Service Specification No.
ES08
Service
Stop Smoking Service – Community Pharmacy Enhanced
Service
Authority Lead
Su Sear
Provider Lead
1st October 2014 – 31st September 2015
Period
Date of Review
1. Population Needs
1.1 National/local context and evidence base
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The Stop Smoking service is one in which pharmacies provide one to one opportunistic
support and advice to people who want to give up smoking. The service will help to increase
choice and improve access to Stop Smoking Services, especially for ‘hard to reach’ groups,
2. Key Service Outcomes
2.1 Insert any locally agreed outcomes and quality requirements which are NOT Quality
Outcomes Indicators which should be set out in Appendix C (Quality Outcomes Indicators)
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The pharmacy provides one to one support and advice to the user, and referral to own GP or
telephone support if necessary.The pharmacy facilitates access to, and where appropriate
supplies, appropriate stop smoking drugs and aids.
This service will contribute to the following indicators within : Improving Outcomes and Supporting
Transparency: A Public Health Outcomes Framework for England 2013-2016 (DH, 2012)
Domain 2: Health Improvement
 Low birth weight of term babies
 Smoking status at time of delivery
 Smoking prevalence – adult (over 18s)
Domain 4: Public Health and Preventing Premature Mortality
 Mortality from cause considered preventable
 Mortality from all cardiovascular disease (including heart disease and stroke)
 Mortality from cancer
 Mortality from respiratory diseases
3. Scope
3.1 Aims and objectives of service
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To improve access to and choice of stop smoking services, including access to
pharmacological and non-pharmacological stop smoking aids.
To reduce smoking related illnesses and deaths by helping people to give up smoking.
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To improve the health of the population by reducing exposure to second hand smoke.
To help service users access additional treatment by offering referral to their own GP or
telephone support where appropriate.
3.2 Service description/pathway
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3
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Access routes to this service are
- self-referral (opportunistic)
- pharmacy referral as a result of the ‘Promotion of healthy lifestyles (Public Health)’ or
‘Signposting’ Essential services;
- signposting from the central booking telephone call centre .
- signposting from GP practices
The initial assessment includes:
- establishing the person is eligible to access the scheme
- an assessment of the person’s readiness to make a quit attempt
- an assessment of the person’s suitability and/preference for nicotine replacement
therapy (NRT), varenicline or bupropion
- an appointment for an initial consultation if appropriate
People not wishing to initially engage, should be given the opportunity to return to the service
in the future, and supplied with any support material, website addresses contact details of call
centre.
The initial consultation should last approximately 30 minutes and include:
- an explanation of the benefits of quitting smoking;
- a description of the main features of the tobacco withdrawal syndrome and the
common barriers to quitting;
- a description of the effects of second hand smoke on children and adults;
- identification of treatment options that have proven effectiveness;
- a description of a typical treatment programme, its aims, length, how it works and its
benefits;
- applying appropriate behavioural support strategies to help the person quit, including
supply of supportive literature;
- a carbon monoxide (CO) test and an explanation of its use as a motivational aid;
- maximising commitment to setting a quit date;
- gaining agreement on the chosen treatment pathway, ensuring the person
understands the ongoing support and monitoring arrangements.
If considered appropriate for NRT, the pharmacist, or other accredited member of staff,
supplies nicotine replacement therapy and advises on its use. A supply sufficient for two
weeks should be made at the initial consultation. The Client Charges Declaration Form must
be completed on EVERY occasion NRT is supplied.
If considered appropriate for Varenicline or bupropion the client is issued with a referral
request letter to take to their own GP
Completion of documentation
- Ensure Stop Smoking Service Registration monitoring form on Pharmoutcomes is
completed.
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Supply of treatment must be recorded on the person’s pharmacy patient medication record
(PMR). Consideration should be given to communicating this information to the person’s GP
where clinically appropriate, eg. Drug interactions.
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Follow up consultations, which should be agreed with the person, last approximately 10
minutes and include support and smoking status validation using a CO test where possible.
Some follow up consultations can be in the form of telephone consultations, where
appropriate. A further supply of NRT or GP request letter should be made, if necessary,
following the appropriate protocol. An entry for each supply should be made on
Pharmoutcomes.
People who chose not to complete the programme at any point should be offered appropriate
health literature and/or referred to an alternative provider as appropriate.
A record of the outcome should be recorded on the Stop Smoking Claims form on
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Pharmoutcomes.
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Following the initial consultation, up to six follow up consultations may be undertaken
depending upon the needs of the client (this includes telephone consultations)
An example of a consultation schedule is shown below
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Start
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3 to 4 days
post
quit
date
10
post
date
days
quit
2½
post
date
wks
quit
4½
post
date
wks
quit
6½
post
date
wks
quit
8½
post
date
wks
quit
The 4-week follow up should include self-reported smoking status, including a CO test for
validation where possible. The Stop Smoking Claims form on Pharmoutcomes should be
completed.
The pharmacy must maintain appropriate records to ensure effective ongoing service delivery
and audit. Client Notes must be stored securely for 8 years.
The materials and equipment such as CO monitor and calibration equipment, and disposable
mouthpieces, must be provided by the pharmacy and equipment maintained by the
pharmacy. A separate notification will be made in circumstances where an agreement has
been reached for re-imbursement of set-up costs and with accompanying advice on
equipment specifications and availability.
The service commissioner will provide a framework for the recording of relevant service
information for the purposes of audit and the claiming of payment (standards and
documentation listed in section 4.2)
The service commissioner will be responsible for the promotion of the service locally,
including the development of publicity materials.
The service commissioner will provide details of relevant referral points which pharmacy staff
can use to signpost service users who require further assistance.
The service commissioner will arrange contractor meetings as appropriate to promote service
development and update the knowledge.
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3.3 Population covered
Residents of Cumbria, aged 16 years and over, who wish to stop smoking and self-refer, or are
referred, to the pharmacy for stop smoking services
3.4 Any acceptance and exclusion criteria and thresholds
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Children and adolescents below the age of 16 years should be offered appropriate health
literature and/or advised to speak to their school nurse.
Alternative providers may include GP practice or the telephone support line as appropriate to
the individual and locality.
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3.5 Interdependencies with other services
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Telephone support line
GPs (for referrals)
NHS Commissioning Board (commissioners & performance monitoring of Pharmaceutical
Terms of Service)
3.6 Any activity planning assumptions
None
4. Applicable Service Standards
4.1 Applicable national standards eg NICE
NICE Public Health Guidance 10 (2008) – Smoking Cessation in primary care, pharmacies, local
authorities and workplaces, particularly for manual working groups, pregnant women and hard to
reach communities
NICE Public Health Guidance 26 (2010) - How to stop smoking in pregnancy and following childbirth
NICE Public Health Guidance 1 – Brief intervention and referral for smoking cessation in primary care
and other settings (2006)
NICE Technology Appraisal Guidance 123 - Varenicline for Smoking Cessation (2007)
NHS Centre for Smoking Cessation and Training (NCSCT) Standard Treatment Programme
http://www.ncsct.co.uk/
NHS Stop Smoking Service, Service and Monitoring Guidance 2012/13 (2012)
Healthy Lives, Healthy People A Tobacco Control Plan for England, 2011
4.2 Applicable local standards
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The pharmacy has a consultation room.
The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the
provision of the service have relevant knowledge and are trained as intermediate level stop
smoking advisers and in the operation of the service.
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 pathways
(listed below), and NICE guidance.
Local protocols, pathways and documentation (updated in February 2013):- Therapy Options
- Nicotine Replacement Therapy (NRT) Protocol
- NRT Protocol - notes
- Varenicline Therapy Protocol
- Varenicline Therapy Protocol notes
- Bupropion Therapy Protocol
- Bupropion Therapy Protocol notes
- Protocol for Pregnant Women
- Pregnancy Protocol – notes
- Prescription Request for Varenicline (“Varenicline 1”, GP referral letter for initial request &
“Varenicline 2” for continuation request)
- Prescription Request for Bupropion (“Bupropion 1” GP referral letter for initial request &
“Bupropion 2” for continuation request)
- Consent Form for Nicotine Replacement Therapy (NRT) in Pregnancy
- Motivation to Quit – the 5R’s
- Treatment Plan – the 5As
- Client History Form (also referred to as Client Notes)
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Training, assessment, accreditation and competency requirements
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All pharmacists, technicians and pharmacy staff providing the service must have achieved
NCSCT Certification (Stages 1 & 2), have their status as working for a Stop Smoking Service
confirmed by their employer or commissioner AND attended a relevant workshop
NCSCT Certification can be achieved through the NHS Centre for Smoking Cessation and
Training by completion of their online training and assessment programme.
- Underpinning knowledge – NCSCT Level (Stage 1)
- Stage 1 Assessment
- Stage 2 Assessment
A relevant workshop must include various appropriate role-play scenarios and assessment.
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The 2 current options are:
- Two-day NCSCT Face-to-Face Training Course on Behavioural Support
- CPPE Local Solutions Workshop
Knowledge of relevant local pathways, protocols, guidelines, as notified by service
commissioner
Access to the NCSCT training and assessment programme is via:
http://www.ncsct.co.uk
A copy of the certificate of completion of the programme must be retained at the pharmacy
premises.
This level of assessment and accreditation only corresponds to Provision of a Smoking
Cessation Intervention Service Stages 1 & 2 (NCSCT levels) of the HAG Competencies and
Training Framework for this service, Version 3, issued January 2012.
Please note that full HAG accreditation, (as specified in the HAG Competencies and Training
Framework for Provision of a Smoking Cessation Service, Version 3, issued January 2012) is
not a requirement of this service specification. Full HAG accreditation would only be
achieved by Stage 3 training and assessment to support the supply of Prescription Only
Medicines (POMs) under Patient Group Direction (PGD).
An additional NCSCT speciality training and assessment module, entitled “Pregnancy and the
Post-partum Period”, has become available from March 2013 and is recommended for
pharmacists, technicians and pharmacy staff who have achieved NCSCT Certification
(Stages 1 & 2) and who help pregnant smokers to stop smoking.
Pharmacies will be advised about the process for verification of the above assessments for
accreditation and about maintenance of accreditation in due course
Quality indicators
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The pharmacy has appropriate health promotion material available for the user group and
promotes its uptake.
The pharmacy reviews its standard operating procedures and the referral pathways for the
service on an annual basis.
The pharmacy can demonstrate that pharmacists and staff involved in the provision of the
service have undertaken CPD relevant to this service.
Evidence of NCSCT accreditation to be retained at the pharmacy premises for all pharmacists
and staff providing the service.
The pharmacy participates in any audit of service provision organised by the service
commissioner.
The pharmacy co-operates with any assessment of service user experience organised by the
service commissioner.
o Enhanced Services in the NHS Northwest which accredits the pharmacist to provide
o Cumbria PCT and may be recognised by other PCTs in NHS Northwest regi
5. Location of Provider Premises
The Provider’s Premises are located at:
[Insert address of Provider’s Premises if applicable]
6. Required Insurances
6.1 Appropriate public liability insurance must be held