service specification for the provision of smoking...

Dorset County Council

Dorset Procurement, Level 3, North East Wing, County Hall, Colliton Park, Dorchester, Dorset, DT1 1XJ

Revised for: 1 April 2014

APPENDIX 2.5

SERVICE SPECIFICATION

FOR

THE PROVISION OF

SMOKING CESSATION

IN BOURNEMOUTH, DORSET & POOLE

DORSET COUNTY COUNCIL of 15 Public Health



1. INTRODUCTION

1.1. This service specification sets the requirements for the provision of a Public Health service

for Smoking Cessation within a Community Pharmacy. The focus of the Service is to offer

one to one support and advice to people who want to give up smoking.

1.2. The Service shall help to increase choice and improve access to Stop Smoking Services.

The Pharmacy shall help facilitate access to, and where appropriate supply, appropriate

pharmacological stop smoking aids.

1.3. The Pharmacy shall refer to specialist services if necessary. Participation by Community

Pharmacies in this service is voluntary and guided by localised need.

2. BACKGROUND

2.1. Smoking remains the leading cause of preventable death and disease in England and is

one of the most significant factors that affect health inequalities and ill health, particularly

cancer, coronary heart disease and respiratory disease. Reducing smoking prevalence

therefore remains a key public health priority and a national focus.

2.2. The support provided by local stop-smoking services continues to offer some of the best

opportunities to stop smoking, proving up to four times more effective than attempting to

stop unassisted and twice as effective as the provision of a stop-smoking medicine by a

healthcare professional. It is therefore important that evidence-based, high-quality stop-

smoking support, configured to meet the needs of the local population, and delivered by

qualified and well-trained service providers, is available to those who require it

2.3. Ambitions set by the Department of Health, in the tobacco control plan, Healthy Lives,

Healthy People have three specific smoking-related outcomes:

2.3.1 Prevalence of smoking among persons aged 18 years and over

2.3.2 Smoking status at time of delivery per 100 maternities

2.3.3 Prevalence of smoking among 15-year-old

2.4. Smoking prevalence is falling nationally in line with lifestyle changes and following

legislation banning smoking in public places. Overall, Bournemouth and Poole local

authorities have a relatively low prevalence of smoking according to estimates based on

Health Survey for England data (19% Bournemouth, 18.3% Poole) and Dorset County

has a prevalence figure of 17.1%. The national average for England is 20%. However,

smoking as a risk factor, is not evenly distributed within the population. The prevalence is

higher in deprived communities compared with other more affluent communities, and

prevalence changes with age.

2.5. Overall, though, these pockets can be masked as Bournemouth, Dorset and Poole have

a relatively low death rate attributable to smoking compared with many other areas of

England. However, smoking still leads to an estimated 511deaths in Bournemouth &

Poole and 725 deaths in Dorset, attributable to smoking related causes every year.

Because the prevalence of smoking is higher in deprived communities, smoking related

disease is unevenly distributed across Bournemouth, Dorset and Poole’s communities.

2.6. The Dorset SmokeStop Service and Bournemouth & Poole Stop Smoking Service are

community based services that operate according to NICE and the Department of Health

guidance. The services work closely with local GP practices and pharmacies to support




stop smoking interventions in primary care. Work has focussed on supporting people

from areas of high deprivation including routine and manual workers, pregnant women,

prisoners, people with mental health issues, young people and secondary care, to help

people plan for routine and emergency admissions.

2.7. The Services offer stop smoking support which includes behaviour change and provision

of pharmacotherapies as appropriate. Outcomes are measured at 4 weeks with

continued support and medication for a minimum of 12 weeks. Further emphasis will be

placed on prevalence figures as they become available.

3. AIMS AND OBJECTIVES OF THE SERVICE / SERVICE OUTCOMES

3.1. Improve access to and choice of stop smoking services, including access to

pharmacological stop smoking aids.

3.2. Reduce smoking related illnesses and deaths by helping people to give up smoking

3.3. Improve the health of the population by reducing exposure to passive smoke.

3.4. Support Service User’s access additional treatment by offering referral to specialist

services where appropriate.

3.5. Reduce health inequalities

4. DESCRIPTION OF SERVICE

The Provider shall:

4.1. Ensure that the Service is fully available to residents of the Bournemouth, Dorset and

Poole local authority areas aged 12 and over.

