………………….

Name of Signatory …………………………………………….

Job Title………………………………………………….………

Signature
Date

The provider shall be liable for and shall indemnify the PCT, its officers, employees and any agents against any liability, loss, claim or proceedings arising under statute or at common law in consequences of this agreement.

Please complete and return to:

PBC Support Team, Charter House, Parkway, WelwynGarden City. Hertfordshire, AL8 6JL. Fax: 01707 361240

April 2010

APPENDIX 1

Smoking Cessation Treatment Episode

Referenced to Department of Health Stop Smoking Service and Monitoring Guidelines2010/11which are evidence based for best outcomes

Minimum 90 minutes consultation time should be offered to each client.

20-30 minutes for the first appointment in which

Reinforce the motivation to quit and agree a Quit Date
Monitoring Form is signed by the client
Client expectations regarding the course structure and process are agreed
Level of nicotine dependence is assessed
Carbon Monoxide reading is taken and used as a motivator
Information on the nature of nicotine withdrawal and advice on the management of withdrawal symptoms is provided
Strategies, coping mechanisms and behavioural changes discussed
Comprehensive information on appropriate pharmacological interventions, possible side effects and methods of access is discussed
Appropriate supply is given

10-15 minute second appointment on or near Quit Date plus

Offer 4 further 10-15 minute appointments in order to

Monitor use of pharmacotherapy
Build on repertoire of coping strategies
Include regular CO checks and give feedback on progress
Address individual client problems
Plan ongoing coping mechanisms, support and pharmacotherapy to the end of treatment

Pregnant Smokers

Smoking is the single most modifiable risk factor for adverse outcomes in pregnancy.

45 minute first appointment is recommended with 20 minute follow up appointments, which may be required more frequently and continue for longer than for other clients.

Telephone Support

To accommodate clients who cannot attend all clinics for face to face consultations or group sessions, telephone support can be given for one or more consultations.

This could impact on the ability to validate Carbon Monoxide for these clients.

Where possible we recommend a final face to face appointment with CO validation. If this is not possiblethe ‘Quit Not CO Verified’ box should be ticked on the Monitoring Form

Monitoring Forms and Quit Manager on-line Monitoring Forms

Where possible the Monitoring Form should be signed by the client during the first consultation.

If telephone support is being given, it should be noted that verbal consent for HSSS to contact and follow up the client has been granted.

When on-line forms (Quit Manager) are completed, ensure that verbal consent is granted and contact routes are ticked on the form.

In all cases it should be made clear that outcome information will be passed to the client’s GP and that HSSS will be making follow ups.

Time Between Treatment Episodes

The Department of Health Service and Monitoring Guidance 2010/11advises that when a client has not managed to stop smoking there is no definite period of time required between the end of a treatment episode and the start of another.

The stop smoking adviser should use professional judgement when considering whether a client should break for a period or even receive support to stop again immediately.

In all such cases, the unsuccessful attempt should be reported as ‘No Quit’ and the form returned to HSSS.

The client must start a new Treatment Episode, setting a new quit date and renew or change pharmacological intervention as required by the client.

This then becomes a new Treatment Episode on the quarterly return to the Department of Health.

The following flowchart should assist all providers – See over page.

April 2010

APPENDIX 1 continued

Smoking Cessation Treatment Episode

April2010

APPENDIX 2

Payment for Smoking Cessation LES and Return of DH Monitoring Forms

BLANK PAGE

(Appendix 3 separate attachment)

April 2010

Appendix 4

INSTRUCTIONS FOR THE INVOICE TEMPLATE

APRIL 2010

Enclosed is an invoice template which should now replace all previous claim forms. We recommend you download it from the PCT Medicines Management webpage:

and use it either to calculate the totals to be used on your invoice or as the actual invoice. Please ensure that you include the following when completing the template:

Tick the former Primary Care Trust for your area in the space provided.
Please enter the Pharmacy name, address, phone and fax number in the fields provided. The invoice date and invoice number (which must be a unique number generated by your internal business systems) must be included in the appropriate fields. The invoice must include your VAT registration number. Alldata entry fields

are highlighted in red.

VAT is calculated at 5% on the net cost of NRT (BNF Price).
The supply fee is chargeable per transaction; for example 2 weeks supply of patches =1 item. The total charge on the invoice is equal to the sum of the cost of NRT plus VAT at 5% and supply fees less the total prescription charges.
NRT claim forms should be returned quarterly, (if expenditure exceeds £1,000 then an interim invoice can be submitted).
The completed invoice must be sent to: Financial Services, Charter House, Parkway, Welwyn Garden City, Herts. AL8 6JL or via Email to:

Sending the invoice anywhere else will delay payment.

In accordance with Caldicott guidelines Patient Identifiable Information must not be included with the invoice.
Our preferred method of payment is by BACS with the remittance advice sent either by fax or email; the BACS payment method will provide you with quicker access to cleared funds. If there are any changes to your payment details or you are currently paid by cheque please complete the section below and return with your invoice.

Name of PCT
Name of Payee
Bank Account no.
Sort Code
Bank Name
Fax Number
Email Address

9. Please return NRT Summary sheet to Hertfordshire Stop Smoking Service

April 2010

Appendix 5

NRT Summary Sheet

Pharmacy Name ______

F Code: _ _ _ _ _

Date of Supply / Patient Name
(Confidential information) / Own LES Patient
(Tick) / Letter of Recommendation
Patient (Tick) / NRT Product Supplied / Amount / Prescription Charge Collected?

I have supplied NRT as part of the LES for smoking cessation, or on receipt of an original NRT Letter of Recommendation generated by a Hertfordshire Stop Smoking Service specialist/advisor.

Signed: ______Date: ______

NRT Summary Sheet: Please either post or email to Hertfordshire Stop Smoking Service -

NRT Invoice Only: Please submit your NRT invoice to Financial Services, Charter House –