Local Enhanced Service For

Stop Smoking Service Local Enhanced Service Specification

LOCAL ENHANCED SERVICE FOR STOP SMOKING SERVICE PROVISION Level 2 Stop Smoking Service Provision

1ST NOVEMBER 2010

Blackburn with Darwen PCT

Janet Hargreaves Version 5 Page 1 Stop Smoking Service Local Enhanced Service Specification

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Stop Smoking Service – Local Enhanced Service Level Title of Document 2 Stop Smoking Service Provision

Author’s Name Janet Hargreaves

Author’s Job Title Commissioning Manager, Cancer, Smoking and Palliative Care

Dept/ Service Commissioning

Doc. Status Final Version

Based on

Signed Off By Commissioning Committee

Original Publication Date September 2010

Next Review Date N/A

Expiry Date 31 March 2012

Distribution All GP Practices and Community Pharmacists

1.0 Background

NHS Blackburn with Darwen Teaching Care Trust Plus (NHS BwD) has decided to change the way stop smoking service provision is delivered in order to offer a more accessible and cost effective service with improved outcomes. Future provision will be delivered by introducing an innovative whole systems community approach model. The initial phase of this will be via the Community Pharmacies and GPs surgeries. Additional phases, throughout 2011/12 will be to employ alternative services such as Borough Council, Children’s Centres and Leisure Centres etc.

2.0 Service Objectives

The service providers will be responsible for delivering support and treatment services stipulated by this Local Enhanced Service (LES) agreement. The service will be responsible for maintaining the quality of treatment delivered (in line with the quality principles set out in this LES) and for ensuring that client data confidentiality is protected in line with agreed protocols.

The service provider objectives are:

 Contribute to the 4 week quit target of NHS BwD  Reduce the prevalence of smoking by provision of evidence based cessation, advice and support  Provide targeted interventions in areas or groups with high prevalence, as a continuation to reducing inequalities in health related to smoking  Assist in reducing health inequalities as measured by mortality targets  Provide targeted interventions in areas or groups with high prevalence or high risk of smoking related harm including people in routine and manual social groups, BME groups and people with co-morbidities  Work with NHS BwD to achieve an integrated support service  Engage with smokers to provide services that are responsive and needs led  Achieve optimal success rates for interventions provided  Enable smokers effective, flexible and quick access to stop smoking services  Work in partnership with other healthy lifestyle programmes  Provide accurate data and activity monitoring information as required by DH and locally

2.1 Principles for quality stop smoking interventions

NHS BwD advocates the NICE programme guidance on smoking cessation and recommends the following interventions to be used:

 Brief intervention  Individual behavioural counselling  Group behaviour therapy  Pharmacotherapies – NRT, Zyban (buropion) and Champix (varenicline)  Self help materials  Telephone counselling and helplines

3.0 Service Description & Outline

The Stop Smoking Service will provide quality, evidence based smoking cessation treatment for smokers in Blackburn and Darwen. The service will increase patient choice and improve access to smoking cessation and pharmacological treatment, particularly in geographical areas of high deprivation and to priority groups such as BME communities, manual workers and people with relevant co-morbidities, as a contribution towards reducing inequalities in health.

The service will support communications strategies on smoking cessation and tobacco control in partnership with NHS BwD. The DoH Smokefree campaign brand should be used on all client information and promotional materials.

The service will work and have links with other lifestyle health improvement services as part of the wider programme of work to improve the health of residents within Blackburn and Darwen.

Effectiveness will be determined from national guidance and local equity audits. Indications of poor performance and/or effectiveness should be acted upon to improve the service. Client satisfaction with the intervention provided shall be assessed using a methodology agreed with the Commissioner.

The service providers will be responsible for delivering treatment services stipulated by this Local Enhanced Service agreement. The service will be responsible for maintaining the quality of treatment delivered (in line with the quality principles set out in this specification) and for ensuring that client data confidentiality is protected in line with agreed protocols.

3.1 Stop Smoking Service pathways

Stop Smoking Service provision is delivered by three tier approach. This LES is for Level 2 only. The following tables briefly describe all three stages and pathways.