4.2. Ensure that the Service can be suitably provided to young people under the age of 16 by

ensuring that at least one advisor for the Service meets the requirements for providing

the Service to young people.

4.3. Provide the Service to Service Users who have followed one or more of the following

access routes:

4.3.1 Referral from the Dorset, Bournemouth or Poole SmokeStop central numbers. 4.3.2 Referral or Signposting via the Health Checks programme 4.3.3 Self referral by the Service User 4.3.4 Referral by another health or social care worker

4.4. Undertake a comprehensive initial assessment which every Service User that shall

include:

4.4.1 Assessment of the person’s readiness to make a quit attempt

4.4.2 Assessment of the person’s willingness to use appropriate treatments.

4.5. Undertake a comprehensive initial consultation which shall include:

4.5.1 a carbon monoxide (CO) test and an explanation of its use as a motivational aid 4.5.2 the identification of treatment options that have proven effectiveness 4.5.3 a description of what a typical treatment programme might look like, its aims,

length, how it works and its benefits 4.5.4 the application of appropriate behavioural support strategies to help the Service

User quit




4.5.5 reaching an agreement with the Service User on the chosen treatment pathway, ensuring that the Service User understands the ongoing support and monitoring arrangements.

4.5.6 describing the effects of passive smoking on children and adults 4.5.7 an explanation of the benefits of quitting smoking 4.5.8 a description of the main features of the tobacco withdrawal syndrome and the

common barriers to quitting.

4.6. Ensure that all information shall be given taking into account the Service User’s current

level of awareness of the issues.

4.7. A quit date shall be set as part of the initial consultation. Nicotine Replacement Therapy

(NRT) must not be supplied unless a quit date has been set. Service users using

varenicline shall set a quit date by the 14th day of treatment.

4.8. Where considered appropriate, the Pharmacist shall supply NRT or varenicline and shall

effectively advise on the use of these products. The Pharmacist shall enter the relevant

information on all supply of these products in PharmOutcomes to prompt payment. The

Pharmacist shall establish the patient medical history, previous use of pharmacotherapy,

and any other current medication to ensure the supply is safe and appropriate.

4.9. A list of products that are authorised for use within the provision of this Service is

included in Appendix A.

4.10. All pharmacotherapy shall be supplied strictly in accordance with the product license and

in the case of Varenicline in accordance with the requirements set out in the Patient

Group Direction (PGD). The varenicline PGD can be found on

www.publichealthdorset.org.uk

4.11. Pharmacists and advisors shall take into account cost effectiveness when assisting

clients with the most suitable therapy. Varenicline should only be supplied if the person

has previously tried NRT without success in giving up smoking and fits the criteria within

the PGD.

4.12. Supplies made by the Pharmacy must be in quantities to last 2 weeks. The bar code on

products supplied should be marked “NHS” with a black marker pen.

4.13. Ensure that where Service Users are required to pay for their prescriptions that they pay

a prescription levy for each supply of NRT or Varenicline.

4.14. Inform the service users’ GP that the Service User is participating in the Service along

with details about which products are being supplied to the person using the fax template

in Appendix B

4.15. If varenicline is the most appropriate option for the Service User, the Pharmacist shall

liaise with the Service User’s GP using the fax template in Appendix C

Follow up Consultations

Pharmacy staff shall:

4.16 Undertake all follow up consultations in line with NICE guidelines.

4.17 Agree timescales for each follow up consultation with the Service User while ensuring

that follow up consultations take place every 2 weeks.




4.18 Undertake an assessment of smoking status based upon the Service Users’ self report

followed by a CO test for validation at all 4-week and 12-week follow up consultations.

4.19 Inform the Service Users’ GP in regard to the quit status of the Service user at 12 weeks

after the quit date using the fax template in Appendix D.

4.20 Provide support to the Service User via the provision of the Service for up to 12 weeks.

Pharmacies must not make supplies of NRT after the 12 week period via funding from

Dorset County Council. If Service Users wish to continue to use NRT after the 12 week

period, the Pharmacist shall ensure that this is funded by the individual Service User.

4.21 Service Users not wishing to initially engage with the Service, or those who do not

complete the programme, shall be offered appropriate health promotion literature and

provided with the local SmokeStop Services telephone numbers. It shall be emphasised

that they can re-engage with the Service at any time. The Dorset SmokeStop Service can

be contacted by telephoning 0800 007 6653 and the Bournemouth & Poole Service by

telephoning 0300 303 8038.

4.22 If Service Users are not able to access the Service within the Pharmacy, (this may be

because another setting or geographical area would be preferred) they should be given

the local SmokeStop Services contact telephone numbers. The Dorset SmokeStop

Service can be contacted by telephoning 0800 007 6653 and the Bournemouth & Poole

Service by telephoning 0300 303 8038.

Training

4.23 All Pharmacy staff (including locums) delivering the Service shall successfully complete

the NHS Centre for Smoking Cessation and Training’s online training and assessment for

level 2 advisors (www.ncsct.co.uk/). Alternatively, level 2 training can be accessed

locally with forthcoming training opportunities advertised at

www.publichealthdorset.org.uk

4.24 Follow up training must be attended annually by at least one member of the pharmacy

team who will if necessary cascade the messages to other members of the team who are

involved in the Service. This will be held as appropriate to ensure that the Service is

continually improved and updated. See www.publichealthdorset.org.uk for follow up

training.

4.25 Pharmacists supplying varenicline via Patient Group Direction are required to complete

the training pack provided and make a declaration to confirm that this has been done.

4.26 Pharmacists shall be responsible for identifying their own learning needs and recording

their Continuing Professional Development (CPD).

Premises and Equipment

4.27 The area within the Pharmacy used for provision of the Service shall provide a sufficient

level of privacy and safety in line with the requirements for the Medicines Use Review

service.

4.28 Pharmacies shall be responsible for the ownership, calibration, maintenance and, where

necessary, replacement of all CO monitoring equipment. Where consumables are

required, e.g. disposable tubes and wipes, these are also the responsibility of the

pharmacy. Where CO monitoring machines were previously purchased by primary care

trusts on behalf of the Pharmacy under previous NHS contracting arrangements,

ownership of the machines shall transfer to the pharmacy under this Service Specification




as of 1st April 2014. Further information on where and how to Pharmacies can source

their own equipment can be found in Appendix E for further details.

4.29 If the Pharmacy is new to providing this SmokeStop Service in 2014/15 and does not

have access to an appropriate CO Monitoring machine in order to fulfil the requirements

set out in this Service Specification, they are able to apply for one off funding to cover the

cost of a single machine (see Appendix E for further details).

4.30 The Pharmacy shall have internet access and be able to use PharmOutcomes to record

consultations and make claims.

Responsibilities of the Pharmacy

The Pharmacy shall:

4.31 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.

4.32 Ensure that Pharmacists and all other staff involved in the provision of the Service are

aware of and act in accordance with the local protocols (as set out in this specification)

and relevant NICE guidance.

4.33 Be responsible for the ownership, calibration, maintenance and, where necessary,

replacement of CO monitoring equipment. Where consumables are required, e.g.

disposable tubes and wipes, these are also the responsibility of the pharmacy.

4.34 Undertake appropriate promotion of the Service locally.

4.35 Provide health promotion material relevant to Service Users.

4.36 Provide details of relevant referral points which pharmacy staff can use to signpost

Service Users who require further assistance.

4.37 Have internet access in place at all times and shall use PharmOutcomes to fully record

all consultations and activity and make claims for payment for provision of this Service.

Responsibilities of Dorset County Council

4.38 Dorset County Council shall monitor the service and ensure prompt payment of claims.

Records to be Kept

4.39 The Pharmacy shall maintain appropriate and accurate records to ensure effective

ongoing service delivery and audit.

4.40 Records of all consultations shall be entered in full on the PharmOutcomes platform. This

will be the means of record keeping and claiming for all service fees.

4.41 Records of patient participation in the Service, and supply of NRT or varenicline shall be

kept on the pharmacy patient medication record and PharmOutcomes.




4.42 The one-to-one session form via PharmOutcomes shall be completed during every initial

consultation and the record of follow up and supply of medication shall be updated on

PharmOutcomes after each session.

4.43 The Pharmacy shall seek verbal consent from the Service User to share their information

on the SmokeStop form (in PharmOutcomes) with their GP and the Public Health Team.

The Pharmacy shall verify the Service User’s consent to this by ticking the relevant box

on the form.

4.44 Where varenicline is supplied, the varenicline PGD consultation checklist shall be

completed by the Pharmacist in addition to the one-to-one session form on

PharmOutcomes (at the time of the first supply). The Pharmacist shall ensure that the

Service User signs the checklist to verify that they have been given the necessary

information

5. QUALITY STANDARDS

The Provider shall:

5.1 Stock and maintain appropriate health promotion material available for the client group

and promote its uptake and is able to discuss the contents of the material with the client,

where appropriate.

