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Providing stop smoking support for patients who want to stop smoking – Service
Specification
Tier 2 Service
1. Introduction
Smoking is the single biggest preventable cause of il ness and premature death in the UK.
It is estimated that 87,000 people die in the UK each year because of smoking.
Approximately 29% of the population across Bradford smoke, however, smoking rates vary considerably across different population groups, both by ethnicity and socio-economic group. Reducing smoking across al groups and especial y those living within areas of high deprivation in the district is one of the key priorities for the PCT. This service forms part of NHS Bradford and Airedale’s Tobacco Strategy which is been update in line with the district’s Tobacco Needs Assessment.
2. Aims and intended Outcomes
 To provide a 1:1 Stop Smoking Service  To maintain a quality professional service for clients  To reduce smoking related il nesses and deaths by helping people to give up  To improve access to and choice of stop smoking services, including access to pharmacological and non-pharmacological stop smoking aids.
 To improve the health of the population by reducing exposure to passive smoke  To help service users access additional treatment by offering referral to specialist  To contribute to NHS Bradford and Airedale 4-week quit targets 3. Brief Overview
Pharmacies wil supply a Smoking Cessation Service to clients of NHS Bradford and Airedale through a trained Stop Smoking Adviser. When commissioned, the service wil help to improve access to NRT and smoking cessation for people who would otherwise might not access any other stop smoking service.
4. Benefit of the Scheme
 Improve access to smoking cessation services for the clients of NHS Bradford and  To reduce smoking related il nesses and deaths by helping people to give up  To improve access to and choice of stop smoking services, including access to pharmacological and non-pharmacological stop smoking aids.
 To improve the health of the population by reducing exposure to second-hand  To help service users access additional treatment by offering referral to specialist  To work in partnership with local GP practices and Stop Smoking Services 5. Description of the Scheme /how the Scheme works
ApptS Structure of Appointments
Minimum Time
Identify readiness to quit and patients commitment to 30 minutes Give information on withdrawal of nicotine Discuss medications available and how to obtain them Refer pregnant smokers to specialist service Organise voucher for pharmacotherapy to aid quit attempt Quit date should ideal y be identified at this appointment For Zyban and Champix patients should be referred to their Plan for the week ahead – danger times, triggers to smoke, Discuss telephone helpline for extra support if required The above structure of appointments is intended as a Vouchers/ Prescriptions should be issued appropriately to CO validation of smoking status should be carried out and documented on the consultation record form 28days from their quit day (- 3days or +14 days for cases where it is impossible to carry out the fol ow-up at the normal 4 week  Al services must offer structured fol ow up sessions of behavioral support and offer weekly support for at least 4 weeks fol owing the patients quit date. Total client contact must not be less than 1.5 hours. 4 week quits that have not been the result of structured 1:1 interventions delivered by pharmacy staff may not be included in monthly or quarterly data returns. Definition of a 4 week quit must be adhered to  Al advisors must confirm smoking status at 4 weeks after the quit date and attempt to confirm by CO validation. CO validation at 4 weeks should be attempted in at least 85% of cases. An ‘attempt’ to carry out CO verification should comprise a minimum of 3 separate attempts to contact the client via telephone, letter, text or e- mail in order to arrange a face to face CO validation. Any patient setting a quit date and not contacted should be classed as ‘lost to fol ow-up’ on the monitoring form.
A carbon monoxide monitor wil be supplied to participating Pharmacies; local terms are included in appendix 5. Pharmacies are responsible for maintenance of the monitor. If the pharmacy then fails to meet the terms and conditions of this agreement the monitor must be returned to the Bradford and Airedale Stop Smoking Service. (See appendix 5 Co monitor agreement)  Al pharmacotherapies used in conjunction with the patients quit attempt wil be provided on a voucher by the smoking cessation advisor at the consultation.
 A Pharmacy who has provided smoking cessation advice under the scheme to a patient, may refer the patient to the GP practice to obtain a prescription FP10 where the patient prefers to use Zyban (Buproprion) or Champix (Varenicline) as opposed to other forms of NRT under the scheme. In issuing such a prescription, unless it is established that the referring Pharmacy has only offered a brief intervention, then the GP practice should not additional y offer smoking cessation advice or submit a claim under their enhanced service agreement.
 Should a client be deemed to be needing specialist support which is outside the capacity of the pharmacy service, the patient wil be referred to the specialist service; these may include heavily addicted smokers, young people under the age of 18, housebound COPD clients etc. (see appendix 3 for referral pathway to specialist service). Additional y if a situation arises where there is a waiting list of longer than 3 weeks then patients should be referred to the specialist Stop Smoking Flow chart showing the exception reporting procedure:
6. Selection Criteria
 Pharmacies wil be selected in areas of need as outlined in the NHS Bradford and Airedale’s Tobacco Strategy which is been update in line with the district’s Tobacco  Pharmacies must be fulfil ing al essential services to a satisfactory level as identified by tPCT contract monitoring visits.
