North Lincolnshire Primary Care Trust NHS Stop Smoking Service

LOCAL ENHANCED SERVICE

INTERMEDIATE STOP SMOKING SERVICES

1st July 2010 –31st March 2011 Introduction

A primary care setting can provide an ideal opportunity to interact with smokers through brief intervention and subject to the smoker’s level of need provide intermediate stop smoking support within the practice setting or refer on to Specialist Stop Smoking Services.

This Locally Enhanced Service (LES) agreement is intended for use by accredited intermediate stop smoking services.

These protocols provide the foundations for offering intermediate stop smoking support through a locally enhanced service arrangement. This would complement the activities of the established North East and North Lincolnshire NHS Stop Smoking Service with the intention of increasing the number of smokers accessing stop smoking provision in North Lincolnshire.

Eligibility

Only staff trained by the Specialist Stop Smoking Service can provide the service. This LES is for operation at the following address only:-

Pharmacy name (Please insert Practice Stamp here)

If the trained member of staff moves branches, prior approval should be sought from NHS North Lincolnshire1 in order to start providing the service from the new premises.

This service is only available to clients aged 18 years and over. If a client aged 17 and under approaches the pharmacy for stop smoking support they should be directed to the local Choices service or they can be directed to the on-line support offered by Quit. on 0800 00 22 00

Definition of Brief Intervention, Intermediate North Lincolnshire NHS Stop Smoking Service

Brief Intervention All smokers engaging with health professionals should be advised on the benefits to be gained from stopping smoking and of the support that is available to them from the North East and North Lincolnshire NHS Stop Smoking Service to do so.

1 Brand name of North Lincolnshire Primary Care Trust. Providers should note that the contractual agreement is with North Lincolnshire Primary Care Trust. Brief intervention is opportunistic and is intended to identify smokers and assess their motivational status in regards to making a quit attempt. Where a smoker is assessed as motivated to quit and is willing to set a quit date they should be signposted/referred to intermediate services or in the case of the more heavily addicted smokers to the specialist stop smoking service support programmes.

Training in Brief Intervention is available from NEL & NL NHS Stop Smoking Service.

Intermediate North Lincolnshire NHS Stop Smoking Service

Stop smoking services provided in a primary care setting under local enhanced service (LES) arrangements will be known as Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care. These services are intended to complement the current North East and North Lincolnshire NHS Stop Smoking Service provision.

Support offered under this arrangement is to be directed at motivated to quit smokers through confidential one to one interventions conducted in accordance with: Department of Health NHS Smoking Cessation Services: Services and Monitoring Guidance 2009.

Minimum criteria to qualify and maintain Intermediate North Lincolnshire NHS Stop Smoking Service - Primary Care services are laid down in The Department of Health NHS Smoking Cessation Services: Service and Monitoring Guidance 2009. In summary they are as follows:

. All advisors should be trained to the standards laid down by the Health Development Agency and are to carry out their role, in accordance with Department of Health guidelines. . Advisors are to offer planned weekly support for at least the first four weeks of a quit attempt. . Advisors are required to carry out the 4 week follow-up promptly, in accordance with the guidance validating self reported quits by Carbon Monoxide monitoring. . Advisors are to complete a Gold Standard Monitoring Form (the individual client data monitoring forms) for each client, fully and accurately, and return the information required to the Contracting Department, NHS North Lincolnshire, Health Place, Wrawby Road, Brigg, DN20 8GS. . Advisors unwilling or unable to comply with the above within the timescale specified should NOT be considered as qualified to provide an NHS stop smoking service.

Additional good practice recommendations:

. Advisors should be allowed dedicated time to carry out planned stop smoking interventions beyond the initial contact rather than fitting it in within their general duties. . All intermediate interventions should be offered from a confidential setting. . Smokers accessing Intermediate Stop Smoking Services should be supported through multiple face to face advisor/smoker contacts on the following schedule 1 x 30 minutes induction week and 1 x 15 minutes sessions per week for a further five weeks. . Advisors will be required to advise on and supply NRT in accordance with NICE guidelines and locally agreed arrangements, Smokers who qualify for the use of other forms of pharmacotherapy (Varenacline - Champix or Bupropion – Zyban) should be referred onto the specialist stop smoking service.

The Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care services is intended to provide additional access and flexibility. However, success rates for effecting quits are commensurate to the level of input required to support the individual smoker. There is a need therefore to consider and balance the needs of smokers against the level of support that they require and make appropriate recommendations as to how their quit attempt would be best served i.e. via Intermediate (for the more lightly addicted smoker) or Specialist intervention (for the more heavily addicted smokers, those smokers who have had multiple quit attempts, pregnant smokers and those requiring Champix/Zyban)

Where a smoker is unable to be facilitated a quit within 3 weeks of indicating that they would like to quit, or where there is a build-up of clients, smokers should be referred on to the Specialist Stop Smoking Service..

Specialist North Lincolnshire NHS Stop Smoking Service

Specialist North Lincolnshire NHS Stop Smoking Service support programmes are provided by stop smoking advisors who are employed solely for the delivery of stop smoking support services. Whilst supporting all smokers who are motivated to quit they have a specific remit to work with the more heavily addicted smoker and those at greatest risk from smoking related ill health. This include smokers with a history of multiple quit attempts, smokers from disadvantaged communities, pregnant smokers, manual workers and those suffering from smoking related illnesses. To this end the service is geared to offering more intensive support through a variety of interventions which include: rolling support programmes, open access sessions, buddy schemes, 1-1 interventions, telephone and text services, linkage to out of hour’s services, micro group work for smokers with specialist needs and opt in relapse prevention.

Criteria for referral to the Specialist Stop Smoking Services

. The smoker falls into one of the specialist stop smoking service target groups – those with a history of multiple quit attempt smokers from disadvantaged communities, pregnant smokers, manual workers and those suffering from smoking related illnesses. . The smoker has tried to quit with the help of NRT and support in the past but has returned to smoking. . The smoker has an urgent medical need i.e pending hospital admission for surgery. . In all cases where a Pharmacy does not currently have a member of staff offering an intermediate stop smoking service. . In all cases where the Pharmacy based intermediate advisor is unable to service a quit within a three week time frame . The Intermediate advisor following assessment of the smokers feels they need more intensive support than they can offer. . Patient choice. . Advisors will be required to advise on and supply NRT in accordance with NICE guidelines and locally agreed arrangements, Smokers who qualify for the use of other forms of pharmacotherapy (Varenacline - Champix or Bupropion – Zyban) should be referred onto the specialist stop smoking service. . In the cases of smokers who fall into the treatment criteria for intermediate services where they would benefit from intervention from their local pharmacy intermediate advisor, they should be directed to access these services.

Targets

All outcomes reported by Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care carried out in accordance with these guidelines will count to NHS North Lincolnshire’s Public Service Agreement Target 08a. Quits reported to NHS North Lincolnshire will be identified through the North East and North Lincolnshire NHS Stop Smoking Service abridged summary of activity.

There is no specific target criterion for Primary Care based Intermediate advisors but a guideline figure is to provide 20 -25 successful 4 week quits per year per individual advisor.

A minimum target success rate for clients entering the programme has been set at 30% (e.g. for every 3 clients who enrol at least 1 should have successfully quit).

Training and Monitoring

All Primary Care providers wishing to provide an intermediate stop smoking services under the LES arrangement will be required to identify a named advisor/s who will be required to attend an intermediate training programme facilitated by North East and North Lincolnshire NHS Stop Smoking Service. Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care are to be run in accordance with the minimum standards as identified in Department of Health NHS Smoking Cessation Services: Service and Monitoring Guidance 2009 and the local North East and North Lincolnshire NHS Stop Smoking Service guidelines.

All Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care interventions must be notified to NHS North Lincolnshire in accordance with local schedules and agreed reporting pathway.

Where a named Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care advisor has not facilitated any stop smoking interventions for a year they will be deemed as being lapsed and must re-train if they wish to resume practice.

Trained advisors must attend at least one out of two 6 monthly update meetings to maintain current advisor status.

When an Intermediate North Lincolnshire NHS Stop Smoking Service – Primary Care advisor leaves a practice the North East and North Lincolnshire NHS Stop Smoking Service Manager should be informed. Should the provider not have a trained replacement advisor in post, a replacement advisor should be nominated and identified for training. In the interim where there is no other intermediate advisor available, smokers wishing to quit should be referred to the Specialist Stop Smoking Service or an alternative Primary Care provider.

All requests for a quit with intermediate stop smoking services should be commenced within 3 weeks of requests. In those cases where this requirement cannot be met, smokers should be referred into Specialist Stop Smoking Service programmes.

In order to meet Health Care Commission requirements all smokers accessing services should complete an evaluation form which should be returned along with the minimum data set to the Contracting Department, NHS North Lincolnshire, Health Place, Wrawby Road, Brigg, DN20 8GS.

