Tobacco Control and Smoking Cessation related training needsanalysis for

NHS Grampian

January 2014

Contents

Section

1RESEARCH CONTEXT AND METHODOLOGY

2PREVIOUS AND CURRENT RELEVANT TRAINING

3RESULTS OF STUDY

4SUMMARY OF KEY ISSUES AND RECOMMENDATIONS

Appendices:

Appendix1: Survey Proforma circulated to Team Leads

Appendix2: Community Pharmacy Smoking Cessation Training Needs Study

Appendix 3: Health Promoting Health Service (HPHS) – Staff Engagement Exercise - Recommendations

Appendix 4: Summary of training requirements indicated on returned Grampian Tobacco Training Plan

1Research Context and Methodology

Introduction

1.1In 2013 tobacco/cessation training requirements, which would support NHS Grampian (NHSG) staff and relevant partners were reviewed. This report presents the findings of that process.

Context

Strategies and Policies: implications

1.2The new Scottish Government tobacco control strategy ‘Creating a Tobacco Free Generation’ sets out ambitious actions to tackle ‘prevention’, ‘protection’ and ‘cessation’. NHSG must ensure that staff are equipped with the knowledge required to help fulfill this ambition. Actions from the strategy include:

  • “Advice on creating a smoke free home should be a feature of all ante-natal and post-natal services” (potentially this affects 345 midwives in Grampian)
  • “We will ensure that advice to reduce exposure to second-hand smoke, as well as cessation advice and support, is fully incorporated in the range of services offered by Scotland’s public health nurses”
  • “NHS Boards should develop systems and provide training to ensure clear and effective pathways for smoking in pregnancy”[1] (this affects 345 midwives in Grampian, although to date 108 have already been trained).

1.3CEL 01 (2012) Health Promoting Health Service: Action in Hospital Settings is the current policy driver for HPHS where all NHS Boards have been asked to ‘implement specific promoting actions on smoking, alcohol, breastfeeding, food and health and health at work to support health improvement inthe acute care setting’.[2] Specific NHSG Tobacco Team training related actions in relation to CEL 01 (2012) are:

  • ‘Make brief intervention training available across all hospital sites and pathways with primary care including maternity (this includes 9 main hospitals and 16 community hospitals)

1.4A recent evaluation of Scottish Smoking Cessation services highlighted the main suggestionsfor future tobacco/cessation related training needs (in the next 5 years). The most common issues were e-cigarettes, harm reduction/cutting down to quit, dealing with clients with multiple or complex illnesses and engaging with hard to reach groups.

1.5NHSG’s Tobacco Control action Plan 2012 – 2014 refers to the following milestones in relation to tobacco training:

  • “Training in brief advice and referral pathways should be completed by primary, secondary and voluntary mental health and substance misuse services”. (Estimated at 90 personnel in Grampian)
  • “Those who work with young people have received training in tobacco awareness, giving brief advice and referral pathways by March 2014”. (Estimated at around 12000 council employees)
  • “Staff in hospital settings are trained in delivering brief advice and referral to smoking cessation services” (26 hospitals in total)
  • “Professionals who work with children and families should undertake Smoke Free Home and Car Training.”

1.6The latest NHSG Tobacco Policy will come in to force early 2014. A consultation with staff has recently taken place in which most measures to be introduced have been viewed favourably. However a high proportion of respondents (71.6%) express concerns with the section concerning proactive implementation of smoke free hospital grounds. They would not feel comfortable to approach members of staff or public who are in violation of the smoke free regulations. Training provision around these concerns would be useful. Some comments received from respondents are:

  • “I don’t think staff have the time! in terms of telling patients etc. 'you cant smoke here' I can foresee angry confrontation. ”
  • “Confrontation can be difficult and could lead to possible episodes of aggressive behavior”
  • “Many staff will lack confidence to confront people”.
  • ” Some staff may feel this is not their role

The part of the policy concerning staff delivering routine brief advice on the benefits of not smoking and referral to smoking cessation service, was regarded as a barrier by 39.5% of respondents, many of which cited lack of training as a reason:

  • “Training will be required”
  • “Staff knowledge resource” (lack of)
  • “Not all staff will have received the relevant training required to enable them to provide brief advice training to acceptable standards”
  • “Lack of confidence in delivering cessation advice by unskilled staff”.
  • “Lack of training amongst staff“[3]

NHSG Health Intelligence studied the date from the Tobacco Policy survey and identified that 79 respondents highlighted lack of training and understanding as a barrier, with 141 respondents suggesting further training as a possible solution.

Study Objectives

1.7The objectives of the study are to:

  • Review existing training available, identifying gaps and the need for any new training provision and support.
  • Identify number of staff who have already received tobacco related training.
  • Ascertain existing and future numbers of staff who require tobacco related training.
  • Determine the timescales and priorities for undertaking the training.
  • Discover the potential impact of any training on current work practice

1.8The findings of the study will support the tobacco team in the creation of a training and development plan

Methodology

1.8The following tasks were carried out to complete this study:

  • A survey of NHSG Team Leads to ascertain their team’s tobacco training requirements. Circulated via e-mail and cascaded to all team leads.
  • Attendance at 12 team lead meetings across Grampian, to introduce and promote the survey form further and answer any questions.
  • A review of existing tobacco training needs surveys.

Methodological Issues

1.9A much larger NHSG Workforce general training needs survey is planned. This led to a delay in the organisation and distribution of this one. That survey has not yet taken place but it was judged necessary to proceed with this one. In consequence, this survey is not as comprehensive as initially planned.

1.10After consultation with NHSG Learning and Development Dept. a simplified version of their new survey form was adopted. Following feedback from respondents, the form was lengthened and adapted (Appendix 1).

1.11This resulted in a longer more cumbersome form which may have resulted in a low response.

2Previous and Current Relevant Training

Introduction

2.1This research has identified the wide range of existing tobacco related training available in Grampian to both NHSG staff and partners. In total we have identified eleven examples of ‘in house’ training and four examples of training possibilities delivered by national or other agencies within Grampian.

Training Delivery

2.2 The Tobacco Training & Development Coordinator post was vacant from 2009-12. Various members of the tobacco team instead delivered training. Anumber of individuals were trained as trainers in ‘Raising the issue of Smoking’, Raising the Issue of Smoking in Pregnancy’, Raising the Issue of Smoking with Mental Health Service Users’ and ‘Reducing Children’s Exposure to second Hand Smoke’. Delivery has been quite limited (with the exception of ‘Reducing Children’s Exposure to second Hand Smoke’ in Aberdeen City). This sort of delivery proved unsustainable and Since Sept 2012 the Training Coordinator post has been filled on a job-share basis. The following training is either provided ‘in-house’ or arranged with external providers:

In-house

  • NHSG Tobacco and Smoking e-learning package (recently developed)
  • Raising the Issue of Smoking
  • Raising the Issue of Smoking in Pregnancy
  • Raising the Issue of Smoking with Mental health service Users
  • Reducing Children’s Exposure to Second Hand Smoke
  • Community Pharmacy General Smoking Cessation Training
  • Community Pharmacy varenicline training
  • Tobacco/Cessation Awareness Sessions (various)
  • Tobacco/Cessation Workshops (various)
  • Carbon Monoxide Monitor Operation Training
  • Helping People change for Health

Externally

  • 2 Day Introduction to Stop Smoking Support
  • Young People and Smoking
  • Cannabis
  • Ready Willing and Able Training (introduction to Motivational Interviewing)

Previous Training Needs Studies

2.3A review of Community Pharmacy smoking cessation training needs was completed in December 2012 (Appendix 2). A further review is to be undertaken in December 2013 with the results available in late January 2014.

2.4Although not specifically a training needs study, a Health Promoting Health Service (HPHS) staff engagement exercise was undertaken in 2012. 65% of staff identified that further training on ‘Raising the Issue’ of various health topics (of which smoking featured highly) would be very useful in their role (Appendix 3).

3Results

3.1The NHSG ‘Tobacco training plan’ (Appendix 1) was circulated to over 200 team leads throughout the organisation. The Tobacco Training and Development Coordinators also attended 12 lead forums to present the plan in person and be on hand to answer any questions.

3.2Five main questions were asked on the form and are summarised below:

1)Who needs training and how many staff?

2)What training has already been undertaken?

3)What are the timescales for training?

4)How will the training be accommodated?

5)What will be the impact of the training on current work practice?

Findings

3.351 completed/semi completed plans were returned. 46 of which indicated training needs and 5 of which indicated no training requirements.

3.4These training needs are highlighted in the chart below and more extensively summarised in Appendix 4.