5.2 Have in place a standard operating procedure for the delivery of the Service and shall

review its standard operating procedures and the referral pathways for the Service on an

annual basis or sooner if there are changes to the service.

5.3 Participate in any Dorset County Council organised audit of service provision.

5.4 Co-operate with any national or Dorset County Council led assessment of Service User

experience.

5.5 Demonstrate that Pharmacists and staff involved in the provision of the Service have

undertaken CPD relevant to this Service.

5.6 Acknowledge that the Service is funded by Public Health Dorset, Dorset County Council.

5.7 Fully comply with the Pan-Dorset’s Multi agency Safeguarding Adults Policy and the Pan

Dorset LSCB Inter-Agency Procedures for Children and Young People.

5.8 Ensure that thorough recruitment and selection processes are in place which include full

tracking of previous employment history, checking of qualifications, two written references

and an enhanced level Disclosure and Barring Service (DBS) check.

5.9 The Pharmacy shall be able to demonstrate that clear and accurate records are kept at

all times.




6. CONTRACT MONITORING

Community Pharmacy Contractual Framework

6.1. The Provider must remain compliant with all the essential services under the Community

Pharmacy Contractual Framework as part of this Agreement.

6.2. No part of this Specification by commission, omission or implication defines or redefines

essential or advanced services.

Monitoring and Review

The Provider shall:

6.3 Ensure that the necessary documentation, as detailed in this Service Specification, is

maintained and made available to the Purchaser to enable the Service to be monitored

and for the purpose of post payment verification.

6.4 The Purchaser may undertake a visit to the Pharmacy to inspect the provision of the

Service and to ensure that the Provider is meeting the Service Specification.

Use of PharmOutcomes

6.6 The Provider shall ensure that all consultations are logged on PharmOutcomes to enable

the Purchaser to monitor activity and verify payments for services provided.

7. SERVICE SPECIFICATION REVIEW

7.1. It is recognised within this specification that the Service may be subject to change due to

a range of national and local policy initiatives. For example, government guidance and

legislation, industry professional standards, NICE Guidance, Public Health England or

Dorset County Council Policy.

7.2. This Service Specification shall be reviewed annually and updated to reflect the changes

in legislation. Adequate notice will be given to the Provider of any significant changes

which may impact on the service provided and will ensure sufficient transition

arrangements are secured to ensure service continuity.

8. FINANCIAL INFORMATION

Payment and reimbursement structure

8.1. A payment of £30.50 will be made for each new client accessing the Service who has their smoking status recorded 4 weeks after their quit date. .This is payable regardless of whether the person has quit smoking or not.

8.2. A bonus payment of £30.00 will be made for every person who has quit smoking at 4 weeks; this will need to be verified with a CO monitor.

8.3. An additional bonus payment of £50.00 will be made for every person who remains quit at 12 weeks. This will need to be verified with a CO monitor.

8.4. A payment of £2.00 will be made for each supply of NRT or Varenicline in addition to the

re-imbursement of the cost price including VAT.

8.5. An additional payment of £6.00 for each initial PGD consultation for Varenicline




Claims for Payment

8.6. Details of the consultation must shall be entered on to PharmOutcomes in a timely

manner to meet claims deadlines to generate claims for payment.

8.7. The information required on PharmOutcomes must be completed in full in order to trigger payment for the following:

8.7.1. Each new client accessing the service who has their smoking status recorded 4 weeks after their quit date shall trigger the payment of £30.50.

8.7.2. Confirmation of those individuals that have quit smoking at 4 weeks will trigger the bonus payment of £30.00.and those that remain quit at 12 weeks will trigger the additional bonus payment of £50.00. In order to claim the bonus payments, smoke-free status shall be verified with a CO monitor.

8.7.3. Supply of NRT or Varenicline will trigger a payment of £2.00 in addition to the reimbursement of the cost price including VAT.

8.7.4. Each initial PGD consultation for Varenicline will trigger a payment of £6.00

8.8. PharmOutcomes will not generate a claim for any information uploaded onto the system more than 4 months after the initial consultation has taken place and Dorset County Council shall not pay for any claims after this period.

8.9. Claims must be sent via the PharmOutcomes system.




Appendix A – List of Approved Products

DORSET COUNTY COUNCI of 15 Public Health



Appendix B – GP Fax Template for Notification of Supply

CONFIDENTIAL FAX

COMMUNITY PHARMACY SMOKESTOP SERVICE

FAO: GP Name:

GP practice name and address:

The following patient has been seen by me for smoking cessation treatment. They have expressed a wish to use NRT / varenicline (delete as appropriate) to aid their effort in stopping smoking. I have ascertained that your patient does not have any contraindications, or risk factors, for using NRT / varenicline (delete as appropriate) and meets the criteria for supplies to be made under the local pharmacy enhanced service specification:

Patient name:

Address:

DOB:

Patient telephone number:

A quit date has been set:

Product(s) to be supplied: (for up to 12 weeks treatment)

The patient will continue to receive supplies of NRT / varenicline (delete as appropriate) and

follow up support from the pharmacy for up to 12 weeks in total.

Pharmacy Name:

Pharmacy address:

Pharmacy telephone number:

Pharmacist name:

Pharmacist signature:

Date:

Data protection confidentiality note: This message is intended only for the use of the individual or entity to who it is addressed and may contain information that is privileged, confidential & exempt from disclosure under law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited




Appendix C – GP Fax Template for Request to Prescribe

CONFIDENTIAL FAX

COMMUNITY PHARMACY SMOKESTOP SERVICE REQUEST TO PRESCRIBE VARENICLINE OR BUPROPION

FAO: GP Name:


The following patient has been seen by me for smoking cessation treatment: Having discussed the possible options, the patient appears to be a suitable candidate for bupropion or varenicline. Please could you see the patient and consider prescribing varenicline or bupropion. The pharmacy will continue to offer one to one support to the patient for up to 12 weeks as appropriate.

Patient name:

Address:

DOB:


A quit date has been set:

Pharmacy Name:

Pharmacy address:


Pharmacist name:


Date:

Comments

Data protection confidentiality note: This message is intended only for the use of the individual or entity to who it is addressed and may contain information that is privileged, confidential & exempt from disclosure under law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited.




Appendix D – GP Fax Template for Notification of Quit Status

CONFIDENTIAL FAX

COMMUNITY PHARMACY SMOKESTOP SERVICE NOTIFICATION OF QUIT STATUS

FAO: GP Name:


The following patient has been seen by me for smoking cessation treatment:

Patient name:

Address:

DOB:


The patient quit smoking at 4 weeks Yes No

The patient quit smoking at a later date

Yes No

The patient will continue to receive supplies of NRT / varenicline (delete as appropriate) and

follow up support from the pharmacy for up to 12 weeks in total (as appropriate).

Pharmacy Name:

Pharmacy address:


Pharmacist name:


Date:

Any other notes:

Data protection confidentiality note: This message is intended only for the use of the individual or entity to who it is addressed and may contain information that is privileged, confidential & exempt from disclosure under law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited




Appendix E – CO Equipment

Carbon Monoxide testing equipment can be sourced from contacting the following companies:

• Bedfont / Intermedical: [email protected]

• MD Diagnostics Sales & enquiries: Martin Marsh [email protected]

• CareFusion (previously known as Micro Medical): http://www.carefusion.co.uk/medical-products/respiratory/cardio-pulmonary-diagnostics/smoking-cessation/

Appendix F - Sources of Guidance Information

NICE/RPSGB/Pharmacy Health Link: Helping smokers to stop: advice for pharmacists in England, August 2005, http://www.publichealth.nice.org.uk/page.aspx?o=517943

NHS smoking cessation services: service and monitoring guidance (www.dh.gov.uk/assetRoot/04/07/81/16/04078116.pdf)

NICE Smoking Cessation Guidance: http://guidance.nice.org.uk/PHI1

NICE Smoking Cessation – bupropion and nicotine replacement therapy: http://guidance.nice.org.uk/TA39

NICE Smoking cessation – varenicline: http://guidance.nice.org.uk/TA123

ASH (UK) website: http://www.newash.org.uk/ash_home.htm

NPA – Stop smoking – Implementing a community pharmacy scheme in England: http://www.npa.co.uk/news_uploads/575979_web_only.pdf

Towards a smoke free England: Brief interventions for stopping smoking by pharmacists and their staff: http://www.pharmacymeetspublichealth.org/pdf/SMOKING_report.pdf

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