Stop Smoking Service pathways

Level 3 Contact details Appendix 1 Clientele All smokers including: √ Pregnant women √ Complex cases √ Repeat relapser’s (after 2 attempts at Level 2) √ Children under 16 years Services √ Individual behavioural counselling √ Group behaviour therapy √ Assessment & referrals for NRT, Zyban (buropion) and Champix (varenicline) √ Referrals to other Healthy Lifestyle services √ Issuing of NRT Vouchers (NHS Voucher Scheme) Referral Pathways Self referral Other healthcare professionals and community workers Secondary Care Maternity services

Level 2 Community Pharmacies and GP surgeries signed up to this LES Contact details will be distributed Clientele All smokers with the exception of: X Pregnant women X Complex cases To be referred to Level 3 X Relapser’s, up to & including 2 attempts at Level 2. Contact details X Children Smokers under 16 yrs Appendix 1 Services √ Individual behavioural counselling √ Referrals to Level 3 √ Referrals to GP for drug therapy √ Referrals to other Healthy Lifestyle services √ Behavioural change support and advice √ Issuing of NRT Vouchers (NHS Voucher Scheme) Referral Pathways Self referral Other healthcare professionals and community workers

Level 1 It is also recommended that all other staff within your work area adopt the Very Brief Advice – 30 seconds to save a life model within day to day practice. There will be no additional payments attached to this as it is regarded as basic day to day health promotion.

VERY BRIEF ADVICE (AAA) - 30 seconds to save a life 1. ASK and record smoking status Smoker- ex - smoker – non smoker 2. ADVISE patient on health benefits Stopping smoking is the best thing you can do for your health 3. ACT on patients response Build confidence, give information, refer, prescribe

3.2 Secondary Care and Maternity Stop Smoking Services

Secondary Care and Maternity Stop Smoking Services have separate agreements and will treat, support and refer into the appropriate Levels when necessary. Contact details can be found in the Master Copy File.

Services will vary in the types of intervention they choose to provide or are trained to provide. The quality of these services will remain consistent;

 All behavioural support should be guided by the treatment manual developed by National Centre for Smoking Cessation Treatment (NCST). The manual can be found in the Master Copy File or on the NCST website; www.ncst.co.uk

 Details of the behavioural support programme should be communicated to clients and clients must commit to them

 All interventions should be multi-sessional with a total potential client contact time of at least 1.5 hours (from pre-quit preparation to four weeks after quitting). This will ensure effective monitoring, client compliance and ongoing access to medication

 There should be a strong emphasis on verifying CO levels four weeks from the quit date. This should be carried out in at least 85% of cases

 Interventions should offer weekly support for at least the first four weeks following the quit date. Appointments should be scheduled when clients are booked into treatment

 All staff involved should have been trained to Health Development Agency (HAD) standards. Health Development Agency (2003) Standard for training in smoking cessation treatment. www.nice.orguk/aboutnice/whoweare/aboutthehda/hdapublications/standard_ for training in smoking_cessation_treatments.jsp

 Prior to treatment all clients should be informed of all available (evidence based) treatment options both locally and nationally

 Only methods recommended by NICE should be adopted

 Stop Smoking advisors should show empathy for their clients and adopt a motivational approach

Expected outcomes

The service will improve patient health and wellbeing and reduce premature mortality by supporting cessation of tobacco use. This will lead to improved health outcomes including: prevention of smoking related disease, preventing the deterioration of existing conditions and reducing health care costs from smoking related diseases.

The following outcomes will be monitored. Success should be validated by a CO monitor reading.  4 week quit rate (Vital Sign VSB05)

 The proportion of people successfully quitting by each of the target groups; BME groups, routine and manual workers, people with a diagnosis of COPD/CVD

 Client satisfaction with the service shall be assessed using a methodology agreed with the Commissioner. At least 50% of people setting a quit date should complete a satisfaction survey

All providers should aim for a success rate of at least 40% at 4weeks, validated by CO monitoring. Service providers will initially receive a target plan to work towards and individual monthly reports will be issued showing performance against the plan.

Dependent on the level of successfulness, NHS BwD reserves the right to ‘cap’ individuals target plan so as to ensure the service is delivered within the financial envelope.