 The area of the pharmacy used for provision of the service provides a sufficient level of privacy. It must meet the fol owing requirements:  The consultation area should be a designated area where both the patient and pharmacist can sit down together.
 The patient and pharmacist should be able to talk at normal speaking volumes without being overheard by other visitors to the pharmacy, or by pharmacy staff undertaking their normal duties.
 The consultation area should be clearly designated as an area for confidential consultations, distinct from the general public areas of the 7. Data collection and recordkeeping
 Al funding is conditional on providing ful y completed Department of Health Minimum Data Sets monthly, on time as requested. In addition (see also section  The stop smoking advisor should complete a Consultation Record Form (see appendix 1) for al referrals for stop smoking support and wil submit on a monthly  Al fields on the form to be completed and the quit date entered (forms should be submitted according to quit date not 1st appointment date)  Data from the Consultation Record Form wil be used to col ect information required for reporting to the Department of Health Completed Consultation Record forms to be faxed to the Stop Smoking Service
Safe haven fax 01274 202803
To contact the Stop Smoking Service (BACHS) Tel: 01274 202793 Bradford and Airedale Community Health Services Submission of Minimum Data Sets
Minimum Data Sets (completed consultation record form) must be returned on the
5th day of every month. If the 5th falls on a weekend day or bank holiday then forms
to be returned on the next working day.
Quit date set:
Submission date for data returns to
Stop Smoking Services
8. Hours of Service Provision
 For the purpose of Tier 2 smoking cessation services al patients must be offered an  Where possible the pharmacy should try and al ocate a regular time slot to offer  The appointments should be offered during the pharmacy opening hours 9. Responsibilities of the Contractors and Quality Indicators
 The service provided by the pharmacy wil complement the other stop smoking services provided across the district. Pharmacy staff undertaking this service should be wil ing and motivated to ful y participate in the service provision and work in partnership with the Stop Smoking Service.
 Al participating pharmacies must agree to receive training and participate in providing sustainable delivery systems of smoking cessation, through the Systems Approach programme. This wil be delivered in-house free of charge by Bradford  Al advisors must adhere to the NHS Stop Smoking Services, Service and Monitoring Guidance 2009/10, which is covered in the 2 day training.
 Al contractors must see a minimum of 30 patients per annum. Al participating pharmacies should proactively offer services. Where pharmacies consistently fail to meet their agreed targets NHS Bradford and Airedale wil look to withdraw the service and re-commission from other providers  Al pharmacies wil be required to keep al records of client consultation for a minimum of 2 years to al ow for audit purposes.
 As a service provider for NHS Bradford and Airedale, pharmacies must not subcontract service provision to other parties, if this should occur then claims for  Al invoices submitted must be signed and dated and must include and conform to the fol owing declaration ‘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, detecting and investigation of fraud’ (see appendix 4 invoice). For an electronic copy of this invoice please email the Stop Smoking Services to request one.
 Providers of this service wil be expected to achieve at least a success rate of between 35% and 70% (NHS Stop Smoking Services Service and Monitoring Guidance 2009/10). The national average is 50%. Results for al intervention types and settings wil be checked by the NHS Bradford and Airedale lead to determine whether the 4 week quit rates fal between 35% and 70%. If overal service results fal outside this range then the exception reporting system wil be implemented.
(See Service and Monitoring Guidance 2007/08 pg 19) If the pharmacy is failing to achieve the requirements, extra support and guidance wil be offered from one of the practice liaison stop smoking specialists.
 The number of clients who set a quit date and quit for four weeks;  The numbers of clients who set a quit date but are then ‘lost to fol ow-up;  The number and percentage of clients who have their smoking status validated, at the end of their support, by carbon monoxide testing; (see 6.5)  The number of forms which are completed correctly, in ful and submitted on time  NHS Bradford and Airedale wil audit the performance of the pharmacy. This may include contacting patients using the minimum dataset to confirm compliance and that the pharmacy has met the requirements of its agreed protocol.
Outcomes wil be monitored by NHS Bradford and Airedale to ensure that a quality service Providers wil be expected to co-operate with local y agreed requests for completion of NHS Bradford and Airedale led evaluation forms/patient satisfaction surveys from users of The pharmacy wil undertake a service audit at least once per annum when required by the The pharmacy wil co-operate with any local y agreed PCT-led assessment of service user experience which wil be required no more than once per annum.
10. Responsibilities of the PCT
To support Pharmacist that provide in-house stop smoking support, the PCT wil commission Bradford Stop Smoking Service (BACHS) to provide the fol owing:  Al resource information and training required to support the pharmacy registered advisor to deliver one to one stop smoking advice  Ongoing support including pharmacy visits by the practice liaison stop smoking  Support via the Systems Approach programme to create sustainable mechanisms for delivery of effective stop smoking interventions within the pharmacy.
 Equipment necessary to conduct the service eg carbon monoxide monitors and 11. Training and Development
 Pharmacy staff providing a smoking cessation service are required to complete, submit and have approved the Enhanced Services Clinical Quality registration form  It is the contractor’s responsibility to ensure that pharmacy staff have undergone appropriate training and keep their skil s up to date. Training wil be commissioned by NHS Bradford and Airedale and provided by the Bradford Stop Smoking Service team as part of Bradford and Airedale Community Health Services (BACHS) and consists of 2.5 days training annual y. Only staff who have successful y completed training and are accredited with Bradford Stop Smoking Service wil be able to offer this support to smokers. Advisors wil be expected to maintain continuing professional development/accreditation/refresher course on an annual basis by 12. Payments
There is a stepped structure of payments: I. For a patient who has successful y quit for 4 weeks, has had their smoking status validated by carbon monoxide testing and where a ful assessment and completed client consultation form has been received by Bradford Stop Smoking Service a II. For patients who have successful y quit for 4 weeks, have not had their smoking status validated by CO testing and where a ful y completed client consultation form has been received by Bradford Stop Smoking Service then a payment of £30 wil be III. For patients who set a quit date but fail to quit for four weeks, or are ‘lost to fol ow- up’ then a payment of £15 wil be made, providing a completed client consultation Al pharmacies that fail to return data within the pre-arranged deadlines wil be made aware that payments wil not be made. This includes late, incomplete or missing data returns also. Payments are made by invoice on a monthly basis.
Where pharmacies fail to return data within the pre-arranged deadlines, or where returned data is incomplete or missing then the service lead wil contact the pharmacy to discuss this and an agreement wil be made at this time to address this by adjusting the invoice or non-payment.
13. References
14. Acknowledgements
15. Appendices
Appendix 1
Consultation Record Form
Details:
Note: Al patient data wil be kept securely in accordance with Caldicott guidelines. Information can only be passed to another healthcare professional if this contributes to the provision of effective care.
For Young People: I understand that this service works within the ‘Fraser Guidelines’
Ethnic Background – please tick
Pharmacotherapy
or Type of Pharmacological
Support Used: (please tick
Client Occupation Code
Background None
Asian
Other Ethnic Group
Type of Intervention
Where did you find out about our
(Please tick ONE type)
service?
(Please tick relevant box)
quit date)
Treatment Outcome
Date of 4 Week
Follow Up
4 Week Outcome
(please tick)
Signature:
___________________________________
(indicating consent to treatment and follow-up and pass on of Not Quit
outcome data to tPCT)
Adviser

Signature: Date:
__________________________________
_________________ Lost To Fol ow Up
Appendix 2
Definition of a four week quit
Appendix 3
Referral Pathway
Is the patient under the age of 18 and/or Appendix 4
Payment to:
Invoice Date:
Invoice to:
Contact Name
Description of Services
Pharmacy based Intermediate Service for Quarter ____ 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, detecting
and investigation of fraud.
Signed:…………………………………………………….Date:…………………………………
Appendix 5
An AGREEMENT between NHS Bradford & Airedale PCT the provider of the
equipment and the Pharmacy (provider) who are users of the equipment
Carbon monoxide monitors are supplied to the user on the fol owing terms and conditions:- 1. The equipment remains the property of BACHS and must be returned to BACHS when authorised usage of such equipment ceases or the Pharmacy contract 2. The user must maintain the equipment in good working order at al times. The carbon monoxide monitor must be returned to Bradford Stop Smoking Service to be calibrated every 6 months. Additional y, it must be returned for an annual maintenance check. The cost of the maintenance check is £24.50 and this amount should be deducted from your Quarter 1 invoice for period 1st April to 30th June.
3. NHS Bradford & Airedale wil pay al costs attributable to the usage of the 4. The equipment is supplied to the user on the strict understanding that it is used
for business use only.
5. Failure of the user to comply with the terms and conditions of this agreement may result in the termination of their contract.
6. If the Carbon monoxide monitor/s are lost or damaged by the Pharmacy the cost of the equipment wil be reimbursed to BACHS Stop Smoking Service.
We hereby agree (on behalf of the Provider) to the terms and conditions as set out above for the Carbon monoxide monitor/s listed below:- Signed ……………………………
Name: ……………………………….
(please print)
Title ………………………………
Pharmacy …………………………
Address …………………………….
…………………………….
…………………………….
Appendix 6
Registered Smoking Advisor Clinical Quality Registration Form
Registered Smoking Advisor
Attendance at Bradford Stop Smoking Service training Evidence
And
Commit to completing annual update training and wil
Signed………………………………… Date…………………………………… I believe the applicant to be competent to deliver this service as described without
direct supervision. Services are accredited for a period of 5 years. If changes in
personnel circumstances occur then submission of a new Clinical Quality
Registration form is required.
Signed………………………………… Date……………………………………(Medical Director or Deputy NHS Bradford and Airedale) Return to, Julie Lyman, Level 2, Douglas Mill, Bowling Old Lane, Bradford, BD5 7JR

Source: http://www.cpwy.org/doc/240.pdf

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