LOCAL ENHANCED SERVICE AGREEMENT TO PROVIDE A

STOP SMOKING SUPPORT SERVICE

Doncaster and Rotherham Smokefree Services

Rotherham Community Health Centre

Greasbrough road

Rotherham

S60 1RY

Tel: 01709 422444

Email: stop smoking service @rothgen.nhs.uk

1. LOCAL ENHANCED SERVICE AGREEMENT: Stop Smoking Support service

Anticipated activity level

Number of smokers to be supported through a quit programme: / NB This must meet the required minimum of <insert number>service users/quits (delete as appropriate) per year
Name of provider lead for this agreement:
Name of LES worker(s):

LES workers are defined as staff who have been on approved Stop Smoking Intermediate Training (Level 2)delivered by a National Stop Smoking Service and will be providing stop smoking support.

On behalf of: Doncaster and Rotherham Smokefree Services

We undertake to comply with the terms of the Stop Smoking Support Local Enhanced Service including the achievement of the Key Performance Indicatorsin section 9andAppendix D. We will ensure that our provision fulfils the requirements of this agreement including national and local guidance and local treatment pathways and medication protocols.

We intend to submit fully completed service user records within the timescales set out in this agreement via Quit Manager and other reports required by the Smokefree Service on behalf of South West Yorkshire Partnership NHS Foundation Trust.

We agree to allow dedicated time for trained staff to provide appropriate support and undertake follow-up work with smokers who have shown an interest in quitting. We understand this will be a minimum of 1.5 hours of support per quitter and each LES worker will need to support at least <insert number>smokers per year to maintain their competency.

Agreed by:

Signed on behalf of the provider
Date
Signed on behalf of SWYPFT
Date

Please return two copies of this signature sheet to:

Doncaster and Rotherham Smokefree Services

Rotherham Community Health Centre

Greasbrough road

Rotherham

S60 1RY

2.Introduction

This Service Level Agreement outlines the service to be provided in relation to Stop Smoking support. The aim of this service is to increase choice of access for smokers who wish to quit and are eligible to receive face to face stop smoking support.

Where this service is provided by NHS providers they are expected to provide all essential and any additional services they are contracted to provide to patients and no part of this locally enhanced service, by commission or omission or implication, defines or redefines these services. This document outlines the detail of the enhanced service to be provided.

The scheme will be delivered using the agreed treatment pathways and medication protocol attached in the appendices tothis Agreement.

Appendix A:Fees

Appendix B:Treatment pathways and eligibility

Appendix C:Medication protocol

Appendix D:Local KPIs

3. Background

Smoking remains one of the most significant modifiable health issues the Yorkshire region. Reducing the overall prevalence of smoking in the country will reduce the burden of ill health across local health communities and is one of the most cost effective health interventions available. Meeting key targets for 4-week quitters is one arm of tobacco control work that contributes to this agenda.

This enhanced service will assist in meeting national prevalence reduction targets, as well as contributing to local Public Health priorities.

There are three key outcome measures, focusing on prevalence reduction:

-Reduce smoking prevalence among adults in England: To reduce adult (aged 18 or over) smoking prevalence in England to 18.5 per cent or less by the end of 2015, meaning around 210,000 fewer smokers a year

-Reduce smoking prevalence among young people in England: To reduce rates of regular smoking among 15 year olds in England to 12 per cent or less by the end of 2015

-Reduce smoking during pregnancy in England: To reduce rates of smoking throughout pregnancy to 11 per cent or less by the end of 2015 (measured at time of giving birth)

4. Eligibility and accreditation

Providers of the service must ensure their employees/agents are appropriately qualified to provide all elements of the service. The provider should ensure that their service users receive behavioural support from a person who has had training and supervision that complies with the NHS Centre for Smoking Cessation and Training (NCSCT). March 2010.

Smokefreeadvisors providing stop smoking support through this agreement must have completed the Intermediate (Level 2) training delivered by a local Smokefree service.

