SOUTH WILTS STOP SMOKING SERVICE
Pharmacy Quit Smoking Scheme
Service Level Agreement (until APRIL 2007)
This Service Level Agreement represents a contract between SOUTH WILTS Stop Smoking Service and the Pharmacy named below.
1 Background
The Pharmacy Smoking Cessation Service is being launched on XXX 2006. Its aim is to provide easily accessible one-to-one smoking cessation support from accredited facilitators across a network of community pharmacies. When commissioned, the service will help to increase choice and improve access for hard to reach groups such as pregnant mothers and young people to NHS stop smoking services. This enhanced service reflects the one-to-one NHS stop smoking service and is to be provided in addition to the essential service “promotion of healthy lifestyles” (Public Health ES4). Clients can register with the service (by a referral from a health professional or by self referral) if satisfying the following criteria:
They are registered with a South Wiltshire PCT GP practice They are motivated to quit They express a desire for support with quitting They are not currently registered with any other Stop Smoking Cessation advisor or Smoking Cessation Service (i.e. group support) They have not registered with the Stop Smoking Service or had any NRT funded by the NHS during the last six months
2 Accredited Advisors
Training in smoking cessation skills and techniques is provided by South Wilts Primary Care Trust for pharmacists and their counter staff. Accreditation is awarded and certificates issued following the completion of a 1½-day training course.
Either the pharmacist or a trained counter assistant or pharmacy technician can provide support as a Stop Smoking Advisor, however an accredited pharmacist must supervise the client at first supply of NRT, whenever the product strength/formulation changes and if the patient experiences any side effects.
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The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service are aware of and act in accordance with local protocols and NICE guidance.
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.
3 Support Programme
The following is the series of interventions to be undertaken by the stop smoking advisor with each client on a one-to-one basis:
Initial Assessment – quit advice should be given and appropriate leaflets. If motivation is established then a mutually convenient first support session should be arranged. Motivation will be confirmed by patient returning for their first support session. No treatment is normally given at this stage, although the first NRT supply of 7 days maybe made and full support given where the patient is suitably motivated and immediate NRT supply is considered appropriate. Referral to specialist services if necessary.
First Support Session: in this session (in an area offering seating and privacy) lasting approximately 20 mins duration, the quit date should be set by the patient (if not already set at the initial assessment). This consultation should include (information provided in Smoking Interventions manual)
A description of the effects of passive smoking on children and adults.
Include an explanation of the benefits of quitting smoking;
Include a description of the main features of tobacco withdrawal syndrome and the common barriers to quitting;
Identify treatment options that have proven effectiveness
Describe what a typical treatment programme might look like, its aims, length, how it works and its benefits;
Maximise commitment to the target quit date; apply appropriate behavioural support strategies to help the person quit;
Conclude with an agreement on the chosen treatment pathway, ensuring the person understands the ongoing support and monitoring arrangements.
The monitoring form should now be filled out and where possible a baseline measure of CO should be taken and recorded. NRT should not be administered until a quit date has been set and may be supplied for one week in advance of the quit date where applicable.
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Supply of treatment must be recorded on the pharmacy medication record.
One-to-one advice and support should then be continued at regular intervals (at least four appointments), over a minimum of four weeks and approx 10- minute duration – this should preferably be face-to-face but could be given over the telephone where necessary. A suitable time would be the supply of NRT.
Four weeks from setting the quit date, smoking status should be determined by self-reporting followed by a CO test for validation in line with NICE guidelines. This is then recorded on the monitoring form. Two attempts should be made to contact each patient for follow-up (in person, by letter or telephone). The dates of both attempts should be recorded on the monitoring form. The follow-up should be completed promptly 4 weeks after the quit date. A CO validation should be carried out to confirm non-smoking status at the four-week follow-up and the results monitored on the client monitoring form.
NRT PRESCRIBING CHART
DAYS WEEKS WEEK SUPPLY FIRST INITIAL CONTACT 0 0-7 Day Supply Issued CONTACT 7 1ST WEEK FOLLOW UP 1 7.21
14 2ND WEEK 2 7-14 21 3RD WEEK 3 7 28 4TH WEEK 4 0-14 or according to prescribed product recommended step down 42 6TH WEEK 6 0-14 or according to prescribed product recommended step down 56 8TH WEEK 8 0-14 or according to prescribed product recommended step down 70 10TH WEEK 10 0-14 or according to prescribed product recommended step down
For those who can provide evidence that they do not pay for prescriptions, NRT will be supplied free of charge for the recommended course of up to 12 weeks.
For those patients who pay for prescriptions, NRT supply will be at a discounted rate equivalent to the current NHS charge. This will be charged as follows:
A charge will be made at the initial 7-day supply. No more than 7 days supply will be made at this point to ensure the recommended product is suitable and tolerated by the patient, and that the patient is committed to the programme.
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A further charge should be taken at 7 days. NRT may be prescribed for up to 21 days to take the patient up to the 4-week follow up point, although contact will continue with the patient as previously described. After 28 days prescription charges should be taken at each step down. Encouragement should be given to follow the regime of the NRT supplied.
After the initial one-week supply of NRT, the course maybe continued for up to 12 weeks, stepping down the dose in accordance with the recommendations of the chosen NRT product.
Clients who did not become quitters can only re-enter the scheme after 6 months.
The Stop Smoking Service will provide CO monitors together with disposable mouthpieces (up to a maximum of 2 boxes of 200 pieces per year) free of charge.
4 Nicotine Replacement Therapy
Nicotine Replacement Therapy (NRT) can be provided within the product license to patients who the pharmacist assesses as being suitable for it.
The cost price of NRT (plus VAT) will be reimbursed against completed claim forms. For those patients who normally pay for their prescriptions, pharmacies will be reimbursed NRT cost price (plus VAT) minus the patient contribution. These should be submitted for each patient at the end of his or her treatment programme. Each patient contribution will be recorded and signed as paid by the client.
The types of NRT dispensed will be at the discretion of the pharmacy and based on patient need. Patients should only continue to receive NRT if they remain completely abstinent.
Generally patients requiring extended support (beyond 8 weeks) should be advised to contact the Freedom From Smoking NHS Stop Smoking Service quit line on 01980 626159 to discuss their continuing needs. Advisors can also telephone for advice.
For a small number of patients NRT may be required for up to 10 – 12 weeks depending on the treatment course prescribed. This may continue to be supplied according to the table and the stepping down process of the product.
5 Bupropion (Zyban)
If this is decided to be the most appropriate quitting aid, a referral to the patient’s GP is necessary for the patient to obtain a prescription.
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6 Submission of forms (Monitoring Forms)
The monitoring forms should be completed accurately and sent to Smoking Cessation at the Primary Care Trust at the end of each quarter. NRT forms will be sent to the same address after the treatment programme has finished, normally 8 weeks. A reminder letter will be sent when data is required.
The following deadlines for submitting monitoring forms are:
Clients setting a quit date in: Form submission deadline Quarter 1 (1 April to 30 June) 27th July 2006 Quarter 2 (1 July to 30 Sept) 28th Oct 2006 Quarter 3 (1 Oct to 31 Dec) 30th January 2007 Quarter 4 (1 Jan to 31 Mar) 30th April 2007
No payment can be made for forms arriving after these dates as they cannot be included in the Service Monitoring data.
7 Fees and Payment
Monitoring forms must be fully completed and submitted before the deadlines above and the service protocol outlined in this document followed to receive payment.
Each quitter is potentially worth £30 if the criteria for payments A, and B are achieved.
The payment model is detailed below:
Payment A (£15) This is given for each correctly completed monitoring form returned. No payment can be given unless a quit date has been set and recorded on the form. Payment A will also be given for patients lost to the service providing two attempts have been made to contact them and are documented on the monitoring form Payment B (£15) This will be applied to documented quit attempts at the 4-week follow-up when returned within deadlines
Incomplete or incorrectly completed forms will be returned to the originating pharmacy for amendment and will not attract any payment until re-submitted and complete.
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8 Agreement to Participate in Pharmacy Quit Smoking Scheme
I have read and understood the agreement and agree to carry out the tasks therein.
Signed (Pharmacist):
Pharmacy Address:
Date:
Signed:
Position: Director of Public Health
Date:
Maggie Thornton October 2005