Local Enhanced Service ForStop Smoking Service

Service Level Agreement (SLA) 2010-12

1.Introduction

2.Signatures

3.Aims and Objectives

4.Service Outline

5.Service Specification

6.Quality Indicators Pharmacy Contractors

7.Quality Indicators PTC

8.Financial Details

9.Monitoring Arrangements

10.Termination of Contract

Appendix A – Service Protocol

Appendix B –Smoking in Pregnancy NRT Assessment and Consent Forms

Appendix C – Sample Monitoring Form

Appendix D – Claim Form

  1. Introduction

This agreement set outs the framework for the Stop Smoking Serviceby community pharmacists,and has been agreed with the Wiltshire Local Pharmaceutical Committee. The implementation, administration, monitoring and review of this agreement is the responsibility of Swindon PCT, or any organisation that takes over the functions of this PCT.

  1. Signatures

This document constitutes the agreement between the pharmacy contractor and the PCT in regards to the above Service Level Agreement for the 24 months from 1st April 2010 to 31st March 2012. We agree to abide by the conditions laid out in the agreement:

Pharmacy Name:
Signature on behalf of the Pharmacy contractor / Name (please print) / Date
Signature on behalf of
Swindon PCT / Name (please print) / Date

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Local Enhanced SLA for Stop Smoking Service in Swindon PCT

  1. Aims and Objectives

3.1.To improve access to and choice of stop smoking services, includingaccess to pharmacological and non-pharmacological stop smoking aids.

3.2.To reduce smoking related illnesses and deaths by helping people to giveup smoking.

3.3.To improve the health of the population by reducing exposure to passivesmoke.

3.4.To help service users access additional treatment by offering referral tospecialist services where appropriate.

  1. Service Outline
  2. The Stop Smoking Service is one in which pharmacies will provide one toone support and advice to people who want to give up smoking, for a maximum of 8 weeks.
  3. Whencommissioned, the service will help to increase choice and improve accessto NHS Stop Smoking Services.
  4. The pharmacy will refer to specialist services if necessary.
  5. The pharmacy will help facilitate access to, and where appropriate supply,appropriate stop smoking drugs and aids.
  6. This enhanced service reflects the provision of one to one NHS stop smoking supportand is to be provided in addition to the Essential Service ‘Promotion ofhealthy lifestyles (Public Health)’ (ES4).
  7. The pharmacy contractor agrees to ensure that there is a trained stop smoking advisor engaged in the pharmacy for the majority of the time that the pharmacy is open.
  8. If the only trained stop smokingadvisor leaves the pharmacy, the pharmacy contractor will need to notify the PCT immediately. The pharmacy contractor will have three months to ensure that a trained advisor is available for the service
  1. Service Specification
  2. The part of the pharmacy used for provision of the service provides a sufficient level of privacy and safety: - the pharmacist and the service user must be able to sit comfortably together, and the conversations between the pharmacist and service user can not be over heard by members of the public or other pharmacy staff.

5.2.Access routes to this service will be determined locally, andcould include:

5.2.1.pharmacy referral as a result of the ‘NHS Health Checks, Promotion of Healthy Lifestyles(Public Health)’ or ‘Signposting’ Essential Services;

5.2.2.direct referral by the individual or NHS Swindon Stop Smoking Service helpline.

5.2.3.referral by another health or social care worker;

5.3.The pharmacy would have to confirm the eligibility of the person to accessthe service, based on local guidelines, and protocol as covered in the local training.

5.4.If considered appropriate, the pharmacist may supply Nicotine Replacement Therapy (NRT), at the cost of an NHS prescription charge for each item dispensed (or free of charge for service users that are exempt from charges) according to the protocol in Appendix A.The prescription charge(s) should be taken at the initial consultation and then every 2-4 weeks thereafter.