3.4 Facilities

Service providers are required to provide effective and efficient facilities and equipment in order to deliver stop smoking support. Service providers must have a suitable private room for client appointments and other relevant resources and equipment such as patient information and visual aids. CO monitors will be provided by and will remain the property of NHS BwD. In the event of the service no longer being delivered all equipment will be returned. NHS BwD will provide calibration of monitors on a 6 monthly basis, in line with manufacturers recommendations. In the event of the CO monitor being lost or damaged through improper use, it will be the responsibility of the service provider to purchase a replacement.

3.5 Future arrangements

This LES is time limited until 31st March 2012. Future arrangements include becoming part of the Pan Lancashire Stop Smoking Service (due autumn 2011) and also being incorporated into the NHS BwD Health Outcomes LES in 2011.

4.0 Accreditation

Health professionals must ensure that staff delivering the service are appropriately trained in line with the national standard on training in smoking cessation treatments1, receive the support they need to carry out their roles and remain up to date with national guidance and research developments. In addition, the service must ensure that all staff are trained in behavioural/change management techniques and basic healthy lifestyle advice.

Initially NHS BwD will organise training events for those health professionals signing up to this LES. Dates will be provided for group training sessions in Level 2 smoking cessation. It is essential that staff are made available to attend the training on the specific dates offered. As NHS BwD are funding the training and essential equipment, there will be no additional monies available for ‘back fill’ of roles.

For control purpose, identified advisors will provide support and treatment for the more complex cases, such as repeat relapser’s and pregnant women. All complex cases must referred to the identified Level 3 trained advisors for support and treatment.

Likewise, identified staff will provide home visit support when necessary. Non identified staff will not receive payments for home visit support.

The contact details and referral pathways will be available in a master file handed to staff on completion of training.

5.0 Service Monitoring and accountability

Stop smoking performance is measured on the Vital Sign VSB05, 4 week quitters target.

The DoH minimum data set will be the mechanism used for recording all clients setting a quit date within the service and the 4 week outcome, in accordance with Department of Health monitoring guidance. Data collection will be on the standardised template supplied by the Department of Health, Appendix 2.

CO verified four-week quitter definition

A treated smoker whose CO reading is assessed 28 days from their quit date (-3 or +14 days) and whose CO reading is less than 10ppm. The -3 or +14 day rule allows for cases where it is possible to carry out a face to face follow-up at the normal four week point (although in most cases it is expected that follow up will be carried out at four weeks from quit date).This means that follow-up must occur 25 to 42 days from the quit date (Russell standard).

1 Health Development Agency, (2003), Standard for training in smoking cessation treatments. HDA Janet Hargreaves Version 5 Page 8 Stop Smoking Service Local Enhanced Service Specification

Records should be faxed in a timely manner to the Stop Smoking Co-ordinator at NHS BwD as required and using the standard template. All fields should be fully completed and the form signed. Payment will only be verified once full details are faxed through. Details of fax number in Master Copy File.

Service providers will initially receive a target plan to work towards and individual regular reports will be issued showing performance against the plan.

The service must be prepared for possible audits of service provision at any time and should maintain detailed records of their activities for inspection. Relevant records should be kept for a minimum of 2 years, in a secure locked cabinet or similar.

Those clients who attend Level 2 service providers on two separate occasions subsequently fall into the ‘repeat relapser’ category and must then be referred into the identified Level 3 service.

Details of the monitoring systems can be found in the master file.

6.0 Payment Schedule

A fee of £20 will be paid for each client setting a quit date

A fee of £50 will be paid for each successful 4 week quit

An additional fee of £30 will be paid for each successful 4 week quit for those clients falling within the Key Performance Indicators (KPI). Those being:-  Routine/Manual workers  BME population  COPD/CVD diagnosis

If a person has successfully quit at 52 weeks a final payment of £50 will be paid

Only one KPI incentive payment will be paid per client irrespective of the numbers of categories they are eligible for.

Routine /Manual workers occupations include:

 Transport and Haulage (eg HGV drivers)  Construction (eg. Labourers)  Manufacturing  Sales and retail  Other blue-collar trades (eg. Van drivers)  Security (eg security guards)  Carers  Cleaners/domestic staff  Educational assistants  Kitchen/catering  Receptionists  Hairdressers

Source: NHS Stop Smoking Services, service monitoring and guidance 2010/11.page 64

6.1 Community Pharmacists payment pathway :

The claim for Community Pharmacists should be submitted when:

A client has set a 4 week quit date and completed the 4 week quit then the full £70 should be claimed

A client has set a 4 week quit date and completed the 4 week quit and is from a KPI group then the full £100 should be claimed.

A client has set a 4 week quit date and has not quit and is lost to follow up then £20 should be claimed

Claim forms, Appendix 3, are to be submitted to LaSCA only when the 4 week follow up is completed and the outcome recorded. Details of fax number in Master Copy File.

Claim forms at LaSCA will be cross referenced with the monitoring information faxed through to NHS BwD. Where discrepancies occur, discussions will take place between provider and commissioner and necessary action/adjustments will be undertaken

6.2 General Practitioners payment pathway :

The claim for General Practitioners should be submitted when:

A client has set a 4 week quit date and completed the 4 week quit then the full £70 should be claimed

A client has set a 4 week quit date and completed the 4 week quit and is from a KPI group then the full £100 should be claimed.

A client has set a 4 week quit date and has not quit and is lost to follow up then £20 should be claimed

Claim forms, Appendix 4, are to be faxed to NHS BwD only when the 4 week follow up is completed and the outcome recorded. Details of fax details in Master Copy File.

Claim forms at NHS BwD will be cross referenced with the monitoring information faxed through. Where discrepancies occur, discussions will take place between provider and commissioner and necessary action/adjustments will be undertaken

7.0 Duration of Contract

This service will be commissioned to this specification from 1st November 2010 to 31st March 2012

8.0 Variation Procedure

NHS BwD by giving notice to vary the contract will give the Provider not less than 3 months written notice or 6 months written notice where the Service Variation is likely to have a material adverse effect on Staff.

9.0 Provision for Disruption of Service

The provider will have plans and procedures in place to provide the service in the event of unforeseen circumstances, ie. Power cuts, floods etc. The practice must notify NHS BwD of any such incidents and if services are unable to take place.

10.0 Termination of Contract

Either party will be entitled to terminate this agreement by giving three months notice in writing (6months if staff are affected).

NHS BwD reserves the right to invoke a remedial notice in accordance with the procedures laid out in the GMS Contract and the National Pharmacy Contract, if it believes that a doctor/practice/Pharmacist/Pharmacy carrying out this service is not complying with the terms of the contract.

11.0 Dispute Resolution

Both parties agree to abide by the terms of this agreement except where in exceptional and unforeseen circumstances it is no longer practicable for one or other of the parties to comply. Under such circumstances, both parties shall meet to resolve the situation. Where agreement cannot be reached an external arbitrator shall be appointed. If both parties cannot agree following arbitration, the agreement will be mutually terminated.

12.0 Application Pack

13.1 PROPOSED PRACTICE MAIN PREMISES

Please give details of main practice premises that will be used by the practice

Main Surgery/Pharmacy:

Full Surgery/Pharmacy Address:

Tel Number:

Fax Number:

Branch Surgery (if applicable):

Full Branch Surgery Address:

Tel. Number:

Fax Number:

13.2 PERSONAL DETAILS OF THE DOCTOR(S)/PHARMACIST(S) WHO WILL PROVIDE THIS SERVICE

Surname(s)

…………………………………………………………………………………………

Forename(s)

………………………………………………………………………………………….

GMC Registration No(s):

………………………………………………………………………………………….

General Pharmaceutical Council (GPhC) Registration Number(s) (Formally Royal Pharmaceutical Society of Great Britain (RPSGB)

………………………………………………………………………………………….

THIS SECTION IS NOT APPROPRIATE FOR EVERY SERVICE – DELETE IF NOT RELEVANT

If any GP/Pharmacist ceases to provide this service the practice must notify NHS BwD

13.2 Practice/Pharmacist & PCT Signature of Service

SIGNATURES

We declare that:

 We are fully registered medical practitioners, included in the Medical Register /Pharmacy Register  The information provided in each section of this form and supplementary sheets, as applicable, is true and complete  The practice/Pharmacy is compliant with the terms this Enhanced Service for

If our application is approved, we agree:-

 To be bound by the Terms of Service/new GMS Contract/National Pharmacy Contract  To notify NHS BwD within 7 days of any material changes to the information which is provided in this application  To inform NHS BwD of any changes of permanent addresses

This document constitutes the agreement between the Provider and the PCT in regards to this Enhanced Service.

Signature

All personnel providing this service to sign one section below –

Provider Name

Signature

Provider Name

Signature

Provider Name

Signature

Practice/Pharmacy Stamp:

Signed on behalf of the PCT

Name and position

14 Appendices

Appendix 1 Stop Smoking Service Level 3 Contact details

Appendix 2 Data Monitoring Form

Appendix 3 Pharmacy Claim Form

Appendix 4 GP Practice Claim Form

Appendix 1 : Level 3 Stop Smoking Service Pharmacist Address Contact details Hours

Zafar Iqbal 95 Accrington Road 01254 680133 Monday - Friday 9am – 7.30pm Blackburn Lancashire Mobile 07870620002 Saturday 9am – 5pm The Pharmacy also provides an BB1 2AF NHS Health Checks service Sunday 10am – 1pm

Omran Majeed 63 Whalley Range 01254 665941 Monday – Friday 8.30am – 6pm Blackburn Lancashire BB1 6EA Tuesday 2pm – 10pm Iqbal Kazi 1 Whalley Range 01254 54988 Thursday 9am – 6pm Blackburn Lancashire The Pharmacy opening hours are BB1 6DX Monday – Saturday 7.30am – 10.30pm Sunday 11am – 10pm Monday & Tuesday , 7am – 7pm the service is available, Mohsin Patel 4 Court Pharmacy however clients can ring through or call in to book an Whalley Banks appointment Blackburn 01254 677447 BB2 1NT The Pharmacy opening hours are Monday – Friday 7am – 11pm Saturday 9am – 10pm Sunday 11am – 7pm Zafar Iqbal Mondays 2pm – 6pm Darwen Health Centre 01254 680133 Thursday 4pm – 7pm Room GF 42 Clients can ring to book an appointment or drop in to one Health Education Suite Mobile 07870620002 of the sessions

Appendix 2 : Monitoring Form (draft)

Appendix 3 – Community Pharmacy Claim Form

NHS BLACKBURN WITH DARWEN

CLAIM FOR PAYMENT – Stop Smoking Service Referring Pharmacy - …………………………………………………………….

Month ended …………………………….. PAGE 1 OF 2

Patient ID Agreed quit date 4 week follow Quit KPI group if 52 week quit Amount Claimed up date Y/N relevant Y/N £

Cont’d

CLAIM FOR PAYMENT –STOP SMOKING SERVICE LES PAGE 2 OF 2

Month ended ……………………………..

Please report below any significant events, complaints or adverse outcomes in respect of any aspect of the service relating to items included on page 1 of this claim or any previous claims.

The achievement of a four week quitter must be verified by the use of a CO monitor between four and six weeks of the individuals ‘quit date’. Failure to confirm the quit status may result in payment being withheld.

Failure of an individual to attend to validate their smoking status may result in the provider withholding further supplies of pharmacotherapies until the individual’s status has been verified.

Service providers must not subcontract service provision to other parties. Claims on this basis will not be paid. An arrangement between pharmacies to ‘host’ clinics is acceptable.

I claim payment for the stop smoking services that I have provided which are shown above. I confirm that the information given on this form is true and complete. I understand that if I provide false or misleading information I may be liable to prosecution or civil proceedings. I understand that the information on this form may be provided to the Counter Fraud and Security Management Service, a division of the NHS Business Services Authority for the purpose of verification of this claim and the preventing and detecting of fraud

Pharmacist Signature……………………………………………………… Date submitted……………………………….. Pharmacy stamp

Authorised for Payment (PCT)………………………………………. Date……………………………………………..

Please submit to: Stop Smoking, Commissioning Department, Guide Business Centre to arrive by 10th monthly Fax No 01254 263692

Appendix 4 : GP Practices Claim Form

CLAIM FOR PAYMENT – Stop Smoking Service Referring GP Practice- ………………………………………………………….

Month ended …………………………….. PAGE 1 OF 2

Patient ID Agreed quit date 4 week follow Quit KPI 52 week Read Code Amount Claimed up date Y/N group if quit £ relevant Y/N

Cont’d

CLAIM FOR PAYMENT –STOP SMOKING SERVICE LES PAGE 2 OF 2

Month ended ……………………………..

Please report below any significant events, complaints or adverse outcomes in respect of any aspect of the service relating to items included on page 1 of this claim or any previous claims.

The achievement of a four week quitter must be verified by the use of a CO monitor between four and six weeks of the individuals ‘quit date’. Failure to confirm the quit status may result in payment being withheld.

Failure of an individual to attend to validate their smoking status may result in the provider withholding further supplies of pharmacotherapies until the individual’s status has been verified.

Service providers must not subcontract service provision to other parties. Claims on this basis will not be paid. An arrangement between pharmacies to ‘host’ clinics is acceptable.

I claim payment for the stop smoking services that I have provided which are shown above. I confirm that the information given on this form is true and complete. I understand that if I provide false or misleading information I may be liable to prosecution or civil proceedings. I understand that the information on this form may be provided to the Counter Fraud and Security Management Service, a division of the NHS Business Services Authority for the purpose of verification of this claim and the preventing and detecting of fraud

GP Signature……………………………………………………… Date submitted……………………………….. Practice stamp

Authorised for Payment (PCT)………………………………………. Date……………………………………………..

Please submit to: Stop Smoking, Commissioning Department, Guide Business Centre to arrive by 10th monthly

READ CODES

Baseline All patients aged between 15 to 74 years LDPWALL_SMOK_COD - LDP Smoking Status Clinical Code Code Type Code Description 137 Read 2 Tobacco consumption 1371 Read 2 Never smoked tobacco 1372 Read 2 Trivial smoker - <1 cig/day 1373 Read 2 Light smoker - 1-9 cigs/day 1374 Read 2 Moderate smoker - 10-19 cigs/d 1375 Read 2 Heavy smoker - 20-39 cigs/day 1376 Read 2 Very heavy smoker - 40+cigs/d 1377 Read 2 Ex-trivial smoker (<1/day) 1378 Read 2 Ex-light smoker (1-9/day) 1379 Read 2 Ex-moderate smoker (10-19/day) 137A Read 2 Ex-heavy smoker (20-39/day) 137B Read 2 Ex-very heavy smoker (40+/day) 137C Read 2 Keeps trying to stop smoking 137D Read 2 Admitted tobacco cons untrue ? 137E Read 2 Tobacco consumption unknown 137F Read 2 Ex-smoker - amount unknown 137G Read 2 Trying to give up smoking 137H Read 2 Pipe smoker 137I Read 2 Passive smoker 137J Read 2 Cigar smoker 137K Read 2 Stopped smoking 137L Read 2 Current non-smoker 137M Read 2 Rolls own cigarettes 137N Read 2 Ex pipe smoker 137O Read 2 Ex cigar smoker

137P Read 2 Cigarette smoker 137Q Read 2 Smoking started 137R Read 2 Current smoker 137S Read 2 Ex smoker 137T Read 2 Date ceased smoking 137U Read 2 Not a passive smoker 137V Read 2 Smoking reduced 137W Read 2 Chews tobacco 137X Read 2 Cigarette consumption 137Y Read 2 Cigar consumption 137Z Read 2 Tobacco consumption NOS 137a Read 2 Pipe tobacco consumption 137b Read 2 Ready to stop smoking 137c Read 2 Thinking about stopping smoking 137d Read 2 Not interested in stopping smoking 137e Read 2 Smoking restarted 137f Read 2 Reason for restarting smoking 137g Read 2 Cigarette pack-years 137h Read 2 Minutes from waking to first tobacco consumption 137i Read 2 Ex-tobacco chewer 137j Read 2 Ex-cigarette smoker 137k Read 2 Refusal to give smoking status NSMKR Internal HI codesNon Smoker SMK Quit Smoking (> 5 years) SMK Quit Smoking (<5 years) SMKR Internal HI codesSmoker 137k. Read 2 137k.

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