Resources

NHS North Lincolnshire will provide the following resources at no cost to participating GP Practice:

Intermediate advisor training Training in the use of the Carbon monoxide monitors Carbon monoxide monitors (one per Pharmacy site) and associated consumables (mouth pieces, connectors and medical wipes) and arrangements for calibration of monitors Gold Standard Monitoring Forms Amended page 23.7.2010

Payments for weeks 1 - 4

Payments for stop smoking interventions will be subject to receipt of fully completed Gold Standard Monitoring Forms for individual clients and a completed consolidation form which is to be received by NHS North Lincolnshire in accordance with the following schedule:

Payment per attendance of £5.00 plus NRT at cost £10.50 per weeks supply (Drug Tariff plus VAT).

Bonus Payment

A bonus payment of £25 per quit will be made for every patient who quits at the end of 4 weeks confirmed by CO monitor and is resident in the North Lincolnshire area.

Payments for Weeks 5 – 12

If client is CO negative at Week 4(therefore, a 4 week quit) – supply 2 weeks NRT

If client is CO negative at Week 6 – supply 2 weeks NRT

If client is CO negative at Week 8 – supply 4 weeks NRT

At Week 12 – Check if client is CO negative

Payment per attendance of £5.00 plus NRT at cost £10.50 per weeks supply(Drug Tariff plus VAT_)

Submission of Invoice

Invoices should be received by the 8th of each month. Failure to submit invoices on time may result in a delay of payment.

Notice Period of LES

Either party may give notice of this LES by giving 3 months written notice.

NHS North Lincolnshire may terminate the LES if the minimum level of quits, 30% is not met and if the health professional providing the service do not attend at least 1 of 2 Continuing Professional Development courses arranged by NHS North Lincolnshire. Prior to termination, discussions will take place between NHS North Lincolnshire and the Contractor.

Notifications to GP Practices

The pharmacy should(with the client’s permission) inform the relevant GP Practice of the client’s involvement in the Intermediate Brief Intervention Programme, by completing the form(Appendix 1) attached to this specification. NHS North Lincolnshire NHS Stop Smoking Service

Protocol for operating Intermediate North Lincolnshire NHS Stop Smoking Service – Pharmacy Practice under Local Enhanced Service arrangements

These protocols should be read and applied in conjunction with: 1. Depart of Health NHS Smoking Cessation Services: Services and Monitoring Guidance 2009. 2. West R et al (2000) National smoking cessation guidelines for health professionals – an update Thorax 55: 987-999

Service details Pharmacy Practice

Name of trained Intermediate advisor/s

Date of initial training

Dates of training updates

Details of Carbon Model Serial No Monoxide Monitor issued by NHS North Lincolnshire

Carbon Monoxide Calibration date Next due calibration monitor calibration details (due 6 monthly)

Details of service provision – time, location, etc

Returns Individual Gold Standard Monitoring Forms along with consolidation sheet are to be completed and returned to: Contracting Department, NHS North Lincolnshire, Health Place, Wrawby Road Brigg, North Lincolnshire, DN20 8GS

SIGNATURE SHEET LOCALLY ENHANCED SERVICE SPECIFICATION for

For the Provision of NHS Stop Smoking Service

Pharmacy Name:

1st July 2010 – 31st March 2011

This document constitutes the agreement between the Pharmacy and NHS North Lincolnshire in regards to this local enhanced service with effect from 1st July 2010.

Signature on behalf of the Pharmacy:

Signature Name Date

Signature on behalf of NHS North Lincolnshire:

Signature Name Date

PAYMENT WILL ONLY BE MADE UPON RECEIPT OF PRACTICE SIGNATURE SHEET

Please return this signature sheet to the Contracting Department, NHS North Lincolnshire, Health Place, Wrawby Road, Brigg DN20 8GS Appendix A

Date: ______

Name of Client’s GP Practice : ______

Notification of participation in the Intermediate North Lincolnshire NHS Stop Smoking Service – Pharmacy Practice under Local Enhanced Service arrangements

Dear Doctor

Client’s Name ______Date of Birth :______

Address: ______

______

I am writing to inform you that the above named client has recently participated in the Intermediate North Lincolnshire NHS Stop Smoking Service, Local Enhanced Service scheme.

I can confirm that following the 4 week programme the results are as follows:-

Client was lost to follow up

Client successfully quit smoking

The pharmacy has continued to supply NRT to the client for a period of

______weeks

Client was unsuccessful in this attempt

I should be grateful if you would record this notification in the client’s medical record as appropriate.

Yours sincerely

Pharmacy Name: