ERYC Standard PH Contract
Administering Authority:
Provider Name:
Contract Title
Contract Number:
Service Area:
Service Type:
Contract Type:
Start Date:
End Date:
Extension Options:
Authority Lead Officer:
Amendment Date:
East Riding of Yorkshire Council
Tier 3 Stop Smoking Service
PHSCS3/2014
Smoking Cessation
ERYC Public Health
Fixed Term
01 April 2015
31 March 2018
Up to Two further Years at the ERYC sole discretion
Paul Wolstencroft
APPENDIX A - SERVICE SPECIFICATION SMOKING CESSATION TIER 3
1.
POPULATION NEEDS
1.1
National/local context
Smoking is the leading causes of preventable deaths and illness in England, with an estimated
19.1% of the East Riding of Yorkshire adult population are smokers1. Smoking contributes
towards the development of many diseases, but is most commonly linked with coronary heart
disease, stroke, lung cancer, asthma and chronic obstructive pulmonary disease. For those who
smoke, quitting is often the single most effective method of improving current health and
preventing illness.
Smoking is a key driver of health inequalities and smoking prevalence is highest in deprived
communities. However reductions in smoking prevalence have been slower in these
communities than other population groups.
In the East Riding of Yorkshire smoking attributable hospital admissions are higher than the
national average at 1,501 per 100,000 and smoking attributable deaths are just below the national
average at 290.5 per 100,000 in addition to this the smoking status at time of delivery for
pregnant women is also higher than the national average at 14%2.
The provision of high-quality stop smoking services is a high priority for Public Health England.
Since their inception in 1999, stop smoking services have helped millions of people to stop
smoking successfully and are a key part of tobacco control and health inequalities policies both at
local and national levels. Stop smoking services should be seen in the same way as any other
clinical service offered to anyone who expresses an interest.
The support provided by local stop-smoking services continues to offer some of the best
opportunities to stop smoking, proving up to four times more effective than attempting to stop
unassisted and twice as effective as the provision of a stop-smoking medicine on its own. It is
therefore important that evidence-based, high-quality stop-smoking support, configured to meet
the needs of the local population, and delivered by qualified and well-trained service providers, is
available to those who require it.
1
The local tobacco profiles for England provide a snapshot of the extent of tobacco use, tobacco related harm, and measures
being taken to reduce this harm at a local level and are available here: http://www.tobaccoprofiles.info/
2 The local tobacco profiles for England provide a snapshot of the extent of tobacco use, tobacco related harm, and measures
being taken to reduce this harm at a local level and are available here: http://www.tobaccoprofiles.info/
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ERYC Standard PH Contract
2.
KEY SERVICE OUTCOMES
2.1
The Service will achieve the following outcomes:
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reduced smoking prevalence in East Riding of Yorkshire and improving the health of the
population;
reduce smoking status of pregnant women at time of delivery;
improve access to and choice of stop smoking services, including access to
pharmacological stop smoking aids;
reduce smoking related illnesses and deaths attributable to smoking;
improve the health of the population by reducing exposure to passive smoke;
reduces health inequalities.
3.
SCOPE
3.1
Aims and Objectives of Service
The aim of this service is to reduce the number of smoking dependent individuals within
the East Riding and negatively impact on instances of smoking related harm.
This will be achieved by:
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providing advice, information, assessment and structured interventions to residents
of the East Riding of Yorkshire who wish to give up smoking and who are unable to
access the community provided services;
offering a range of NRT products to support service users in their attempt to quit;
Signposting those service users experiencing difficulties to relevant GP services;
providing training to other Public Health service areas to enable identification and
assistance in accessing stop smoking services;
delivering national and locally coordinated marketing and communication strategies
designed to motivate and encourage quitting through the provision of information
and identification of service access points;
Ensuring integration and transferability from the Tier 3 to Tier 2 service on
discharge from hospital or where a work based programme ceases.
Service Elements:
Element One – Support and Advice
Stop Smoking Services which are easily accessible for targeted groups by placing the
service in hospitals and outreaching into target communities. Target groups will include:
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Patients in acute hospital settings covering emergency care, planned specialist
medical care or surgery, outpatient clinics, and community based secondary care;
Pre-operative patients within the primary care setting prior to hospital admission;
Pregnant women accessing maternity services;
Patients with severe mental illness accessing mental healthcare services in hospital.
outpatient, community, psychiatric and secure settings;
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ERYC Standard PH Contract
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Other cohorts of people within the community as determined by the Commissioner
and in response to identified need e.g. workplace initiatives, routine and manual
workers, young people aged 12 – 15 years, areas with high smoking prevalence and
limited stop smoking service provision.
The provider will ensure immediate access and supply to the Commissioner full list of
approved NRT products as identified on the monitoring template. In order to ensure
continued high motivation levels Providers must be able to access and issue NRT to
Service Users as part of the registration process and follow up appointments.
Element Two – Training Packages
The provision of ad hoc training packages as instructed and agreed by the Commissioner,
these will consist of low level training to groups identified by the Commissioner and will
not be inclusive of the providers tender bid. The Provider will undertake all
administration and planning including evaluation. Prices for individual training sessions
will be agreed with the Commissioner prior to the delivery.
Element Three – Marketing and Communication
The Provider will work collaboratively with providers of other Public Health services to
ensure the promotion and marketing of smoking cessation and other appropriate related
services. Additionally, the Provider will coordinate the ERYC participation in National
Smoking and related Campaigns.
3.2
Service Description
3.2.1
Element One – Provision of Stop Smoking Services to Targeted Groups
The Provider will:
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3.2.2
Ensure that the Service is targeted at residents of the East Riding of Yorkshire local
authority area who are in the target groups outlined in Paragraph 3.1, Element one
above;
Provide sessions at the hospitals identified in Paragraph 5.2, for residents of the East
Riding of Yorkshire local authority area who are in the target groups outlined in
Paragraph 3.1. Element one;
Provide outreach sessions with various organisations for example - local employers,
education establishments, mental health providers and areas identified as high need
with limited stop smoking service provision;
Work closely with East Riding Tier 2 Stop Smoking Services to ensure continuation
of provision when transferring between Tier 3 and Tier 2 services.
Eligibility
Provide the Service only to Service Users who are residents of the East Riding of
Yorkshire aged 12 and over.
3.2.3
Process
3.2.3.1 Registration – Initial Assessment
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ERYC Standard PH Contract
Undertake a comprehensive initial assessment/consultation with every Service User that
shall include:
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assessment of the person’s readiness to make a quit attempt;
assessment of the person’s willingness to use appropriate treatments;
explain the carbon monoxide (CO) test and an explanation of its use as a
motivational aid;
the identification of treatment options that have proven effective;
a description of what a typical treatment programme might look like, its aims, length,
how it works and its benefits;
the application of appropriate behavioural support strategies to help the Service User
quit reaching an agreement with the Service User on the chosen treatment pathway,
ensuring that the Service User understands the ongoing support and monitoring
arrangements;
describing the effects of passive smoking on children and adults;
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.
3.2.3.2 Set Quit Date
A quit date will normally be set as part of the initial consultation. NRT must not be
supplied unless a quit date has been set.
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undertake an assessment of smoking status based upon the Service Users’ self-report
followed by a CO test for validation at the Initial Assessment/Set Quit Date, 4 week
consultation and 7 week consultation. A CO reading of less than 10ppm validates a
non-smoking status where this has been achieved at the four week consultation the
provider must identify this on the template;
explain how and where to access follow up consultations delivered free as part of
this service and delivered in line with NICE guidance;
ensure that all information will be given taking into account the Service User’s
current level of awareness of the issues.
where considered appropriate, the Provider will in line with NICE guidance, register
the individual and enter the required information on the PharmOutcomes templates
as necessary and set a Quit Date. The Provider will then supply Commissioner
authorised NRT products as per the service model and provide advice and support
on their use. All supply of NRT products must be recorded in PharmOutcomes to
activate re-payment for products and service charges. The Provider will establish the
Service Users medical history, previous use of pharmacotherapy, and any other
current medication to ensure the supply is safe, appropriate and in accordance with
NICE documentation.
a quit date will normally be set as part of the initial consultation however where this
is not possible, NRT must not be supplied. Service users who are unsuitable to quit
via this service but are still motivated to quit should be signposted to their GP;
agree timescales for each weekly follow up consultation with the Service User see
Annex A Model of this specification for treatment pathway;
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ERYC Standard PH Contract
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only the list of products authorised by the Commissioner and available on the
PharmOutcomes template will be re-claimable for the provision of this service
however, the Service User may at their own discretion purchase more or other
products. A list of Commissioners currently authorised NRT products is included
within the PharmOutcomes template. Any amendments to this list will be reflected
in an updated template. No other products will be funded in whole or part;
the Provider will be responsible for ensuring all pharmacotherapy will be supplied
strictly in accordance with the manufacturer’s product license;
Providers will take into account Service User preference and cost effectiveness when
advising Service Users with the most suitable NRT products;
provide advice and support to the Service User for up to 8 weeks as per the attached
model at Annex A of this specification.
supply of NRT products will only be on a one week basis (in exceptional
circumstances such as pre planned holidays/work commitments NRT may be
supplied for a maximum of 2 weeks and the PharmOutcomes template must be
annotated to reflect this);
all products issued must have a sticky label affixed covering the bar code;
NRT products funded through the Service will only be re-paid at tariff price and
where issued as per the model attached at Annex A to this specification;
Providers will not provide NRT products after the 8 week CO reading via funding
from this contract. If Service Users wish to continue to use NRT after this period,
they must be purchased by the individual Service User;
Service Users not wishing to initially engage with the Service or those who do not
complete the programme, will be offered appropriate health information and
provided with the national Smokefree telephone number. It shall be emphasised that
they can re-engage with the Service at any time however they will not be eligible for
free NRT products within three months of any failed quit attempt;
a minimum of 3 months must lapse before a client who has previously participated
in the Service can be re-registered, unless prior agreement with commissioner is
obtained;
all Service Users referred to or from the East Riding Tier 2 Stop Smoking Service
will receive a seamless continuation of service provision ensuring the entire
treatment pathway is completed as per the treatment model and PharmOutcomes
template.
3.2.3.3 Weekly Behavioural Support Sessions
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check Service Users progress;
enquire about medication and ensure sufficient supply;
discuss withdrawal symptoms, cravings urges experienced and strategies for dealing
with them;
discuss any difficulties and coping mechanisms;
discuss and agree any potential high risk situations in the coming week and methods
for coping;
provide a summary of the week’s positive achievements;
ensure CO reading is taken at weeks 4 and 8.
3.2.3.4 Premises and Equipment
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ERYC Standard PH Contract
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the Provider/s must ensure that there is an appropriate area within the settings used
for provision of the Smoking Cessation Service which will provide a sufficient level
of privacy and safety;
Providers will be responsible for the ownership, calibration, maintenance and, where
necessary, replacement of all CO monitoring equipment. Where consumables are
required, e.g. disposable tubes and wipes, these are also the responsibility of the
provider.
3.2.3.5 Records/Templates
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3.2.4
the Provider will maintain appropriate and accurate records to ensure effective
ongoing service delivery and audit via PharmOutcomes/Outcomes4Health;
records of all consultations must be entered in full on the software platform which
will be the means of reporting, record keeping and invoicing for all of Element one
service fees including NRT re-payment.
the appropriate software template for each one-to-one session must be completed
during the initial consultation and registration additionally, a record of all follow up
advice and support sessions and the supply of NRT products must be updated on
PharmOutcomes to enable payment.
Element 2 – Training Packages
The provision and administration of ad hoc Smoking Cessation training packages as
agreed and instructed by the Commissioner. Training recipients will include, but not be
limited to, Health Visitors, School Nurses, Midwives, and Practice Nurses. The provider
will be responsible for all pre-course administration, providing all hand-outs and
resources required to deliver the training and provide an evaluation report following each
training package.
The training will normally be based around the three main elements of very brief advice:
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establishing smoking status;
advice on how to stop smoking;
how and where to access support and treatment.
The training must reflect the provision of stop smoking services in the East Riding of
Yorkshire. The final content of the training course will be agreed with the Commissioner
along with the price per session prior to delivery.
3.2.5
Element 3 – Marketing and Communications
The Provider will:
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design and deliver local campaigns including insight, segmentation of audiences,
internal behaviour change, promoting best practice and buying of media space for a
minimum of six campaigns per year with two of the six campaigns per year
supporting the local roll out of national campaigns currently “No Smoking Day” and
“Stoptober”;
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ERYC Standard PH Contract
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3.3
will coordinate the implementation of the campaigns and on-going marketing
activity via a broad range of marketing channels ensuring that communication is
tailored to the relevant population groups;
be responsible for creating, editing, proofing and production of publications and
materials in consultation with the Commissioner Lead Officer prior to final
implementation;
be responsible for marketing and promotion of all of the East Riding Stop Smoking
Services and will be responsible for linking with the Tier 2 provider/s to ensure the
full range of services are promoted to all population groups within the East Riding;
local marketing campaigns must be designed to improve understanding of what local
services are on offer, how to access them and where additional or alternative help is
available;
submit a cost in their bid that includes all costs of any resources required, in
exceptional circumstances the Lead Officer may exceptionally allocate additional
funds to the achievement of specific aims identified by the Commissioners;
Acceptance and Exclusion Criteria and Thresholds
Element 1 of the Tier 3 (Smoking Cessation) Service will be available to those residents
of the East Riding of Yorkshire local authority area aged 12 years or older and fall into
one or more of the following target groups:
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3.4
Patients in acute hospital settings covering emergency care, planned specialist
medical care or surgery, outpatient clinics and community based secondary care
Pre-operative patients within the primary care setting prior to hospital admission
Pregnant women accessing maternity services
Patients with severe mental illness accessing mental healthcare services in hospital.
outpatient, community, psychiatric and secure settings
Other cohorts of people within the community as determined by the Commissioner
and in response to identified need e.g. workplace initiatives, routine and manual
workers, , areas with high smoking prevalence and limited stop smoking service
provision
Interdependencies with Other Services
This service will work collaboratively with other public health services as part of an
integrated approach to achieving positive health outcomes for residents of the East
Riding of Yorkshire; these will include but not be limited to:
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Primary and Secondary Health providers;
All Public Health Commissioned services;
Pharmacists;
East Riding Tier 2 Stop Smoking Service.
Employers;
Ethnic Groups;
Schools;
Colleges;
Leisure/fitness providers
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ERYC Standard PH Contract
Please note this list is indicative and not exclusive.
3.5
Activity Planning Assumptions
The service will be supported by the provision of NRT products as approved by the
Commissioner which will be re-paid at tariff price. The current authorised list will be
included within the PharmOutcomes template.
4.
APPLICABLE SERVICE STANDARDS
4.1
Applicable National Standards
The Provider will be responsible for ensuring all Service Users received behavioural
support from a person who has had training and supervision that complies with the
‘Standard for training in smoking cessation treatments’
(http://www.nice.org.uk/proxy/?sourceUrl=http%3a%2f%2fwww.nice.org.uk%2fpage.
aspx%3fo%3d502591) or its updates. The Providers will also ensure that staff maintain
competencies and describe these arrangements in its standard operating policy.
The provider will deliver services in line with the following guidance:
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The National Institute of Clinical Excellence publication, Public Health Guidance 10
– Smoking Cessation Services
(http://guidance.nice.org.uk/PH10/Guidance/pdf/English)
The National Institute of Clinical Excellence publication, Public Health Guidance 45
– Tobacco: harm-reduction approaches to smoking
(http://publications.nice.org.uk/tobacco-harm-reduction-approaches-to-smokingph45)
The National Institute of Clinical Excellence publication, NICE quality standard 43
– Smoking Cessation: supporting people to stop smoking
(http://guidance.nice.org.uk/qs43)
The National Institute of Clinical Excellence publication, TA123 – Varenicline for
smoking cessation (http://publications.nice.org.uk/varenicline-for-smokingcessation-ta123)
The National Institute of Clinical Excellence publication, PH48 – Smoking
Cessation in Secondary Care: acute, maternity and mental health services
(http://www.nice.org.uk/guidance/PH48)
The National Institute of Clinical Excellence publication, PH6 – Behaviour change:
the principles for effective interventions (http://www.nice.org.uk/guidance/ph6)
National Centre for Smoking Cessation and Training’s publication Local Stop
Smoking Services: Service and Delivery Guidance 2014
(http://www.ncsct.co.uk/publication_service_and_delivery_guidance_2014.php)
This list is not exhaustive and may be subject to change.
4.2
Applicable Local Standards
The Provider can refer to the following local strategy:
East Riding Joint Strategic Needs Assessment
http://dataobs.eastriding.gov.uk/jsna/jsnahome
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ERYC Standard PH Contract
This guidance is not an exhaustive list. The Provider will be expected to work in
collaboration and flexibly with the Commissioners to implement any new and emerging
policy guidance which relates to, and links with, the delivery of care and well-being of the
population of the East Riding of Yorkshire under this specification.
5.
GEOGRAPHIC COVERAGE/BOUNDARIES
5.1
Location of Provider Premises
Element one
The provider will be required to provide a minimum of one two hour session per week at
each of the following ward and/or clinic types with the purpose of targeting patients in
acute hospital settings covering emergency care, planned specialist medical care or
surgery, outpatient clinics, community based secondary care and maternity units.
Hospitals:
 Castle Hill Hospital
 Bridlington Hospital
 Goole Hospital
 Hull Royal Infirmary
 York District Hospital
 Scarborough Hospital
The Provider must be able to offer flexibility to ensure referrals from primary care are
picked up and initial assessments are made and appropriate continued service provision is
provided, either via the tier 3 or tier 2 services.
A minimum of six outreach programmes will be undertaken annually with the purpose of
recruiting new service users from the target groups agreed with the Commissioners Lead
Officer. The annual programme of venues will be submitted to the Commissioners Lead
Officer for agreement by the end of February of the affected year with the exception of
year one where it will be required one calendar month following commencement of the
contract. The programmes will ensure that appropriate continued service provision is
provided, either via the tier 3 or tier 2 services by referring, signposting and providing
Tier 2 providers’ information as necessary.
Element 2
Ad hoc training packages will be agreed by the Commissioner to deliver low level training
to other Public Health providers to assist them in identifying, motivating and signposting
potential quitters appropriately. Precise content will be agreed by the Commissioners
who will give a minimum of 6 weeks’ notice to the provider prior to training taking place.
The provider will be responsible for all administration, venues etc and will quote a price
to be agreed by the Commissioner prior to delivery. These costs are not included within
the requested contract delivery price and will be agreed separately however no guarantee
of usage is given.
5.2
Days/Hours of Operation
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ERYC Standard PH Contract
Element 1
The Service Provider will need to be flexible in arranging different appointments at times
that suit the particular target group of Service Users, ensuring evening and weekend
appointments are available to meet the needs of Service Users who are working or in full
time education and the settings where provision is supplied.
The Provider must ensure and liaise with hospitals and health settings to ensure that Tier
3 services do not interfere with the normal operation but do meet the access needs of the
target groups therefore a regular programme must be established and the Commissioner
informed of the details.
5.3
Element 2
Provision of an unspecified number of training sessions annually with the additional
costs to be agreed prior to delivery. These will normally take place during normal office
hours, Monday to Friday between 9am and 5pm at venues within the East Riding of
Yorkshire.
5.4
Element 3
A minimum of six local marketing campaigns will be undertaken annually with the
purpose of improving understanding of what local services are on offer and how to
access them. The annual programme of marketing campaigns will be submitted to the
Commissioners Lead Officer for agreement by the end of February of the affected year
with the exception of year one where it will be required one calendar month following
commencement of the contract.
Two of the local campaigns per year will support the local roll out of the national
campaigns currently “No Smoking Day” and “Stoptober”.
6.
REQUIRED INSURANCES
6.1
In addition to Clauses 27.1, 27.2, 27.3 and 27.4 of the Contract Terms and Conditions,
Providers are required to have insurances at the minimum levels detailed below:
Employer Liability
£10 million
Public Liability
£5 million
Professional Indemnity/medical negligence
£2 million
Providers will be required to evidence the above by submitting copies of their policy
documents and proof of payment prior to being awarded a contract.
Regarding cover, successful parties may need to evidence that the cover will operate in
respect of Public Health contracts issued by the local authority for which they will
receive a fee.
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ERYC Standard PH Contract
Annex A to Appendix A (Tier 2/3 Smoking Cessation Specification) –Treatment Pathway
Week
1
• Registration and Pre-Assessment - 35 Mins
• Quit Date Session - 10 Mins
• Issue up to two NRT Products - 5 Mins
• Total 50 Mins - Payment £21 - (50% withheld until week 4)
Week
2
• Behavioural Support and issue up to two NRT Products
• Total 15 Mins - Payment £6.30 - (£1.30 with held until week 4)
Week
3
• Behavioural Support and issue up to two NRT Products
• Total 15 Mins - Payment £6.30 - (£1.30 with held until week 4)
Week 4
Quitter
• CO Reading must be taken to verify Quitter status and Trigger remaining 50% Registration Payment
• Issue up to two NRT Products
• Total 25 Mins - Payment £10.50
• Verified quitter status triggers remaining 50% Registration and Assessment Payment, and £1.30 payment with held
from weeks 2 and 3 - End of Programme
• Still Smoking as verified by CO reading triggers 25% of remaining Registration and Assessment Payment - up to 4
further weeks service offered
Week 5
Non-Quitter
• Behavioural Support and issue of one NRT Product
• Total 15 Mins - Payment £6.30 - (£1.30 with held until week 8)
Week
6
• Behavioural Support and issue of one NRT Product
• Total 15 Mins - Payment £6.30 - (£1.30 with held until week 8)
Week
7
• Behavioural Support and issue of one NRT Product
• Total 15 Mins - Payment £6.30 - (£1.30 with held until week 8)
Week
8
• CO Reading must be taken to verify Quitter status and Trigger remaining 25% Registration Payment - 12.5 Mins - £7.35,
and £1.30 payment with held from week 5, 6 and 7 - End of Programme
NB: Service Users leaving the programme before week 4 would negate the remaining assessment and NRT payments;
Service Users would not normally be allowed back in to the system within three months of completing or dropping out.
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