1 April 2021 to 31 March 2023 Public Health – Stop smoking service
For the provision of a Community Pharmacy Locally Commissioned Service.
Community Pharmacy Stop Smoking Service.
Jimmy Burke - Health Improvement and Tobacco Control Programme Manager
Becky Woodiwiss – Public Health Principal
1 April 2021 to 31 March 2022
6 April 2021
This variation provides an addendum to the existing Stop Smoking Services in Community Pharmacy Settings Specification 1 April 2020 to 31 March 2021, now updated to cover the period 1 April 2021 to 31 March 2023, which follows. It details variations in service requirements and contractual terms and conditions for the Stop Smoking Services in Community Pharmacy Locally Commissioned Service.
These changes are being implemented in response to the national COVID-19 lockdown requirements, which have implication for normal service provision. Evidence tells us that COVID-19 presents some greater risks to people who smoke and so it is crucial that stop smoking services continue to be offered, albeit that support must be offered only in an appropriately risk-managed way. This may mean that smoking cessation support will be delivered remotely via telephone or online video-conferencing platforms as well as face-to-face with appropriate infection control protections.
This variation should be read in conjunction with and in addition to the Stop Smoking Services in Community Pharmacy Settings Specification 1 April 2021 to 31 March 2023, which follows. This variation has precedence.
The provisions in this variation apply only for the period 1 April 2021 to 31 March 2022 (12 months) and a review will take place at that time to ascertain if circumstances relating to the COVID-19 pandemic necessitate a further contract variation.
Stop smoking advisors are expected to take an initial carbon monoxide (CO) reading at the initial assessment appointment but only if it is assessed as safe to do so. Providers should carry out a risk assessment (or review their existing risk assessments) to ascertain whether this step is sufficiently safe to undertake. Where it is assessed as not sufficiently safe, this step can be omitted and the clients’ self-reported smoking status shall suffice.
CO readings are normally required to be taken at weekly appointments. However, this requirement is subject to the same risk assessment, professional judgement and individual discretion of the provider’s stop smoking advisors. CO readings may be omitted where the process is judged unsafe.
A final CO reading to confirm quit status at 4 weeks is normally required. Once again, following an appropriate risk assessment, if the provider assesses CO monitoring as not sufficiently safe, this step can be omitted, and the clients’ self-reported smoking status shall suffice. However, as per the payment schedule, only CO validated 4-week quits will attract the higher quit payment of £70. The payment for a non-CO verified quit remains £20.
Community Pharmacies signing up to deliver the stop smoking service must adhere to the service targets as detailed in the Stop Smoking Services in Community Pharmacy Settings Specification 1 April 2021 to 31 March 2023, which follows, with the following change:
Providers no longer need to ensure that 85% of four week quits are CO validated.
Payment arrangements will be as detailed in Stop Smoking Services in Community Pharmacy Settings Specification 1 April 2021 to 31 March 2023, which follows, with the following change:
Payments for attendance of training events will still be paid as per existing terms, however, the delivery of training will be adapted to ensure appropriate physical distancing and/or infection control is maintained – see section 6.
The stop smoking service will be delivered in line with the most recent evidence based practice recommendations for stop smoking services issued by the National Institute for Health and Care Excellence (NICE: NG92 / PH14), National Centre for Smoking Cessation and Training (NCSCT) guidance and Local Stop Smoking Services: Service and delivery guidance 2014 published by PHE. In addition:
Where remote consultations are delivered, the service should be delivered in line with the most recent National Centre for Smoking Cessation and Training (NCSCT) guidance: Remote consultations: Delivering behavioural support and supply of NRT, March 2020.
Training, professional development and update meeting requirements are as detailed in the Stop Smoking Services in Community Pharmacy Settings Specification 1 April 2021 to 31 March 2023, which follows, with the following amendments:
The two-day face-to-face course provided by the BSUH Stop Smoking Lead will be replaced by a shorter, appropriate remotely provided solution. This training solution will encompass the same content as the training previously provided but will be delivered in a safe way e.g. via an online video-conferencing platform. Participation in both parts of the training will continue to be mandatory.
Registered advisors will continue to be expected to maintain continuing professional development by participating in a minimum of one CPD/network session annually (delivered Quarterly by the Healthy Lifestyles Team Stop Smoking Lead at BSUH).
Additionally, providers will be expected to promote and participate in local and national smoking cessation campaigns to promote the uptake of local stop smoking services among members of the public who smoke.
Providers may continue to provide the domiciliary service, as detailed in appendix 9 of the Stop Smoking Services in Community Pharmacy Settings Specification 1 April 2021 to 31 March 2023, which follows, but only if it is formally assessed as safe to do so. Providers will carry out a risk assessment (or review their existing risk assessments) to ascertain whether this service is sufficiently safe to provide. Where it is assessed as not sufficiently safe, the service will not be provided. Telephone and video appointments may be a suitable alternative, with arrangements made for delivery of pharmacotherapies. Once again, the provision of a domiciliary service is subject to the same risk assessment, professional judgement and individual discretion of the provider’s stop smoking advisors.
For the provision of a Stop Smoking Locally Commissioned Service
Community Pharmacy Stop Smoking Service
Rebecca Robb - Public Health Tobacco control and Healthy Lifestyles Manager
1 April 2021 to 31 March 2023
March 2023
The Community Pharmacy Stop Smoking Service Specification is applicable as the overarching specification to provide stop smoking services in the community pharmacy setting. The following additional Community Pharmacy Stop Smoking Specifications must be delivered according to the service descriptions and objectives defined in this document.
Community Pharmacies signing up to provide Stop Smoking services must indicate on the sign-up sheet provided by Public Health which elements of the service they intend to provide.
Locally commissioned stop-smoking services continue to offer the best opportunities for individuals to make a quit attempt. This service specification is intended to support the residents of Brighton and Hove to stop smoking and applies to the provision of a locally commissioned stop smoking service within a community pharmacy setting. The focus of the service is to offer one to one behavioural support and advice to people who want to give up smoking including the supply of appropriate stop smoking pharmacotherapy.
The UK is a world-leader in tobacco control, but smoking remains the leading cause of preventable illness and premature deaths in England. It is one of the most significant factors that affect health inequalities and the biggest contributor to ill health, particularly cancer, coronary heart disease and respiratory disease. Reducing smoking prevalence therefore remains a key public health priority and a national focus.
National trends show that overall prevalence of tobacco smoking has declined since 2004, from 19% in 2014 to 14.9% in 2017, however in contrast, rates amongst vulnerable population groups have not fallen and this remains a priority target area for Brighton and City Hove Council. At a rate of 18% for adult prevalence (APS, 2017), there are around 42,630 smokers in Brighton & Hove, this is significantly higher when compared to the South East (13.7%) and England average (14.9%) (PHE Fingertips, Local Tobacco control Profiles, Annual Population Survey 2017). Priority sub groups for service targeting in Brighton & Hove City Council include individuals from, routine and manual occupations, Black Asian Minority Ethnics (BAME), Lesbian, Gay, Bisexual, Trans and Queer (LGBTQ) and people under the age of 25 years.
Smoking is more prevalent in areas of the city with higher levels of deprivation. General Practitioner (GP) cluster statistics for smoking prevalence show that both the upper centre and east of the city are most impacted and would benefit from targeted support. See Table 1 below.
| Cluster by area | Current smoking prevalence rate |
|---|---|
| Cluster 1 East | 32.6% |
|
Cluster 5 Centre and North East |
27.5% |
| Cluster 2 Centre and East | 27.1% |
| Cluster 4 West | 25.7% |
| Cluster 3 North | 24.2% |
| Cluster 6 West and North | 24.0% |
In addition, Brighton & Hove City Council has commissioned a Hospital Stop Smoking Lead (HSSL) based at the Brighton Sussex University Hospital (BSUH). The post supports inpatients, outpatients and all BSUH staff to stop smoking. The role is also commissioned to provide the Brighton & Hove City Council Stop Smoking Training Programme and stop smoking update meetings for community pharmacy teams.
Ambitions set by the Department of Health, in the tobacco control plan, ‘Towards a smoke-free generation: a tobacco control plan for England’ have 4 specific smoking-related outcomes to achieve by the end of 2022:
This service specification applies to the provision of stop smoking services within the community pharmacy setting. The focus of the service is to offer one to one behavioural support and advice to people who want to give up smoking including the supply of appropriate stop smoking pharmacotherapy.
The service will be commissioned in line with the most recent evidence based recommendations for stop smoking services issued by the National Institute for Health and Care Excellence (NICE: NG92 / PH14), National Centre for Smoking Cessation and Training (NCSCT) guidance and Local Stop Smoking Services: Service and delivery guidance 2014 published by Public Health England (PHE).
The service will help to increase choice and support individuals from identified sub-groups with high prevalence tobacco use, such as routine and manual occupations, Lesbian, Gay, Bi-sexual, Trans and Queer (LGBTQ), Black, Asian Minority Ethnics (BAME) and individuals under the age of 25.
The service will be provided by Stop Smoking Advisors (SSA) in accordance with the training requirements of BHCC. A minimum of two trained Stop Smoking Advisors (SSA) are required to complete the training within six months of starting to offer the service. A disclosure barring service (DBS) check must be in place for all staff providing the service.
The SSAs will help facilitate access to, and supply appropriate stop smoking pharmacotherapy. The pharmacy can provide up to 12 weeks of nicotine replacement therapy (NRT) or Varenicline tablets. Varenicline can only be supplied on Patient Group Direction (PGD) by authorised pharmacists who have enrolled to provide the service on PharmOutcomes (refer to the Community Pharmacy Provision of Varenicline under PGD service specification). Individuals requesting Bupropion as a stop smoking pharmacotherapy should be referred to their GP.
Information collected from individuals using the service must be recorded on PharmOutcomes. PharmOutcomes records (non- identifiable patient data) will be used for audit and evaluation purposes .The templates also includes the information required for the Gold Standard Monitoring Form. This standard monitoring form provides the quarterly data required by stop smoking services for submission to the Health and Social Care Information Centre (HSCIC).
The Service is remunerated quarterly when PharmOutcomes data is submitted. Data must be submitted before the 14th of the following month.
To provide a high quality, accessible and comprehensive stop smoking service across the city, delivered by trained (Disclosure and Barring Service (DBS) checked) Stop Smoking Advisors.
To support the government’s Tobacco Plan (published March 2018) to reduce prevalence by 2022.
To have a sufficient number of suitably qualified and skilled staff available (minimum of 2 trained Stop smoking advisors per pharmacy) within 6 months of starting the contract.
SSAs are trained to provide individuals with informed choices on the following quit methods:
See Appendix 5 for latest guidance on electronic cigarettes (e-cigarettes) and vaping.
To ensure that robust data is collected using Pharmoutcomes in order to measure the outcomes and effectiveness of the service.
To refer all individuals that have not maintained a 4 week quit or have relapsed into other stop smoking services, such as Health Trainers (for 18 years and over). Refer to the Community Pharmacy Young Persons Stop Smoking Service Specification (Appendix 11) for details on the provision of services to individuals under the age of 16.
To refer housebound Individuals unable to access the stop smoking services to pharmacies commissioned to provide the Community Pharmacy Domiciliary Stop Smoking Service – see Appendix 9
To refer young people under the age of 16 years to pharmacies meeting the YPSS service standards to provide the Community Pharmacy Young Persons Stop Smoking Service- see Appendix 11.
The stop smoking service should be promoted by the whole team and pharmacies should participate in annual health promotion campaigns such as National No smoking Day, World No Tobacco Day and Stoptober.
Individuals aged 16 years and over are eligible to engage with the SS service. Young people under the age of 16 years should be referred to pharmacies meeting the service standards to provide the Young Persons SS service.
Individuals not sufficiently motivated to quit or who prefer to access another stop smoking service should be referred to Health Trainer’s Service.
Individuals with severe cardiovascular disease, for example, myocardial infarction with a history of recent cerebrovascular disease such as a stroke should be referred to their GP for stop smoking advice.
All pharmacies signed up to the specification are to also dispense NRT products to an individual referred into service from Health Trainers of Sussex Partnership Foundation Trust (SPFT) under the NRT voucher scheme.
Individuals who do not achieved a quit at 4 weeks or significantly relapsed (smoking 1 to 5 cigarettes daily during the quit attempt at any given time) are eligible to restart a new stop smoking cycle at any time. The trained SSA should use discretion when considering whether an individual is ready to restart the programme. In order to be counted as a new data entry on the quarterly return the individual must agree, to another initial appointment (discuss relapse reasons, provide behaviour change support and advise on pharmacotherapy where appropriate) and set a new quit date.
The contractor must ensure that all other pharmacy staff that may have contact with individuals using the service are trained accordingly. This training should include confidentiality and signposting to alternative services in the area if appropriate.
The contractor must ensure that SSAs are subject to a Disclosure and Barring service (DBS) check. See section 7
The contractor must ensure that accredited SSAs follow the SS consultation format outlined in Appendix 3.
SSAs must check with a pharmacist that NRT or Varenicline (under PGD in commissioned pharmacies) supply is suitable for all individuals if they have a medical condition and/or are taking other medications.
Contractors signing up to this specification are also required to dispense NRT products to an individual referred into service from Health Trainers or Sussex Partnership Foundation Trust (SPFT) under the voucher scheme. Please refer to Appendix 14 for details of the NRT e-voucher scheme.
The contractor must ensure the pharmacy premises have a consultation room in which the individual can be seen privately and have their confidentiality maintained.
The contractor must purchase their own carbon monoxide (CO) monitor and be responsible for the infection control and supply of mouthpieces, wipes and the calibration of the monitor according to the manufacturer’s instructions.
Details of individuals engaging with the Stop Smoking service must be recorded on the PharmOutcomes registration and supply templates. The data must be stored in line with General Data Protection Regulations (GDPR).
The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely for a length of time in line with local NHS record retention policies.
The contractor is required to take part in an annual audit of the service.
The contractor is required to co-operate with any Brighton & Hove City Council led assessment of an individual’s experience of using the service. If required to do so please use the Service User Survey in Appendix 8.
To deliver the service, contractors are expected to achieve a minimum of 2 four week quits per month or a minimum of 24 across the reporting year April to April.
The contractor must develop a standard operating procedure (SOP) for the SS service incorporating the referral and signposting pathway for the service.
Contractors are expected to achieve a quit rate of at least 55%. 35% of quits should be from the target groups. (RMO, BAME, LGBTQ, Under 25’s) listed in section 1. 85% of four week quits must be CO validated.
Contractors are expected to achieve a lost to follow up rate of less than 15%.
The contractor must be able to demonstrate that staff involved in the provision of the service have undertaken the required training, accreditation and continuing professional development (CPD) relevant to this service.
The training schedule below must be considered mandatory to providing the Stop Smoking Service.
It is a requirement to attend a two day face to face course provided by the BSUH Stop Smoking Lead at least every two years. A maximum of 4 members of staff annually (April – April) per practice can claim for training on the two-day level 2 course with the BSUH lead. Enrolment on to the training course should be completed by registering on the Brighton & Hove City Council Learning Gateway. Training course details are listed in Appendix 1.
It is a requirement to have at least 2 trained SS advisors per pharmacy within 6 months of starting to offer the service.
The contract should aim to initiate individual quit activity within 3 months of receiving the level 2 training course
It is beneficial to have completed the Making Every Contact Count (MECC) e-learning course found online at (completion time of approximately 3 hours).
Stop smoking advisors are required to maintain continuing professional development by attending one annual update session delivered by the Smoking Cessation Lead at BSUH. Update meeting details are listed in Appendix 1.
There will be payment for Stop smoking advisors upon completion of the NCSCT Stop smoking practitioner training only (Completion time approximately 4 hours). SSA’s are also encouraged to complete the online:
On completion of the training SS Advisors are required to declare their competence to provide the service by enrolling on PharmOutcomes.
A DBS check must be in place for all staff delivering this service. Contractors should assure themselves that the appropriate DBS check, for the type of service being undertaken is in place for each member of staff providing the service.
The Brighton & Hove City Council policy is that DBS checks are refreshed every 3 years.
Contractors must ensure local safe guarding arrangements are in place for vulnerable adults when appropriate. Any concerns about safeguarding should be raised with line managers or acted in accordance with your pharmacy safeguarding policy and procedures. Get information regarding local safeguarding arrangements.
An enhanced DBS check must be in place for all pharmacy staff providing the stop smoking service. The Brighton & Hove City Council policy is that DBS checks are refreshed every 3 years. Safeguarding concerns (for children aged 13 to 18) identified at presentation should be referred to the Local Safeguarding Children Board. Get information regarding local safeguarding arrangements for children.
Pharmacy staff are required to consider Gillick Competency (see Appendix 13) to assess competence and risk when providing advice or treatment to young people[1]
Attendance at the 2 day training course will be back filled at £100 per member of staff to attend both days. Pharmacy staff selected to attend the training must be permanent and committed to providing the stop smoking service for at least six months after the training.
Attendance at the one annual update meeting is remunerated at £20 per advisor, with a maximum of 4 advisors annually.
Completion of the NCSCT Stop smoking practitioner training for Health and Social Care workers will be remunerated at £10 per SS advisor.
The Stop Smoking consultation will be remunerated as listed below (See Appendix 3 for the detailed consultation stages). Data collection and equipment costs are reflected in the fee.
PharmOutcomes links to the NHS dictionary of medicines and devices. Medications supplied will therefore be remunerated at the drug tariff price.
Stop smoking advisors must check with a pharmacist that NRT supply is suitable for all individuals if they have a medical condition and/or are taking other medications.
Individuals who are taking medicines that require monitoring when they stop smoking or take medicines that interact with other stop smoking pharmacotherapy should be referred back to their GP.
Varenicline can only be supplied by a pharmacist under PGD by contractors commissioned to provide the Community Pharmacy Provision of Varenicline on Patient Group Direction service.
The contractor can provide up to a maximum of 12 weeks of NRT products or Varenicline tablets (under PGD only) per individual under this contract
NRT products are to be dispensed to individuals at the setting a quit date (SAQD) appointment. The full 4 weeks of NRT can be issued at this time to give the individual the best opportunity in succeeding a 4 week quit
NRT product supply is reimbursed at a maximum of 2 separate products per week per individual for the first 4 weeks of a quit attempt. Then only 1 product to be dispensed per week per individual if they receive continued support for up to 12 weeks.
The pharmacy will be reimbursed for the cost price for the NRT product. (Drug tariff cost + 5% VAT).These prices will be fixed for the term of this contract.
No NRT products are to be issued for more than 12 weeks per individual for that quit attempt.
All pharmacies signed up to the specification are to dispense NRT products to an individual referred into service from Health Trainers of SPFT under the voucher scheme.
Reimbursement of NRT products can only be claimed for if an individual is going through a full 4-week quit programme under the practice or via an agreed voucher scheme (with Health Trainers or Sussex Partnership NHS Foundation Trust).
The individual should be charged £9.15 (or the current NHS prescription charge) or declare the reason for NHS prescription charge exemption for each supply of NRT or Varenicline. The individuals’ reason for exemption from NHS prescription charges should be recorded on the PharmOutcomes registration template. If a combination of two NRT products are supplied this would constitute two charges.
This service specification runs for the period from 1 April 2021 to 31 March 2023. Including a review of the service in April 2022.
Termination can be made earlier by either party at 3 month written notice or on failure to provide activity data or meet the terms and conditions of the service specification as stated above.
Contractors must inform the commissioner within 72 hours if for any reason they are unable to provide the service either temporarily or permanently.
Contact Information
Brighton & Hove City Council
2nd Floor, Hove Town Hall, Norton Road , Hove, BN3 3BQ
Send an email to publichealth@brighton-hove.gov.uk
Hospital Smoking Cessation Service Lead (HSCSL)
Send an email to anna.fairhurst@nhs.net
Attendance to both Part A and Part B is required for completion of the Brighton & Hove City Council local stop smoking advisor accredited training.
This online 2 part (4.5 hours total) training course will run quarterly.
Book online via the Learning Gateway.
|
Date |
Time |
Venue |
|---|---|---|
|
20 April 2021 Part 1 |
2pm to 4:30pm |
Microsoft Teams
|
|
27 April 2021 Part 2 |
10am to midday |
Microsoft Teams
|
|
15 July 2021 Part 1 |
2pm to 4:30pm |
Microsoft Teams |
|
22 July 2021 Part 2 |
10am to midday |
Microsoft Teams
|
More dates will be announced on the Learning Gateway.
These sessions will run quarterly and are open to those who have completed:
Please attend at least one date annually.
Book online via the Learning Gateway.
|
Date |
Time |
Venue |
|---|---|---|
|
16 June 2021 |
10am to 12.30pm
|
Microsoft Teams |
|
15 Sept 15 2021 |
10am to 12.30pm
|
To be confirmed |
|
15 December 2021 |
10am to 12.30pm |
To be confirmed
|
|
16 March 16 2022 |
10am to 12.30pm |
To be confirmed
|
Use this guide to book yout training session. Download the PDF version of this document to view this guide with images.
Go to the Brighton & Hove city Council Learning Gateway.
Many pharmacies are already registered on the portal. If yours is in the drop down list then it has already been registered. You can now go back to the homepage and log in.
If you don't know the log in details, send an email to learning@brighton-hove.gov.uk.
If the pharmacy is not registered then you will need to register it. The first person to register the pharmacy will lead the account. They can book others from the pharmacy onto training courses when it is set up.
When your pharmacy is registered you can then register against that pharmacy or alternatively, the person who set up the account can sign you up for training.
If the course is already fully booked you will be given the option to get onto the waiting list.
A confirmation email will be sent to you in due course once your place has been approved.
Discussion of quitting options (NRT) and Set Quit Date (discussed with individual)
Face to Face
Approximately 20 minutes
Payment: £25
Identify readiness to quit and commitment to participate in Stop smoking programme
Describe:
Discuss:
Take an initial carbon monoxide (CO) reading.
Set a 4 week quit date:
Refer individuals over 35 years old presenting with the following: Chronic Obstructive Pulmonary Disease (COPD) risk factors to their GP:
Support following Quit Day
Face-to-face or phone call (provided 2 weeks after the quit date)
Approximately 10 to 15 minutes
Payment £5
Face-to-face or phone call
Approximately 10 minutes
Optional: Payment £5
4 weeks after Quit Day
Best practice is to take CO validation reading
CO verification must be taken for £70 payment to be made at 4 Weeks
Individual advised to notify GP of quit attempt to update records
Encourage total abstinence onwards from quit date
Inform individual of further online quit support resources available on the:
A Self-reported smoker is one who reports not smoking for at least 15 to 28 days of a 4 week attempt. Please see Appendix 4 and appendix 7 for guidance on the questions required to ask individuals via the telephone conversation in order to make a claim.
A CO-verified four-week quit = A treated smoker who reports not smoking for at least days 15 to 28 of a quit attempt and whose CO reading is assessed 28 days from their quit date (-3 or +14 days) and is less than 10 ppm. This is lower for women who are pregnant at 4 ppm or less. The -3 or +14 day rule allows for cases where it is impossible 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 the quit date). This means that follow-up must occur 25 to 42 days from the quit date (Russell Standard).
A treated smoker who reports not smoking for at least days 15 to 28 of a quit attempt and not relapsed within the last 72 hours and is offered a follow-up appointment with the opportunity to complete a CO verification at 3 months.
In England, e-cigarettes are the most popular stop smoking aid for adults and based on the evidence to date are considered 95% less harmful than cigarettes and this has contributed to the decline in tobacco smoking nationally. Combined with behavioural support from stop smoking advisors, quit success rates can be greatly improved.
Latest research from Public Health England (PHE) (2015) states that although not completely risk free, e-cigarette use is significantly less harmful than tobacco smoking and as such, PHE recommends that services should offer e-cigarettes friendly support to people who are using Electronic Nicotine Delivery Devices (ENDS) in a quit attempt. Optional online training on E-cigarettes can be accessed via the NCSCT online training page.
Many users of e-cigarettes continue using the product both before and after quitting smoking, and for a longer period after quitting than most NRT users. It is advisable to suggest to individuals wanting to use e-cigarettes, to access further guidance on which type of devices are best suited for them and their quit (Generation 1, 2 and 3 for Tank models)[2]. All devices can be used with NRT and nicotine delivery from E-cigarettes is capped at 20mg under the Tobacco Product Directive (TPD).
View a current list of local Independent British Vape Trade Association (IBVTA) registered Vape. These are reputable sellers following national TPD and trading standard regulations and ensure no association or funding from big tobacco companies (PMI / BAT).
NICE NG92: Stop smoking interventions and services March 2018
PH14: Young people services (2014 update)
Under 18s guide to quitting smoking
Tobacco control plan for England 2022
National Institute for Health & Care Excellence Guidance (NICE) guidelines
NCSCT – Service delivery guidance, individual stop smoking intervention delivery and extra Training support.
Questions to ask individuals self-reporting a 4 week quit via the telephone and reasonable answers.
Positive - Discuss with individual to receive feedback on service.
Negative - provide them with the opportunity to attend another appointment or refer on to other services for support.
Yes - I have not smoked for 15 to 28 days of my 4 week quit (follow on to next question).
No – Use professional discretion to offer them to start their quit journey again and set-up initial appointment.
Yes – Next question.
No – Offer another appointment to start quit attempt again or refer into health trainer service for extra advice and support.
Yes – make a referral to service.
No – provide recognition for quit and motivation to continue. Remind the individual that they can come back for further information if required or direct to the health trainer service online or by phone.
We are very keen to improve the Stop Smoking Service provided in Brighton & Hove. Your views about this are very important to us and will be treated in the strictest confidence. Please answer the following questions as honestly as you can. The results of this survey will be used for evaluation and to improve services for the future.
|
1 |
Overall how satisfied are you with the stop smoking service you received? |
Unsatisfied |
Unsure Please comment
|
Satisfied
|
|
2 |
Would you recommend this service to others who want to stop smoking?
|
No
|
Unsure Please comment
|
Yes
|
|
3 |
If you started smoking again would you return to the service for help to stop? |
No
|
Unsure Please comment
|
Yes
|
|
6 |
How satisfied were you with the amount of time you had to wait for your first appointment with the Service? |
Too long Please specify
|
Unsure Please comment |
Satisfied please specify |
|
7 |
How helpful was the advisor support? |
Unhelpful
|
Unsure - Please comment |
Helpful
|
|
11 |
Were you offered a range of Nicotine replacement therapy -medication? |
No
|
Unsure Please comment |
Yes
|
|
12 |
Was it easy to obtain your Nicotine replacement therapy -medication?
|
No
|
Unsure Please comment |
Yes
|
|
13 |
If you have any suggestions as to how we can improve our Stop Smoking Service please give details here: |
Thank you for your time in completing this survey. Please return it to your stop smoking advisor or in the envelope provided.
The DSS service builds on the Community Pharmacy Stop Smoking Service Specification utilising the service delivery framework to provide a home-based service.
Stop Smoking Advisors will offer a home-based stop smoking service for individuals with Chronic Obstructive Pulmonary Disease (COPD) and other long term conditions.
The DSS service will provide one to one behaviour support along with the supply of stop smoking pharmacotherapy to individuals within their own homes.
The DSS will improve access to stop smoking services through the development of a citywide domiciliary service that mirrors the population coverage of the six Brighton and Hove GP clusters (see page 3) including prevalent locations to ensure equitable access to home based services.
Contractors providing the DSS must adhere to the criteria in the Community Pharmacy Stop Smoking Service Specification. The community pharmacy stop smoking delivery model is detailed in Appendix 3 .The same process and consultation format should be used for individuals using the domiciliary service. Individuals requiring the service are eligible for up to three visits during the stop smoking support cycle.
Contractors offering the DSS must meet all the requirements of the Community Pharmacy Stop Smoking Service Specification.
Contractors must ensure there are no exclusions to the DSS service before visiting an individual.
Lone working and risk assessment policies must be in place to safeguard and protect SSAs providing the domiciliary service.
Contractors must ensure SSAs are fully enabled to raise safeguarding issues with their line manager, and where appropriate support these members of staff to raise safeguarding concerns with the local authority (refer to Section 7)
Contractors must ensure that all SSAs providing the domiciliary service have completed a successful enhanced DBS check.
Contractors must have adequate business insurance to cover provision of the DSS.
Details of individuals engaging with the Domiciliary Stop Smoking service must be recorded on the PharmOutcomes registration and supply templates. Remuneration will be based on the data entered into PharmOutcomes. The data must be stored in line with General Data Protection Regulations (GDPR).
Contractors must adhere to GDPR by providing a NHS email account for communication with hospital and community services and for sharing individuals’ information.
Contractors are required to contact individuals before initiating the service. The initial conversation should include discussions around the visit risk assessment, current medical history and medications and information about previous stop smoking attempts. Contractors should ensure the initial screening conversation covers all the requirements of their lone working and risk assessment policies
To undertake the domiciliary service the stop smoking advisor will need access to a home visit kit bag. For guidance on the suggested contents of the kit bag to be included within the kit bag please see Appendix 10.
The SSA must ask the individual engaging with the DSS to complete a patient satisfaction questionnaire (Service User Survey Appendix 8) at the second or third visit in the stop smoking support cycle.
The contractor must comply with the Brighton & Hove City Council auditing procedures for locally commissioned services as defined in the service contract.
Individuals requiring smoking cessation support in their own homes can be referred to the community pharmacy of their choice by sending a referral email to the community pharmacy NHS email address or by contacting the pharmacy by telephone. A list of DSS providers will be made available on Brighton and Hove City Council (BHCC) website
Hospital patients will receive an initial stop smoking assessment by the Hospital Smoking Cessation Service Lead (HSCSL). Patients identified to be housebound will be referred by the HSCSL to the commissioned community pharmacy of their choice commissioned to provide the DSS service.
Individuals in the community identified by the Community Respiratory Service (CRS) as requiring stop smoking support can be directly referred to the community pharmacy of the individual’s choice using the NHS email address or by phone. Adult Social Care services and other community providers can also signpost to community pharmacies offering the DSS service. A list of Community Pharmacy DSS providers will be available on the BHCC website
GP practices can refer individuals to community pharmacies by sending an email to the community pharmacy NHS email address or by phone. Brighton and Hove GP practices will be provided with a list of DSS providers and sign posted to the Brighton & Hove City Council website. It is the responsibility of the community pharmacy to engage with local GP practice to raise awareness of the DSS service and how to refer into it.
Community pharmacies NOT offering the DSS service can signpost individuals to community pharmacies commissioned to provide the service. Information detailing Community Pharmacy DSS providers will be available on the BHCC website
The payment schedule and claim procedure for the delivery of the SS aspect of the domiciliary service is defined in the Community Pharmacy Stop Smoking Service Specification section 8.
The domiciliary service requirements of the SS service will be remunerated at £25 per visit. The remuneration takes into account the costs associated with setting up a domiciliary service such as training, enhanced DBS checks, risk assessment and lone working policies. The remuneration also includes the costs associated with travel, parking, insurance and mobile phones. A maximum of three visits can be claimed per individual for each stop smoking support cycle.
The DSS service specification runs for the period from 1 April 2021 to 31 March 2023. Including a review of the service in April 2020.
Termination can be made earlier by either party at 3 month written notice or on failure to provide activity data or meet the terms and conditions of the service specification as stated above.
Pharmacies must inform the commissioner within 72 hours if for any reason they are unable to provide the service either temporarily or permanently.
Kit Bag- recommended contents:
Discuss the visit risk assessment/ lone worker policy criteria with individuals before arranging a visit
Discuss the format of the 12 week programme and the number of home visits available
Discuss relevant medical conditions and medications being taken by the individual
To decide on the NRT to include in the kit bag discuss options with the patient, such as, gather information about how many cigarettes smoked per day, when they have their first cigarette, have they tried any NRT and formulation preferences.
Discuss payment criteria. If an individual pays for NHS prescriptions ensure they are aware that the NHS levy (per formulation) will be collected when the NRT is supplied and to ensure change is available.
The YPSS service builds on the Community Pharmacy Stop Smoking Service Specification utilising the service delivery framework to provide an accessible service to young people between the ages of 12 to 15 years old.
Young people wishing to access the service will be referred from the Schools Stop Smoking Lead (SSSL) or the School Nurse Service to the community pharmacy of their choice commissioned to provide the service.
The service will be provided by SSAs using a young person friendly and non-judgemental approach. The contractor will ensure that all staff involved in the provision of the service maintain individual confidentiality, and are appropriately trained in the operation of the service, including sensitive, person centred communication skills.
In the UK more than 207,000 children aged 11 to 15 start smoking each year. Smoking just one cigarette in early childhood doubles the chance of a teenager becoming a regular smoker by the age of 17. The earlier the young person becomes addicted and continues smoking into adulthood the greater the risk of developing heart and lung disease later in life. (BMA Board of Science. Breaking the Cycle of Children’s Exposure to Tobacco Smoke. British Medical Association, London, 2007). In 2014, 77% of smokers aged 16 to 24 said they began smoking before the age of 18. (Department of Health. Towards A Smokefree Generation: A Tobacco Control Plan for England. 2017).
According to the national What about Youth survey Brighton & Hove has the highest rate of current 15 year old smokers with a prevalence rate of 14.9%, Compared to the south East at 9% and the English National average at 8.2% (NHS Digital, 2015). (Current smokers include regular and occasional smokers).
NICE guidance supports smoking cessation in young people through local smoking cessation services giving access to behavioural support and pharmacotherapy. Smoking cessation services in Brighton & Hove for under 16 year old residents is currently limited to GPs and the Schools Stop Smoking cessation Lead. This service specification improves options for young people by providing stop smoking services in the community pharmacy setting. For further information regarding the risks associate with childhood smoking please see Appendix 12.
Contractors offering the YPSS must meet all the requirements of the Community Pharmacy Stop Smoking Service Specification.
Contractors must ensure that all SSAs providing the YPSS service have completed a successful enhanced DBS check. See section 7 of the Community Pharmacy Stop Smoking Service Specification.
Service delivery must be in accordance with the Brighton & Hove City Council accredited training standards for the Stop Smoking service detailed in section 5 of the Community Pharmacy Stop Smoking Service Specification. In addition the CPPE e-learning training module Safeguarding children and vulnerable adults: Level 1 (2019) must also be completed. The contractor must ensure that at least one SSA is trained to provide the YPSS service
Pharmacotherapy should be supplied in accordance with section 9 of the Community Pharmacy Stop Smoking Service Specification. Please note Varenicline is not licenced for use in young people under the age of 18 years and young people under the age of 16 are exempt from the NHS prescription levy.
SSAs must use the Gillick Competency checklist (Appendix 13) to assess a young person under 16 years of age to ensure they fully understand the stop smoking programme. The Gillick Competency checklist should be completed on Pharmoutcomes during or after the consultation.
Contractors must ensure SSAs are fully enabled to raise safeguarding issues with their line manager, and where appropriate support these members of staff to raise safeguarding concerns with the local authority(refer to Section 7 of the Community Pharmacy Stop Smoking Service Specification)
The SSSL will be notified of contractors signing up to provide the service for referral purposes. Young people not meeting the inclusion criteria of the service should be referred back to the SSSL.
Contractors should aim for at least 85% of all young people using this service to have a validated quit at 4 weeks with an expired breathe into a carbon monoxide monitor that is less than 10 parts per million.
The contractor will ensure that pharmacists and counter staff involved in the provision of the service have up to date knowledge, maintain patient confidentiality, offer a user-friendly and non-judgemental service and are appropriately trained in the operation of the service, including sensitive, person centred communication skills
Details of individuals engaging with the YPSS service must be recorded on the PharmOutcomes registration and supply templates. Remuneration will be based on the data entered into PharmOutcomes. The data must be stored in line with General Data Protection Regulations (GDPR).
The SSA must ask the individual engaging with the YPSS service to complete a patient satisfaction questionnaire (Service User Survey Appendix 8) at the CO verified 4 week quit consultation.
The contractor must comply with the Brighton & Hove City Council auditing procedures for locally commissioned services as defined in the service contract.
The payment schedule and claim procedure for the delivery of the YPSS is defined in the Community Pharmacy Stop Smoking Service Specification section 8. Please Note: The 4 week quit payment for the YPSS service is enhanced and will be paid at £90 for a CO verified 4 week quit.
The enhanced DBS check will be remunerated by Brighton & Hove City Council for one Stop Smoking Advisor per contractor per year, additional costs related to the enhanced DBS check must be incurred by the provider or as negotiated with the commissioner on an individual basis.
The additional safeguarding training required to provide the young people’s service will not be remunerated; however costs are reflected in the 4-week quit enhanced payment.
The YPSS service specification runs for the period from 1 April 2019 to 31 March 2021. Including a review of the service in April 2020.
Termination can be made earlier by either party at 3 month written notice or on failure to provide activity data or meet the terms and conditions of the service specification as stated above.
Pharmacies must inform the commissioner within 72 hours if for any reason they are unable to provide the service either temporarily or permanently.
In the UK more than 207,000 children aged 11 to 15 start smoking each year. Smoking just one cigarette in early childhood doubles the chance of a teenager becoming a regular smoker by the age of 17. The earlier the young person becomes addicted and continues smoking into adulthood the greater the risk of developing heart and lung disease later in life. (BMA Board of Science. Breaking the Cycle of Children’s Exposure to Tobacco Smoke. British Medical Association, London, 2007). In 2014, 77% of smokers aged 16 to 24 said they began smoking before the age of 18. (Department of Health. Towards A Smokefree Generation: A Tobacco Control Plan for England. 2017).
Living with adults or siblings who smoke also makes it much more likely that a young person will start and continue smoking.
Other factors that influence and contribute to smoking uptake in this age group include:
Young people who smoke are more susceptible to coughs, wheeziness and shortness of breath. This has a direct effect upon school attendance and education due to school absence. (Smoking and Young People, Royal College of Physicians; 1992).