5.5.Service users who are exempt from prescription charges should sign the exemption certificate on a standard prescription. A copy of this signed exemption certificate must be included with the pharmacies payment claim form. (Appendix B)

5.6.Combination NRT has been shown to have an advantage over using just one product and is also considered to be cost effective. It can therefore be used when considered clinically appropriate. When using combination therapy please ensure that the quantity suppliedof the supplementary NRT product meets their clinical need. (The majority of patients will not require the full dose).

5.7.Support will be given at weekly visit to the pharmacy for the first 4 weeks and then fortnightly for a further 4 week period according to the protocol in Appendix A. Alternatively, clients can be referred to the NHS Swindon Stop Smoking Service for further support following the 4-week follow-up appointment.

5.8.It is expected that any stop smoking advisor dealing with clients under 18 years old will have a valid Clinical Records Bureau (CRB) certificate and will have undertaken foundation child protection training. The NHS Swindon Stop Smoking Service has a specialist stop smoking advisor for young people.

5.9.The NHS Swindon Stop Smoking Service has a specialist advisor for pregnant women who supports women in their own home. Pregnant women should be referred to the specialist advisor when appropriate. If supporting a pregnant woman, please use the NHS Swindon Stop Smoking Service “Assessment for supplying NRT in Pregnancy” and “Consent form for supplying NRT in pregnancy” forms. (Appendix C). Pregnant women should only receive a single form of NRT.

5.10.Pharmacists will need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements. At the first stage in their consultation all clients should be made aware that the details of their quit attempt will be passed in confidence to NHS Swindon for monitoring purposesonly.

5.11.The pharmacist will request consent to allow contact by the NHS Swindon Stop Smoking Service and obtain patients signed consent accordingly.

5.12.The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records and documentation will be confidential and should be stored securelywhilst at the pharmacy premises.

5.13.The pharmacist or pharmacy technician must ensure that a completed record consisting of the minimum data set as defined within the ´NHS smoking cessation services: service and monitoring guidance’and must be recorded on the NHS Swindon Stop Smoking Service Monitoring Form. (Appendix D)

5.14.All documentation (including claim form), with the exception of the summary sheet, is sent on, confidentially, to the NHS Swindon Stop Smoking Service at Swindon PCT.

5.15.Copies of the monitoring form may be taken by the pharmacy for their records.

5.16.All records and forms should be retained in line with national governance standards.

  1. Quality Indicators Pharmacy Contractors
  2. Participating pharmacist/pharmacy technician must have successfullycompleted the following training:-
  3. TheLevel 2 Stop Smoking Advisor training (Swindon).
  4. Participating stop smoking advisors must ensure that they maintain and update their stop smoking expertise through the various sources made available to them by the NHS Swindon Stop Smoking Service.
  5. The pharmacy contractor should provide evidence that the above training has been completed by all participating staff within three months of the start of participation in the service.
  6. A participating pharmacy contractor must have in place in their pharmacy suitable procedures and appropriately trained staff to ensure that the good practice detailed in this service specification operates in their absence.
  7. The pharmacy has appropriate PCT provided health promotional materials available for the service users and actively promotes its uptake and is able to discuss the contents of the material with the service user, where appropriate.

6.6.The pharmacy has details of relevant referral points which pharmacy staff can use to signpost/refer service users who require further assistance

6.7.The pharmacy contractor reviews its Standard Operating Procedures and the referral pathways for the service on an annual basis.

6.8.The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service.

6.9.The pharmacy contractor has a duty to ensure that pharmacists and staffinvolved in the provision of the service are aware of and act in accordancewith local protocols and NICE guidance[Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. National Institute for Health and Clinical Excellence, February 2008.]

6.10.The pharmacy contractor can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service and are aware of and operate within local protocols.

  1. Quality Indicators PTC
  2. The PCT will provide the following local training requirements.
  3. Level 2 Stop Smoking Advisor Training.
  4. The PCT will provide a framework for the recording of relevant service information for the purposes of audit and the claiming of payment. (Appendix E).
  5. The PCT will provide up to date details of other services which pharmacy staff can use to refer service users who require further assistance. The information should include the location, hours of opening and services provided by each service provider.
  6. The PCT will support the promotion of the service locally, including the provision of publicity materials, which pharmacies can use to promote the service to the public.
  7. The PCT will be responsible for the provision of health promotion material, relevant to the service users and make this available to the pharmacies.
  8. The PCT has quarterly network meetings topromote service development and participating pharmacists are welcome to attend this meeting.
  9. Financial Details
  10. The pharmacy contractor will received the following payments per service user:
  11. Initial Assessment £15
  12. Week 1-3 Follow-Up Assessments (maximum of 3) £5
  13. Week 4 Week“Quit” Assessment £5
  14. Week 5-8 Follow-Up Assessments (maximum of 2) £5
  15. Maximum for 8-weeks course £45
  16. The PCT will reimburse the pharmacy for the cost of NRT supplied including the VAT costs.
  17. The materials and equipment required, including CO monitors anddisposable mouthpieces, are supplied free of charge to the pharmacy by thePCT.
  1. Monitoring Arrangements
  2. The Stop Smoking Service at Swindon PCT will monitor the service and will feedback performance at quarterly network meetings. Any pharmacy whose results fall outside the standard range may be contacted to identify reasons.
  3. The pharmacy contractor may be requested to participate in an audit or service users’ survey of the by the NHS Swindon Stop Smoking Service.
  4. The pharmacy contractor may be requested to provide a copy of their patient medication records to assist in the monitoring arrangements.
  1. Termination of Contract
  2. This agreement will run for a period of 24 months, however during this period, it may be terminated by either party by giving three months written notice.

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Local Enhanced SLA for Stop Smoking Service in Swindon PCT

Appendix A – Service Protocol

Community Pharmacy Enhanced Service – Stop Smoking Service

The initial assessment

The initial consultation should include:-

  • An assessment of the person’s readiness to make a quit attempt.
  • An assessment of the person’s willingness to use appropriate treatments.
  • A carbon monoxide (CO) test and an explanation of its use as a motivational aid.
  • A description of the effects of passive smoking on childrenand adults;
  • An explanation of the benefits of quitting smoking.
  • A description of the main features of the tobacco withdrawalsyndrome and the common barriers to quitting.
  • Identify treatment options that have proven effectiveness.
  • A description of what a typical treatment programme might look like, itsaims, length, how it works and its benefits;maximise commitment to the target quit date.
  • Application of appropriate behavioural support strategies to help the personquit; andconclude with an agreement on the chosen treatment pathway.
  • Ensuring the person understands the ongoing support andmonitoring arrangements.
  • An explanation that the Nicotine Replacement Therapy (NRT) will be provided weekly for the first 4 weeks of treatment, and then fortnightly for a further 4 weeks if considered appropriate.
  • Obtaining consent for the weekly visits for 4 weeks and the 52 week follow-up by the NHS Swindon Stop Smoking Service.
  • If considered appropriate, the pharmacist may supply (or supervise the supply of) one week’s supply of an appropriate NRT.
  • Completion of a declaration of exemption from prescription charges or payment of prescription charges as appropriate. Each form of NRT will require a standard prescription charge.
  • Making an appointment for follow-up in one week’s time.
  • People not wishing to initially engagemay be offered appropriate health literature or referral toan alternative stop smoking service, and asked to return when they do wish to set a quit date.

Supply of treatment must be recorded on the person’s pharmacymedication record. Consideration should be given to communicating this information to the person’s GP where clinically appropriate.

Week 1-3 Follow-Up Assessments

Follow-upassessments, in line with NICE guidelines, should be agreed with the person.

The follow-up assessmentsshould include:-

  • Continued application of appropriate behavioural support strategies to help the personquit;
  • Ensuring the person understands the ongoing support andmonitoring arrangements.
  • A carbon monoxide (CO) test and an explanation of its use as a motivational aid, if wanted by the service user.
  • A further supply of one week of NRT treatment should be made at these consultations.
  • Service users who choose not to complete the programme should be offered appropriate health literature or referral toan alternative stop smoking service.
  • Making an appointment for follow-up in one week’s time.
  • Completion of the monitoring form.

The Week 4“Quit” Assessment

The Week 4 assessment consultation should include:-

  • Self-reported smoking status.
  • A CO test for validation.
  • A successful quitter is as defined by the DH stop smoking guidelines, as one who has not smoked at all in the 2 weeks prior to the 4 week follow up visit.
  • Continued application of appropriate behavioural support strategies to help the personquit;
  • Completion of the monitoring form.
  • Advise on the next steps:
  • Client continues to see the pharmacy stop smoking advisor for a further 4 weeks
  • Client referred to the NHS Swindon Stop Smoking Service
  • Client continues with a self maintenance programme.

The completed monitoring forms for all clients seen should be returned as soon as possible after 4 Week “Quit” Assessment has been completed and within a month of the last visit. Forms should still be returned for all clients assessed who do not take up the service.

Monitoring forms and claim forms should be sent to NHS Swindon Stop Smoking Service, NHS Swindon, North Swindon District Centre, Thamesdown Drive, Swindon, SN25 4AN, 01793708751. They can also be sent to the PCT Safe Haven fax on 01793 704583. The NHS Swindon Stop Smoking Service must be notified before they are sent.

The Week 5-8 Follow-Up Assessments

Where appropriate, the quitter can be seen fortnightly for two further visits (up to 8 weeks from initial quit date) if further support seems necessary. The format of the visits should be the same as the Week1-3 Follow-Up Assessments, and two weeks supply of NRT may be supplied at each visit.

If, at the final assessment, the client requires further stop smoking support, he/she should be referred to the NHS Swindon Stop Smoking Service.

Appendix B –Smoking in Pregnancy NRT Assessment and Consent Forms

Assessment for supplying NRT in Pregnancy

Patient Name______DOB ______

Patient Address______

______

Has the patient:

  1. Had a heart attack within the last 4 weeks?YES/NO
  2. Got heart failure?YES/NO
  3. Got unstable angina?YES/NO
  4. Got cardiac arrhythmia?YES/NO
  5. Had coronary artery bypass graft within last 4 weeks?YES/NO
  6. Had angioplasty within the last 4 weeks?YES/NO
  7. Had a stroke/TIA within the last 6 weeks?YES/NO
  8. Got serious liver or kidney disease?YES/NO
  9. Got a stomach ulcer?YES/NO
  10. Got an overactive thyroid?YES/NO
  11. Got high blood pressure?YES/NO
  12. Got any sensitivity to nicotine replacement therapy?YES/NO
  13. Got diabetes?YES/NO
  14. Got any generalized skin conditions?YES/NO

(only excludes nicotine patches)

If the answer is YES to any of the above , refer to the GP or consultant.

Have you discussed all the NRT options?YES/NO

Client’s NRT treatment choice______

Carbon monoxide reading______ppm

Number of cigarettes smoked per day______

Time of first cigarette on waking______

Is the client sufficiently motivated to stop smoking?YES/NO

Is the use of NRT appropriate in this instance?YES/NO

If NO, please state why______

Type of NRT prescribed______

Name of NHS Swindon Stop Smoking Advisor: ______

Signature: ______Date: ______

NHS SWINDON STOP SMOKING SERVICE

Consent form for supplying NRT in pregnancy

This must be completed before NRT can be supplied.

Name______

Address______

______

DOB______

Please sign below to say that you understand the information that has been given to you.

  1. The Advisor has completed an assessment form
  1. I have been advised not to exceed the recommended dose of NRT
  1. I understand that I should not smoke whilst taking NRT
  1. I have been given the opportunity to ask questions
  1. I have received clear instructions about the correct use of NRT
  1. I agree to the Advisor passing information to my consultant/GP/Midwife and the NHS Stop Smoking Service if necessary
  1. I agree to be supported by the Advisor throughout the course of treatment

Client Signature______Date ______