Locally Enhanced Service for provision of a pilot Smoking Cessation Service at Boots Pharmacy, Mell Square, Solihull
To be used in conjunction with NRT protocol (See Appendix 1)
Background
Solihull Stop Smoking Service is funded by Solihull CT to develop, deliver, monitor and evaluate smoking cessation services across the borough. Currently the Service along with most GP surgeries in Solihull, provides intensive support to smokers who wish to quit. This has proved an effective way of helping smokers to quit.
This Service Level Agreement (SLA) outlines the responsibilities and actions required by the Pharmacy and Solihull Stop Smoking Service for this scheme.
Rationale:
There are good opportunities to reach smokers via pharmacies. Helping smokers quit is both clinically and cost-effective. Nicotine Replacement Therapy (NRT) can double the chances of somebody quitting smoking. When NRT is used correctly in conjunction with intensive behavioural support provided by a trained Advisor, it can quadruple their chances of quitting.
Aims
1. Support the development of stop smoking services in Solihull.
Use of a pharmacy based service will increase the accessibility and availability of stop smoking support that is provided throughout Solihull borough.
2. Enable supply of Nicotine Replacement Therapies (NRT) by appropriately trained non-physician health care professionals.
In most cases, where Pharmacy Staff (Pharmacists and Pharmacy Technicians) have been trained to level 2 in smoking cessation and are offering intensive stop smoking support, the LES will mean they can supply NRT direct (within the licence conditions), rather than rely on access to a medical practitioner. This will enable convenient and timely provision of NRT to clients.
Duration
Funding for this LES will be capped and the pilot run until the allocated funding has expired. At this point the service provision will be reviewed in light of effectiveness, further available funding, service objectives and the evidence-base at the time.
Guidance on Reimbursement & Monitoring
The proposal and payments
Pharmacies will be eligible to receive the following payments only on adequate completion and submission of Solihull Stop Smoking Service Monitoring Forms (See Appendix 2).
Payment A
£15 per client setting a quit date, with agreed date for follow-up.
Payment B
£15 extra per client for successfully quitting at 4-week follow-up. This should be validated with a Carbon Monoxide (CO) reading.
Payment C
The standard tariff charge for each NRT product given will be reimbursed to the pharmacy on a monthly basis. Up to a maximum of 8 weeks supply can be claimed per treated smoker. A prescription charge of £6.85 should be taken from the client every 2 weeks, (where this applies), and a signature obtained. Where prescription payment is made this will be deducted from the reimbursement of NRT . Two weeks supply of one product can be given at a time.
NB. If the client wishes to use combination therapy as an option, then the second NRT product must be purchased by the client.
Payment will be made at the end of the each month in arrears on prompt return of the monitoring forms to Solihull Stop Smoking Service.
N.B. Funding for prescriptions will be via the allocated prescribing budget held by the Stop Smoking Service.
The Monitoring Form, Claim Form (see Appendix 3) and NRT Claim Forms (See Appendix 4), should be submitted simultaneously to the Manager of the Stop Smoking Service to be verified by the dates outlined in the table 1.
A Monitoring Form must be completed for each client. Incomplete monitoring forms may be returned and payment cannot be made if the form is not adequately completed.
The number of monitoring forms received by the Stop Smoking Service will verify the claim for the number of clients seen.
Criteria for processing Claims:
Payment will be subject to the following criteria and regulations:
- Only named members of staff who have attended level 2 training delivered by Solihull CT Stop Smoking Service or equivalent and are therefore accredited service providers, will be eligible to participate in this LES. Only accredited advisors will receive monitoring forms to complete.
- People quitting as a result of interventions provided by Solihull Stop Smoking Service Specialist Advisors will not count towards the LES payments or number of quitters at that practice.
- One monitoring form is to be completed for each client supported through a quit attempt per quarter (April – June; July – September etc). A client can be claimed for only once per quarter.
- All sections of the monitoring forms must be completed.
- Payments will only be issued when correctly completed monitoring forms and claim forms have been returned and verified by the Stop Smoking Service Manager.