The harms from smoking begin for many children at birth. Exposure to second-hand smoke during pregnancy increases the risk of miscarriage, premature birth, still birth and low birth-weight. The early exposure to second-hand smoke in the womb also increases the risk of infant mortality, wheezy illnesses and psychological problems such as attention and hyperactivity problems after birth.
Many children are also born into households that smoke with more than two thirds of children reporting high exposure to second-hand smoke from within their own homes or in other people’s homes.
This early exposure to second-hand smoke contributes to many adverse health outcomes including:
There is also evidence linking exposure to second-hand smoke with impaired mental health and with increased school absenteeism.
Ambitions set by the Department of Health, in the tobacco control plan, ‘towards a smoke-free generation: a tobacco control plan for England’ have a specific smoking-related outcome to achieve for young people. That is to reduce the number of 15 year olds who regularly smoke from 8% to 3% or less by 2022.
According to the national What about Youth survey Brighton & Hove has the highest rate of current 15 year old smokers with a prevalence rate of 14.9%, compared to the south East at 9% and the English National average at 8.2% (NHS Digital, 2015). Current smokers include regular and occasional smokers.
Older students are more likely to smoke with 95% of 11 to 12 year old students saying they have never smoked. This falls to 49% for 15 to 16 year old students (Brighton & Hove City Council, 2015).
For pupils aged 11 to 14, there is not much difference between girls and boys who have tried smoking (girls 13%, boys 12%). However this changes with age and for pupils aged 14 to 16, girls are more likely to have smoked (49%) compared to boys (39%). Also for pupils aged 14 to 16, girls are more likely to be regular smokers (12%) compared to boys (7%) (Brighton & Hove City Council, 2015).
Adolescents over 16 years of age are presumed to have sufficient capacity to decide on their own medical treatment, unless there is sufficient evidence to suggest otherwise.
Young people under 16 years of age who wish to receive health care and stop smoking services can do so without the consent of a parent/carer. However, the young person needs to be assessed as ‘Gillick Competent’, that is, ensure they fully understand the treatment they will be involved in.
Gillick competency can be assessed by completing the checklist below. The checklist is available to complete on PharmOutcomes.
Your assessment of Fraser |
Yes |
No |
|---|---|---|
| Understanding of advice given | ||
|
For example, understands the service they are accessing, understands what access they need to take during or following access to the service. Notes (please record discussion) |
||
| Encouraged to involve parent/carer | ||
|
For example, client not prepared to talk to parent/carer at this time but will try to do so in due course. May be able to discuss with another responsible adult. Any coercion? Notes: |
||
| The effect of physical and mental health of young person if advice / treatment withheld. | ||
|
For example, advice/treatment/service is needed now, to ensure their wellbeing. Notes: |
||
| Action in the best interest of the young person | ||
|
For example, providing the professional service/advice at this time is in the best interest of the client, regardless of parental consent. Notes |
||
The aim of the NRT e-voucher scheme is to enable individuals to easily access NRT when attending a stop smoking programme provided by the Brighton & Hove City Council Health Trainer team and other authorised Stop Smoking Advisors (SSAs). The NRT e-voucher scheme is a mandatory requirement of providing the Community Pharmacy Stop Smoking Service.
NRT products are classified as General Sales List products; they can therefore be supplied directly from community pharmacies without a prescription. This enables individuals to access stop smoking pharmacotherapy at the same cost as the NHS prescription levy, or free if the individual is exempt from NHS prescription charges, instead of the recommended retail price.
Under the scheme, a trained stop smoking advisor (Health Trainers or Sussex Community Partnership Staff) recommends the supply of NRT products using an e-voucher that is issued to a pharmacy participating under the scheme of the individual’s choice. The NRT e-voucher request is generated on PharmOutcomes by a Health Trainer (or other authorised SSA) who assesses suitability of individuals attending the local stop smoking service for stop smoking pharmacotherapy. Please note that this scheme does NOT apply to varenicline (Champix) and buproprion (Zyban) – both are Prescription Only Medicines (POMs).
The authorisation is granted by the Public Health Tobacco Control and Healthy Lifestyles Manager. Please note that SSA’s do not have to be from a clinical background but must have received the 2 day level two training from BSUH lead and be NCSCT certified in order to recommend NRT supply under this protocol and keep their knowledge and skills up to date.
Advisors should keep up to date with their knowledge on medications. This can be done by searching the latest summary of products and characteristics (SPC) of each individual NRT all of which are available on the NCSCT website and guidance from the National Institute for Health and social care excellence.
The NRT e-voucher request is then sent to the pharmacy (selected by the individual requiring treatment) via PharmOutcomes. SSAs at pharmacies commissioned to provide the Community Pharmacy Stop Smoking Service receive and process the request on the PharmOutcomes template.
Please see the guide for using the NRT e-voucher supply in PharmOutcomes for pharmacy available on the PharmOutcomes template and as a supplement to this specification from the Public Health team.
Individuals will be advised by Health Trainers that they must collect their NRT products from the nominated pharmacy within seven days of issue of the NRT e-voucher. Attempts to redeem after 7 days should be referred back to the Health Trainer team for approval (see contact details below).
A maximum of two NRT products can be recommended on one e-voucher. Individuals will pay a NHS prescription charge for each product supplied. If applicable the stop smoking advisor issuing the NRT must ascertain from the individual if they are exempt from prescriptions charges and note the reason for exemption in PharmOutcomes.
A professional fee (claimed through PharmOutcomes) of £1.25 will be paid to contractors for each voucher presented
PharmOutcomes links to the NHS dictionary of medicines and devices and therefore NRT supplied will be remunerated at the listed price.
Health Trainer Team
Phone 01273 294 589