3.5On the vast majority of forms only the questions relating to training required and timescales were completed in full (questions 1 and 3)

3.6Only 12 of the 51 responses indicated figures for training already completed (question 2). 8 failed to respond to this question and 31 indicated that either no training had been completed or the figure was unknown. The Tobacco Training and Development Coordinators own records since coming into post confirm that considerable numbers have been trained since September 2012:

  • NHSG Tobacco and Smoking e-learning -230
  • Raising the Issue of Smoking- 249
  • Raising the Issue of Smoking in Pregnancy-108
  • Raising the Issue of Smoking with Mental Health

Service Users- 5

  • Introduction to Stop Smoking Support-22
  • Ready Willing and Able (Intro to MI training)-25
  • Reducing Children’s exposure to second hand smoke-262
  • Pharmacy General Training- 64
  • Pharmacy Varenicline Training- 77
  • Medical Students Awareness Sessions- 296
  • Student Midwife Awareness sessions- 16

3.7Common themes for the 43 responses to question 4 “How will the training be accommodated” were:

  • Work base training session would be ideal so whole team can be trained together.
  • Staff will use the computer in the workplace to complete the e-learning when time allows (e-learning training only)
  • Small numbers of staff can be released to ‘dip in’ to local sessions when provided.
  • Protected Learning Time sessions can be utilised to train entire team.

3.8Common themes for the 39 responses to question 5 “What will be the impact of the training on current work practice” were:

  • Staff will be able to use ad hoc contacts for brief intervention
  • Improved staff awareness and improved outcomes for patients.
  • Staff will not be afraid to ‘Raise the Issue’ and signpost accordingly
  • Will help equip staff with knowledge and confidence on this topic and hopefully increase referrals.
  • Improved health promotion and discussion with patients

3.9Respondents also had the opportunity to suggest any other tobacco/cessation related training needs or advise on similar training undertaken. Very few completed this part, however the only 4 suggestions were:

  • Advisory sessions for Healthy Working Lives clients
  • Cannabis training
  • Young People and Smoking Training
  • Wider range of suitable leaflets for parents/carers/extended family on smoking/second hand smoke issues

And the one response to other related training completed was:

  • “Kick Butt” project training

4Summary and Recommendations

Summary

4.1This study has highlighted the range of existing tobacco related training activity which is available locally to support NHSG and partner agency staff in their work with patients/clients.

4.2A number of key local and national policy/strategy drivers have been identified in relation to tobacco related training provision

4.3Levels of tobacco related training have significantly increased over the past year or so with the provision of dedicated tobacco training staff.

4.4The review has highlighted a significant amount of tobacco related training requirements which ‘ad hoc’ trainers would struggle to provide due to their main role priorities. One could assume that this training need is in reality much higher as over 75% failed to respond to the survey.

4.5The sustainability of existing activity is a cause for concern as there is no guarantee at present, that the Tobacco Training and Development Coordinators post will continue to be funded beyond March 2014.

4.6This review has highlighted demand for different levels of training to suit different staff roles.

Recommendations

  • NHSG should consider the feasibility of first level (NHSG Tobacco and Smoking e-learning) mandatory training as part of staff induction with regular and ongoing updates built in.
  • If the delivery of mandatory training is not possible, efforts should be made to explore how to promote and encourage senior lead buy-in.
  • If the Tobacco Training & Development Coordinator post is continued, thought should be given to developing further training resources such as equivalents to ASH Scotland’s ‘Smoking and Cannabis’, Young People and Smoking’ and ‘Introduction to Stop Smoking Support. This would remove the need to book outside trainers, therefore creating greater flexibility with delivery.

1

-Appendix 1

NHS Grampian’s Tobacco Training Plan 2013 - 2015

Team………………………………………………………………… Please complete and return by ……..

  • What are the key tobacco/smoking cessation related training needs of staff in your team/area?
  • Which policies or strategies may indicate these training needs? (Some examples may be * CEL01, *QOF, * SCIP Pathway – see below)
Available courses:- Would any of the courses listed below be helpful to support your team’s tobacco/smoking cessation work?
Who needs this training (please identify staff groups) and how many staff? / What tobacco/
smoking cessation training has already been undertaken by current staff? / What are the timescales priorities for undertaking training? (Short/med/long term)
1-6 months;6-12 months; 12-24 months / Howwillany training be accommodated by your team? (e.g. will staff be released?) / What will be the impact of this training on current work practice?
E Learning
30/40 min NHSG training presently accessed via AT learning (future plans to make it accessible to a wider audience)
Who needs this training (please identify staff groups) and how many staff? / What tobacco/
smoking cessation training has already been undertaken by current staff? / What are the timescales & priorities for undertaking training?
1-6 months;6-12 months; 12-24 months / How will any training be accommodated by your team? (e.g. will staff be released?) / What will be the impact of this training on current work practice?
Raising the Issue of Smoking
Health Scotland training delivered by NHSG trainers: 1 hour e-learning plus 2 hour participatory session – for individuals who have contact with patients and may have the opportunity to raise issue and refer on
Raising the Issue of Smoking in Pregnancy
Health Scotland training delivered by NHSG trainers: 1 hour e-learning plus 3-4 hour participatory session aimed at individuals working with pregnant mums and families
Raising the Issue of Smoking with Mental Health Service Users
Health Scotland training delivered by NHSG trainers: 4 hour participatory session, aimed at individuals in contact with Mental Health Service users
Who needs this training (please identify staff groups) and how many staff? / What tobacco/
smoking cessation training has already been undertaken by current staff? / What are the timescales & priorities for undertaking training?
1-6 months;6-12 months; 12-24 months / How will any training be accommodated by your team? (e.g. will staff be released?) / What will be the impact of this training on current work practice?
2 Day Introduction to Stop Smoking Support
Delivered by NHSG trainers: Would allow participants to provide a basic level of cessation support to patients/clients
Smoke Free Homes 2 hour participatory session delivered by NHSG trainer, aimed at individuals in contact with parents/families
Motivational Interviewing
can be tailored and arranged as necessary
Any other training, not listed above, that has been undertaken or is planned to be undertaken by current staff?

Completed by: …………………………………Date: ………………………

Contact number: ………………………………E-mail: ………………………………………………………

Please return completed forms to: Angela Smith or Ian Milne, Tobacco Training & Development Coordinators (Job Share), at Tel: 07500 573240 or Tel: 07952 062714

(Same contacts if you have any queries or to book training).

* CEL01- Health Promoting Health Service: Action in Hospital settings – health boards are asked to implement specified health promotion actions contained in this CEL:

* QOF - The Quality and Outcomes Framework (QOF) is a system for the performance management and payment of GP’s in the in the UK. It was introduced as part of the new General Medical Services (GMS) contract in April 2004, replacing various other fee arrangements. Points are allocated against various indicators of which smoking is one.

* SCIP - Smoking Cessation In Pregnancy Pathway – A new CO monitoring and referral pathway is gradually being implemented in Grampian, (commenced May 2013).

Appendix 2

SMOKING CESSATION TRAINING NEEDS

Pharmacy Name / Pharmacy Address / Contractor Number / Pharmacists/Pre Reg/CA/Techs NES – Fully Trained / Pharmacists/Pre Reg/CA/Techs NES NES– Training in Progress / Pharmacists and Pre Reg Pharmacists – NHS Grampian Training / Technicians/Counter Assistants/Store Managers – NHS Grampian Training / Other
Aberlour Pharmacy / 112 High Street Aberlour / 4093 / 2 / 1
Anderson and Spence / 31 Fountainhall Road Aberdeen / 4041 / 1 / 2
Albyn Pharmacy / 156 Union Grove Aberdeen / 4001 / 4 / 4
Asda Pharmacy / Jesmond Drive BOD Aberdeen / 4173 / 1 / 3
Bairds Pharmacy / 144 Mid Street Keith / 4010 / 2 / 1 / 2
Bairds Pharmacy / 498 King Street Aberdeen / 4065 / 1 / 2
Buchanhaven Pharmacy / 23 Skelton Street Peterhead / 4326 / 4
Boots Pharmacy / 2-4 Evan Street Stonehaven / 4025 / 2 / 2 / 1
Boots Pharmacy / 27 Scotstown Road Aberdeen / 4304 / 1 / 1 / 1 / 1
Boots Pharmacy / 7-11 Broad Street Fraserburgh / 4020 / 2 / 3
Clarks Pharmacy / 12-16 Regent Street Keith / 4302 / 3 / 2 / 2
Cruden Pharmacy / Aulton Road Cruden Bay / 4348 / 1 / 1
Davidson Chemist / Aboyne Aberdeenshire / 4055 / 1 / 1 / 2 / 5
Davidsons Chemist / 10 Bridge Street Ballater / 4056 / 1 / 3
Davidsons Chemist / 61-63 High Street Banchory / 4069 / 1 / 10
Dickies Pharmacy / 96 Victoria Road Torry Aberdeen / 4321 / 1 / 4 / 0
Duke Street Pharmacy / 24 Duke Street Huntly / 4084 / 2 / 1
George Ellis Chemist / 69 High Street BANFF / 4248 / 1 / 2
George Ellis Chemist / 1 Seafield Street Portsoy / 4220 / 2 / 2
Kemnay Pharmacy / 15 High Street Kemnay / 4306 / 2 / 2
Kingswells Pharmacy / Village Centre Kingswells / 4322 / 1
Kintore Pharmacy / 1 The Square Kintore / 4291 / 1 / 1 / 1
Largue Pharmacy / 10-12 Gordon Street Huntly / 4310 / 1 / 2
Lewis Road Pharmacy / Unit 1 Lewis Road Aberdeen / 4079 / 1 / 1 / 1
Lhanbryde Pharmacy / 32 St Andrews Road Lhanbryde / 4349 / 1
Listermac Pharmacy / 3 Union Street Portknockie / 4091 / 1
Lloyds Pharmacy / 48 High Street Elgin / 4106 / 1 / 1
Lloyds Pharmacy / 57 Duff Street Macduff / 4299 / 1 / 1
Lloyds Pharmacy / Great Northern Road Aberdeen / 4107 / 1 / 2
Lloyds Pharmacy / Westhill Medical Centre, 12a Arnhall Bus Park / 4328 / 1 / 1 / 1
Lloyds Pharmacy / 23a Clifton Road Lossiemouth / 4300 / 1
E I Mackie Pharmacy / 7 Ramsay Crescent Garthdeee Aberdeen / 4153 / 2 / 2
Charles Michie / 57 King Street Inverbervie / 4162 / 1 / 2 / 1 / 2
Charles Michie / Portlethen / 4116 / 2 / 1
Charles Michie / 287 Rosemount Place Aberdeen / 4170 / 1
Charles Michie / 391 Union Street Aberdeen / 4166 / 1 / 1 / 2
Charles Michie / 24 High Street Laurencekirk / 4164 / 1 / 2 / 1
Morrisons Pharmacy / 215 King Street Aberdeen / 4333
Newmachar Pharmacy / 17 Oldmeldrum Road Newmachar / 4332 / 1 / 2 / 1
Newtonhill Pharmacy / 1 Skateraw Road Newtonhill / 4023 / 1
Normac Pharmacy / Ardach Health Centre Buckie / 4189 / 1 / 1
Norvik Pharmacy / 1 High Street Buckie / 4196 / 2
Parhead Pharmacy / 26 Harbour Street Hopeman / 4331 / 1
Parhead Pharmacy / 18 Grant Street Burghead / 4330 / 1
PHCC Ltd Pharmacy / Peterhead Medical Practice / 4202 / 2 / 1 / 1
S & N Purdie / 14-16 Main Street New deer / 4208 / 3 / 2
Rowlands Pharmacy / City Hospital Park Street Aberdeen / 4318 / 1 / 1 / 1
Rowlands Pharmacy / 381A North Deeside Road Aberdeen / 4316 / 1 / 1
Rowlands Pharmacy / 32 Market Street Ellon / 4315 / 1 / 1
Rowlands Pharmacy / The Square Mintlaw / 4314 / 3 / 1
Rowlands Pharmacy / 83 High Street Forres / 4329 / 2
Rowlands Pharmacy / 695 George Street Aberdeen / 4319 / 2 / 2
Sainsbury Pharmacy / Berryden Aberdeen / 4287 / 2 / 2
Scott the Chemist / 9-11 Castle Street Banff / 4226 / 1 / 2
Strachan Pharmacy / 29 Main Street Turriff / 4305 / 2 / 2
Summers Pharmacy / 47 Broad Street Fraserburgh / 4051 / 2 / 1
Tarland Pharmacy / 1 The Square Tarland / 4109 / 1 / 1
Tarves Pharmacy / 8 Duthie Road Tarves / 4095 / 1
Torphins Pharmacy Ltd / 1 Beltie Road Torphins / 4021 / 2
Websters Pharmacy / 7-9 Queen Street Peterhead / 4259 / 1 / 2 / 1 / 2
Websters Pharmacy / 62 High Street New Pitsligo / 4334 / 1 / 2
Websters Pharmacy / 624 King Street Aberdeen / 4063 / 2 / 1
Robert Whitelaw / 3 Waverly Place Aberdeen / 4260 / 1 / 1
Robert Whitelaw / 46 Rosemount Aberdeen / 4262 / 1 / 1
N S Wilson / High Street Insch / 4077 / 1
Michael Wood Pharmacy / 187 North Deeside Road Peterculter / 4281 / 4

1