Monitoring forms, claim forms and information on those within a current quit attempt, need to be received by the monthly deadlines. See below:
Table 1
Clients setting a quit date in: / Monitoring Submission Deadline:Month 1 - April 2007 / 29 / 05 / 07
Month 2 - May 2007 / 27 / 06 / 07
Month 3 - June 2007 / 26 / 07 / 07
Month 4 - July 2007 / 28 / 08 / 07
Month 5 - August 2007 / 27 / 09 / 07
Month 6 - September 2007 / 25 / 10 / 07
Month 7 - October 2007 / 27 / 11 / 07
Month 8 - November 2007 / 27 / 12 / 07
Month 9 - December 2007 / 28 / 01 / 08
Month 10 - January 2008 / 27 /02 / 08
Month 11 - February 2008 / 31 / 03 / 08
Month 12 - March 2008 / 27 / 04 / 08
- The Pharmacy Advisor and Lead Pharmacist must sign the claim form.
Please note random checks may be made on the information supplied in the monitoring forms by the Care Trust.
CRITERIA FOR THE PROVISION OF SMOKING CESSATION SUPPORT
The following are the minimum standards of service provision by which service providers should adhere. For further clarification on the minimum standards for advisors please refer to The Russell Standard (see Appendix 5). The Pharmacy Advisor providing the support must have been trained for their role via Solihull Stop Smoking Service Level 2 Training.
- Clients who have expressed a desire to quit but who fall into the following categories should be referred to either the Stop Smoking Service Specialist Support and advice or their Practice based Stop Smoking Advisor as appropriate:
Specialist Service
Clients unable to attend the sessions provided;
Those who would prefer or would benefit (eg. very heavily dependent smokers) joining a group.
[1]Pregnant women.
Clients requiring home visits.
Clients with significant learning disabilities or mental health problems.
Clients who would have to wait more than 7 days for a first appointment to see their pharmacy based Level 2 Advisor.
Practice Based Advisor
Clients who wish to use Varenicline or Bupropion.
- Face to face support should be offered for at least the first four weeks of the quit attempt (5 weeks including assessment).
- The initial consultation should last between twenty and thirty minutes and involve assessment, using the Stop Smoking Service Assessment Form (See Appendix 6); partial completion of the Monitoring Form, including setting a quit date; advice on coping with withdrawal symptoms and advice on the provision and use of NRT. The Protocol in Appendix 7 should be used as the basis for all sessions.
Please note a one off five-minute chat with the Pharmacy Advisor falls into the same category as ‘brief advice’ and not ‘specialist treatment’.
- Only those who are motivated to stop and set a quit date should be considered for the 4-week treatment programme.
- Where NRT is to be used then the appropriate Protocol (Appendix 1) should be used. Treatment must be supplied in accordance with NICE guidance and must be recorded in the client’s notes.
- Up-to date pharmacy held records for each client starting a course of treatment must be kept. Spot checks may be made by the Specialist Stop Smoking Advisors to ensure this procedure is being adhered to.
- All clients must be followed up 4-weeks after their quit date to assess smoking status. The person who provided the initial intervention should, wherever possible, carry out the 4-week follow-up.
- Quit rate for treated smokers should not fall below 45%. (The national average around 50%).
Please note. Three attempts to contact the client for 4-week follow-up must be made if necessary, either by phone or in writing. If after these three attempts the client cannot be contacted, the client must be recorded as ‘Lost to follow-up’.
- It is the responsibility of the pharmacy to ensure they have a carbon monoxide monitor that is fully calibrated and in working order. The Stop Smoking Service will calibrate the monitor when required (usually 6 monthly).
- Service providers should attend smoking cessation update network meetings at least once a year and the half-day update training bi-annually.
- Service providers agree to be visited by a Specialist Advisor on a bi-annual basis. This is to ensure that pharmacy advisors are kept up to date and well supported.
- The Stop Smoking Service will provide the Pharmacy with appropriate resources when required. It is the responsibility of the pharmacy to ensure that they have adequate resources, including promotional and informational materials.
- Solihull Stop Smoking Service should be informed immediately about any changes to staff and or the provision of smoking cessation services within the pharmacy.
- The Stop Smoking Service will design the posters and leaflets required fro the service.
FEEDBACK:
The Pharmacy will receive a quarterly individual practice report on:
- The Number of clients supported through a quit attempt (setting a quit date).
- Number quit at 4 weeks.
- Number Lost to Follow-up (LTFU’s)
- 12 month follow-up
Alison Trout
Stop Smoking Service Manager - July 2007
Acceptance of SLA:
______(name of pharmacy) andSolihull Stop smoking Service agree to:a)Meet the above requirements
b)Review the SLA annually or at any other time if required
Signed on behalf of the Pharmacy Contractor:
Signature ______Date ______
Name (print) ______Position ______
Pharmacy DetailsTo be completed and returned with signed Service Level Agreement
Name of Pharmacy
Address of Pharmacy
Phone No.
Fax No.
Name of Trained Staff (1) & Job Title
Name of Trained Staff (2) & Job Title
Name of Trained Staff (3) & Job Title
Name of Trained Staff (4) & Job Title
Days/times when smoking cessation service available
Nature of service delivery
Drop-inY / N
AppointmentsY / N
Signed on behalf of Solihull Stop Smoking Service:
Signature ______Date ______
Name: Alison TroutPosition: Solihull Stop Smoking Manager
Signed on behalf of the CT:
Signature ______Date ______
Name (print) ______Position: ______
A signed copy of this agreement will be kept by the Pharmacy and Solihull Stop Smoking Service.
Summary NRT Claim Form
Pharmacist details (including telephone number)
Please use official stamp
Please return this form along with the client Proformas to: Alison Trout
Stop Smoking manager
Solihull Stop Smoking Service
2nd, Floor, Mell House,
46, Drury Lane,
Solihull,
West Midlands
B91 3BU
Reimbursement for Month Ending…………………………
For information: a. NRT is reimbursed at tariff price as per current “Chemist and Druggist”
No
/ Client initial & DOB / Date / NRT code / Script Charge Collected Y / N / Payment due1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Declaration
The supplies listed were undertaken as stated above by authorised pharmacists.
I hereby claim the stated monetary amounts as above for NRT.
I declare that information given on this form is true to the best of my knowledge
I understand that action may be taken against me if I make an incorrect claim.
I consent to the disclosure of relevant information on this form for the purposes of fraud prevention, detection and investigation.
Pharmacist Signature: ______
Pharmacist Name: ______
Date of Declaration: ______
Details supplies by Alison Trout, Stop Smoking Service, 2nd Floor, Mell House, Solihull, B91 3BU. Copies of all data relating to the Stop Smoking Pharmacy scheme are held by Alison Trout, if required.
Smoking Cessation ProformaClient ID no….
1. DOB. 2. Sex M / F 3. Date:4. Postcode:
NRT Supply:
NRT code: (see overleaf)Quantity: (1, 2, 4 weeks)
Batch No.Expiry Date:
If offering intensive support:
- Withdrawal symptoms explained? Y/N
- How to use NRT product explained? Y/N
- Client assessment and monitoring forms completed? Y /N
- Client Consent form and Risk assessment has been completed? Y /N
- Importance of weekly & 4 week follow up discussed? Y/N
Declaration by Pharmacist: I declare that I am a Pharmacist accredited or overseeing an accredited Stop Smoking Advisor by Solihull CT to issue Nicotine Replacement Therapy under the Locally Enhanced Service and within the current licensing conditions.
Signed: Date:
Name in Capitals:
NRT Code:
01-Microtab – 2mg10 – 24 hour patch 21mg02-Nasal spay11 – 24 hour patch 14mg
03-Inhalator – starter pack 12 - 24 hour patch 7mg
04-Inhalator - cartridges 13 – 16 hour patch 15mg
05-Lozenge – 4mg 14 – 16 hour patch 10mg
06-Lozenge – 2mg 15 – 16 hour patch 5mg
07-Lozenge 1mg
08-Gum – 4mg
09-Gum –2mg
Pease return this form along with your claim form to:
Alison Trout
Stop Smoking Manager
Solihull Stop Smoking Service
2nd, Floor, Mell House,
46, Drury Lane,
Solihull,
West Midlands B91 3BU
Where overseen by a Pharmacist
[1] Unless the pregnant woman insists that she would rather be supported at the pharmacy. In this case, the Pharmacy Advisor should consult the Pregnancy Advisor or the Service Manager for guidance.