  • New Advisors must complete the on line NCSCT advisor training. This is a mandatory requirement for all advisors before they can attend the level 2 training provided by the Service. They will be required to provide evidence that they have successfully completed NCSCT stage 1.
  • Each prospective adviser must complete approved level 2 training course provided free by the local Smokefree service
  • Advisors are encouraged to completed further local and NCSCT training to further advance their skills and competencies
  • Advisors must maintain personal accreditation with the South West Yorkshire Partnership NHS Foundation Trust through attending refresher training as required by the local Smokefree service.
  • Advisors must be non-smokers, or ex-smokers of more than 12 months and must not be current users of electronic cigarettes.
  • The provider must inform South West Yorkshire Partnership NHS Foundation Trust if the advisor is no longer eligible to provide theservice (e.g. if they relapse or become a smoker themselves)
  • Only trained advisors will provide a support programme to service users – payment for quits will not be made for service users supported by staff who are not fully trained and approved.
  • South West Yorkshire Partnership NHS Foundation Trust will assist new providers in the set up of the stop smoking support service and provide a Carbon Monoxide (CO) monitor on loan to the provider free of chargefor the duration of this agreement
  • Providers must ensure that advisors delivering this service on their behalf have appropriate checks and clearance to work with service users in this manner
  • There will be no charge to the provider for the provision of this CO monitor. However, if a CO monitor is lost or damaged by the provider, the Service may charge the provider the cost of a new replacement monitor (cost approx £120 in March 2014)
  • The Advisor must have access to a calibrated CO monitor and must present the CO monitor to the local Smokefree service for calibration every 6 months.

5. Use of electronic cigarettes

South West Yorkshire Partnership NHS Foundation Trust recognises that a significant number of smokers are turning to electronic cigarettes (e-cigs) as a means of reducing or ceasing their use of smoked tobacco. E-cigs are currently unregulated and untested. In 2013 the UK Medicines and Healthcare Products Regulatory Agency (MHRA) announced that from 2016, it intended to regulate electronic cigarettes and other nicotine-containing products as medicines by function which will require manufacture to medicinal purity and delivery standards and control advertising. The proposed regulation will provide a route to licensing by deeming any nicotine device that is proved to deliver nicotine to be effective as a smoking substitute or cessation aid.

Until there is clear guidance from the (MHRA) and Department of Health, South West Yorkshire Partnership NHS Foundation Trust and any agents operating through this agreement are unable to provide e-cigs as part of a stop smoking support programme or recommend their use as a means to quitting smoking. This is particularly the case whilst there are ongoing concerns about safety and nicotine concentrations in e-cigs where data is limited.

However, in order to take a pragmatic approach and in recognition of the fact that some smokers are using e-cigs as the first step to quitting the use of smoked tobacco, South West Yorkshire Partnership NHS Foundation Trust requires providers to take the following approach:

  • For the purpose of this agreement, e-cigs are to be treated as a nicotine containing device (akin to nicotine replacement products)
  • Providers can support anyone to quit smoking under current NHS guidance, whether they are using any smoking cessation aids or not
  • Provider’s advisorsshould provide behavioural support to smokers who chose to use an e-cig to help them stop using smoked tobacco products
  • Advisors should provide the standard stop smoking support programme to smokers using e-cigs, in line with the local treatment protocol and eligibility criteria in Appendix B
  • Advisors should still advise smokers using e-cigs to support their quit attempt about the full range of stop smoking pharmacotherapy available locally (Appendix C) and discuss the relative benefits of using these products
  • Providers must ensure that use of e-cigs are clearly recorded on the clinical record on Quit Manager in the appropriate
  • A smoker who has set a quit date and who has refrained from smoking tobacco at 4 weeks will be recorded as a treated smoker whether or not they are continuing to us an e-cig or other nicotine containing product
  • A treated smoker quit at 4 week will be recorded as either a CO verified quit or a self reported quit even if they are continuing to use an e-cig to support their ongoing abstinence from smoked tobacco
  • Advisors must not promote or give any specific advice or support around use of e-cigs
  • Advisors should not provide Nicotine Replacement products, Champix or any other stop smoking pharmacotherapy to people using e-cigs

6. Service Principles

From this point forward, reference to smokers, quitters and recording of outcomes includes people using e-cigs as part of their stop smoking attempt.

  • All service providers will be responsible for ensuring the support programme is delivered in an appropriate setting (e.g. a confidential environment) and by appropriately trained staff as described in Eligibility and Accreditation above.
  • The provider will implement the toolkit “Smoking Interventions in Primary Care” (SSIPC) throughout the practice/service and co-operate with their named Specialist Stop Smoking Advisor.
  • The provider will appoint a practice/service Co-ordinator to undertake the duties outlined in the SSIPC toolkit. This person will act as champion in the practice/service for stop smoking issues and take responsibility for ensuring monitoring forms are submitted on time.
  • All interventions should have a clear structure and content, which is communicated to service users in advance and to which service users must commit.
  • The provider will adopt a holistic approach to assessment of smoking, smoking behaviour and lifestyle including consideration of other health problems e.g. other physical and mental health problems, pregnancy etc.
  • Advisors should adopt an empathic and a motivational approach to their service users taking into account individual needs and choices particularly for minority ethnic and disadvantaged groups
  • Providers will respect people’s choices and lifestyles and maintain effective communication with all service users.
  • The provider must adopt and adhere to the data collection methodology set out in Department of Health guidance and by the local Smokefree service
  • Services will be tailored to include the provision of nationally recommended stop smoking medicines, in line with the medication protocol referred to in Appendix C
  • Service users should be informed of all available (evidence-based) treatment /medication options both locally and nationally in line with eligibility criteria in Appendix C.
  • Interventions should be efficiently managed and there should be sufficient administrative support for general organisation, service user contact processes and data handling.
  • Providers will engage appropriately with Yorkshire Smokefree including appropriate use of branding and promotional materials, signposting to the telephonic hub and Yorkshire Smokefree website and use of Quit Manager

By signing this agreement, the provider commits to:

  • Allow sufficient protected time for the approved advisor to run an effective stop smoking support clinic in accordance with prescribing guidelines and service user eligibility criteria.
  • Advisors should allow at least 20 minutes for the first (and if appropriate, the second) appointment and approximately 10 minutes for each follow up appointment, up to the 4 week confirmation of quit.
  • Advisors must have sufficient time to ring service users if needed and complete Quit Manager records during or immediately after the service user consultation. See Key Performance Indicators below and Appendix D
  • Keep full and accurate records of all vouchers issued via the Quit Manager database for the duration of the service user’s medication programme. This may be up to twelve weeks.
  • Establish the quit status of the service user at 4 weeks and record this on Quit Manager.
  • Give every service user the opportunity to feed back on their experience of the service, using the appropriate service user feedback forms
  • Notify the local Smokefree service in a timely manner if their advisor leaves that job, stops working as a stop smoking advisor, or is no longer able to provide the service.
  • Advertise the availability of the Level 2 Stop Smoking Service using approved Yorkshire Smokefree branding.
  • Refer any smoker who requires more intensive specialist support to the local Smokefree service.
  • Refer service users wanting to quit to the local Smokefree service If the provider has a waiting list of 3 weeks or moreso that they do not lose their motivation to quit.

7. Service outline

  • The Provider will offer dedicated stop smoking appointments as an enhanced service, outside of the core services currently delivered
  • Interventions should offer weekly support for at least the first four weeks of a quit attempt (weeks following the quit date) and appointments for sessions should ideally be scheduled when service users are booked into treatment.
  • Face to face interventions should have a clear structure and content, which is communicated to service users in advance and to which service users must commit.
  • The stop smoking support programme should be multi-session with total potential contact time with the service user being a minimum of 1.5 hours duration (from pre-quit preparation and during the 4 weeks post-quit) to ensure continued monitoring, service user compliance and ongoing access to medication where eligible.
  • Face to face quitters are supported for a maximum of 8 weeks (with exception of Champix service users), with weekly meetings for the first 4 weeks post quit date and a further 2 fortnightly sessions if needed.
  • The programme for each individual will incorporate the setting of a “quit date” and will make provision for confirmation of abstinence at the four week stage confirmed by a carbon monoxide (CO) monitor reading of less than 10ppm.
  • There should be a strong emphasis on CO (carbon monoxide) verification of quit status at 4 weeks from the quit date. This should be attempted in all face to face cases and in at least 85% of cases.
  • Following up any service users who do not attend or miss an appointment, making at least 3 attempts on 3 separate occasions to contact the service user before classifying them as ‘lost to follow up’.
  • Nicotine replacement therapy or Varenicline (Champix) will be discussed and the service user offered a voucher if appropriate
  • Single NRT therapy via voucher is the norm. Providers will adhere to the exceptional eligibility criteria for dual NRT therapy.
  • Providers must ensure they are able to offer service continuity, including arrangements for leave and other absences. This includes the ability to offer a weekly appointment to service users in the first four weeks of their quit attempt

8. Activity and Finance

Please see Appendix A for the local fees paid to the provider for the Stop Smoking Support Service.

Payment is subject to meeting the following conditions:

  • A provider will not sub-contract stop smoking service provision to other parties. Any claims for quit payments made on this basis will not be paid.
  • As part of the Trust’s counter fraud and financial governance processes, the local Smokefree service will send a verification statement to each provider on a quarterly basis listing all service users who have set quit dates and quit with that provider according to Quit Manager records.
  • This verification statement should be checked by the provider for accuracy and signed off and returned to the local Smokefree service. Payment is then determined by the number of confirmed quit dates and 4 week quits in line with the Fee structure in Appendix A.
  • The local Smokefree Service will provide the Finance Dept of South West Yorkshire Partnership NHS Foundation Trust with the quarterly summary of confirmed quit dates and quits for each provider, in order to generate payments.
  • Payments will be made by BACS into the provider bank account on a quarterly basis.
  • South West Yorkshire Partnership NHS Foundation Trust will undertake random spot checks by way of post-payment verification.
  • Methods that are not evidence based (e.g. hypnotherapy, acupuncture or laser therapy) will not be funded.

9. PERFORMANCE MANAGEMENT AND KEY PERFORMANCE INDICATORS (KPIs)

Please see Appendix D for additional local KPIs that form part of this agreement. The local KPIs will also be subject to performance monitoring by South West Yorkshire Partnership NHS Foundation Trust.

  • All providers must aim for a 50% quit conversion rate and achieve a minimum standard of 35% quit conversion rate i.e., for every 3 people that set a quit date, at least 1 successful quit must be achieved. Providers will be expected to exception report performance that falls outside these limits.
  • The provider will achieve85% CO-monitor verified quits, in line with Department of Health standards.
  • A Lost to Follow up (LTF) rate not exceeding 10%of people who set a quit date, i.e. a confirmed outcome of quit or not quit must be established for nine out of ten people setting a quit date
  • The provider must complete service user records on Quit Manager during the service user consultation or within 24 hours, in accordance with NHS clinical record keeping requirements.
  • The Provider will fully complete the Minimum Data Set (MDS)provided by South West Yorkshire Partnership NHS Foundation Trust for all smokers who set a quit date.
  • All service user episodes on Quit Manager should have a completed code recording service user ethnicity and service user occupation.
  • Where paper records are used, these must be completed and returned to the local Smokefree service within ten days of the 4 week outcome being verified (within the nationally agreed timescale of six weeks from the service user’s quit date)
  • In order to maintain clinical competency, each advisor must achieve a minimum of 12 confirmed 4-week quits per year.
  • The Provider will meet with representatives of the local Smokefree servicein person at least annually to monitor compliance with this agreement.

The provider must also be expected to demonstrate: