Local Enhanced Service Forstop Smoking Service

Local Enhanced Service ForStop Smoking Service

Service Level Agreement (SLA) 2008-2009

1.Introduction

2.Signatures

3.Aims and Objectives

4.Service Outline

5.Service Specification

6.Quality Indicators Pharmacy Contractors

7.Quality Indicators PTC

8.Financial Details

9.Monitoring Arrangements

10.Termination of Contract

Appendix A – Service Protocol

Appendix B – Summary Form for the Supply of NRT from Community Pharmacies

Appendix C – Sample Monitoring Form – this will be on special headed paper

Appendix D – Claim Form

Introduction

This agreement set outs the framework for the Stop Smoking Serviceby community pharmacists,and has been agreed with the Wiltshire Local Pharmaceutical Committee. The implementation, administration, monitoring and review of this agreement is the responsibility of Swindon PCT, or any organisation that takes over the functions of this PCT

Signatures

This document constitutes the agreement between the pharmacy contractor and the PCT in regards to the above Service Level Agreement for the 12 months 1st April 2008 to 31st March 2009. We agree to abide by the conditions laid out in the agreement:

Name of the Pharmacy contractor:
Signature of behalf of the Pharmacy contractor / Name (please print) / Date
Signature of behalf of Swindon PCT / Name (please print) / Date

Page 1 of 11

J:\PCandC\PRIMARY CARE\Community Pharmacy\Enhanced Services\smoking cessation\2008-09\smoking project SLA 08-09.doc

Local Enhanced SLA for Stop Smoking Service in Swindon PCT

Aims and Objectives

3.1.To improve access to and choice of stop smoking services, includingaccess to pharmacological and non-pharmacological stop smoking aids.

3.2.To assist in the delivery of the Public Service Agreement (PSA) target included in the NHS Improvement Plan.

3.3.To reduce smoking related illnesses and deaths by helping people to giveup smoking.

3.4.To improve the health of the population by reducing exposure to passivesmoke.

3.5.To help service users access additional treatment by offering referral tospecialist services where appropriate.

Service Outline
The Stop Smoking service is one in which pharmacies will provide one toone support and advice to people who want to give up smoking for a 4 week period.
Whencommissioned, the service will help to increase choice and improve accessto NHS Stop Smoking Services.
The pharmacy referral to specialist services if necessary.
The pharmacy will help facilitate access to, and where appropriate supply,appropriate stop smoking drugs and aids.
This Enhanced service reflects the one to one NHS stop smoking serviceand is to be provided in addition to the Essential service ‘Promotion ofhealthy lifestyles (Public Health)’ (ES4).
The pharmacy contractor agrees to ensure that there is a trained stop smoking pharmacist(s) / pharmacy technician (s) engaged in the pharmacy for the majority of the time that the pharmacy is open.
If the only trained stop smoking pharmacist / pharmacy technician leaves the pharmacy, the pharmacy contractor will need to notify the PCT immediately. The pharmacy contractor will have three months to train a new pharmacist for the service
Service Specification
The part of the pharmacy used for provision of the service provides a sufficient level of privacy and safety: - the pharmacist and the service user must be able to sit comfortably together, and the conversations between the pharmacist and service user can not be over heard by members of the public or other pharmacy staff.
Access routes to this service will be determined locally, andcould include:
pharmacy referral as a result of the ‘Promotion of healthy lifestyles(Public Health)’ or ‘Signposting’ Essential services;
direct referral by the individual or Swindon NHS Stop Smoking service phone line.
referral by another health or social care worker;
The pharmacy would have to confirm the eligibility of the person to accessthe service, based on local guidelines, and protocol as covered in the local training.
If considered appropriate, the pharmacist may supply Nicotine Replacement Therapy (NRT, at the cost of an NHS prescription charge (or free of charge for service users that are exempt from charges).
Support will be given by weekly visit to the pharmacy over a 4 week period according to the protocol in Appendix A.
Pharmacists will need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements, including, where appropriate, the need for the permission of the client to share the information. This needs to be explained that this is not a breach in confidentially to the service user at the beginning of the consultation. The service user must be informed that all forms will be sent to Swindon PCT.
The pharmacist will obtain consent to allow contact by the Smoking Cessation Coordinator at 52 weeks.
The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Summary of supply will be recorded on the provided forms (Appendix B). Records and documentation will be confidential and should be stored securely whilst at the pharmacy premises.
The pharmacist or pharmacy technician must ensure that a completed record consisting of the minimum data set as defined within the ´NHS smoking cessation services: service and monitoring guidance’and must be recorded on the Swindon Stop Smoking service monitoring form. (Appendix C)
All documentation (including claim form), with the exception of the summary sheet, is sent on, confidentially, to the Smoking Cessation Coordinator at Swindon PCT.
Copies of the monitoring form may be taken by the pharmacy for their records.
All records and forms should be kept for a minimum of two years to allow for possible audit.

Quality Indicators Pharmacy Contractors
Participating pharmacist/pharmacy technician must have satisfactorily completed the following training:-
TheLevel 2 Stop Smoking Advisor training.
Participating pharmacist/pharmacy technician must have attended local update training within the last two years.
The pharmacy contractor should provide evidence that the above training has been completed by all participating staff within three months of the start of participation in the service.
A participating pharmacy contractor must have in place in their pharmacy suitable procedures and appropriately trained staff to ensure that the good practice detailed in this service specification operates in their absence.
The pharmacy has appropriate PCT provided health promotional materials available for the service users and actively promotes its uptake and is able to discuss the contents of the material with the service user, where appropriate.
The pharmacy has details of relevant referral points which pharmacy staff can use to signpost/refer service users who require further assistance
The pharmacy contractor reviews its Standard Operating Procedures and the referral pathways for the service on an annual basis.
The pharmacy contractor has a duty to ensure that pharmacists and staff involved in the provision of the service have relevant knowledge and are appropriately trained in the operation of the service.
The pharmacy contractor has a duty to ensure that pharmacists and staffinvolved in the provision of the service are aware of and act in accordancewith local protocols and NICE guidance.
The pharmacy contractor can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service and are aware of and operate within local protocols.
The pharmacy contractor co-operates with any assessments of service user experience.

Quality Indicators PTC
The PCT should arrange at least one contractor meeting per year to promote service development and update pharmacy staff with new developments, knowledge and evidence, which will ensure that the participating pharmacist/technician has the opportunity to update their skills.

7.2.The PCT will provide the following local training requirements.

7.2.1.Level 2 Stop Smoking Advisor Training.

7.3.The PCT will provide a framework for the recording of relevant service information for the purposes of audit and the claiming of payment. (Appendix D).

7.4.The PCT will provide up to date details of other services which pharmacy staff can use to refer service users who require further assistance. The information should include the location, hours of opening and services provided by each service provider.

7.5.The PCT will be responsible for the promotion of the service locally, including the development of publicity materials, which pharmacies can use to promote the service to the public.

7.6.The PCT will be responsible for the provision of health promotion material, relevant to the service users and make this available to the pharmacies.

7.7.The PCT has quarterly network meetings topromote service development and participating pharmacists are welcome to attend this meeting.

Financial Details
The pharmacy contractor will received the following payments per service user:
Initial Assessment £15
Follow Up Assessments (maximum of 3) £5
Final Assessment £5
Total if complete 4 weeks is £35,
The PCT will reimburse the pharmacy for the cost of NRT supplied including the VAT costs.
The materials and equipment required, including CO monitors anddisposable mouthpieces, are supplied free of charge to the pharmacy by thePCT.

Monitoring Arrangements
The Stop Smoking Service at Swindon PCT will monitor the service.

Termination of Contract
This agreement will run for a period of 12 months, however during this period, it may be terminated by either party by giving three month written notice.

Page 1 of 11

J:\PCandC\PRIMARY CARE\Community Pharmacy\Enhanced Services\smoking cessation\2008-09\smoking project SLA 08-09.doc

Local Enhanced SLA for Stop Smoking Service in Swindon PCT

Appendix A – Service Protocol

Community Pharmacy Enhanced Service – Stop Smoking Service

The initial assessment

The initial consultation should include:-

An assessment of the person’s readiness to make a quit attempt.
An assessment of the person’s willingness to use appropriate treatments.
A carbon monoxide (CO) test and an explanation of its use as a motivational aid.
A description of the effects of passive smoking on childrenand adults;
An explanation of the benefits of quitting smoking.
A description of the main features of the tobacco withdrawalsyndrome and the common barriers to quitting.
Identify treatment options that have proven effectiveness.
A description what a typical treatment programme might look like, itsaims, length, how it works and its benefits;maximise commitment to the target quit date.
Application of appropriate behavioural support strategies to help the personquit; andconclude with an agreement on the chosen treatment pathway.
Ensuring the person understands the ongoing support andmonitoring arrangements.
An explanation that the Nicotine Replacement Therapy (NRT) will be provided for the first 4 weeks of treatment, and subsequent supplies will need to be purchased.
Obtaining consent for the weekly visits for 4 weeks and 52 week follow-up by the smoking cessation service co-ordinator.
If considered appropriate, the pharmacist may supply one week’s supply of an appropriate NRT.
Completion of a declaration of exemption from prescription charges or payment of prescription charges as appropriate. Each form of NRT will require a standard prescription charge.
Making an appointment for follow-up in one week’s time.
Completion of the monitoring form.
People not wishing to initially engagemay be offered appropriate health literature or referral toan alternative stop smoking service, and asked to return when they do wish to set a quit date.

Supply of treatment must be recorded on the person’s pharmacymedication record. Consideration should be given to communicating this information to the person’s GP where clinically appropriate, e.g.Buproprion interactions.

The Follow-Up assessments

Follow up consultations, in line with NICE guidelines, should be agreed with the person.

The follow up consultation should include:-

Continued application of appropriate behavioural support strategies to help the personquit;
Ensuring the person understands the ongoing support andmonitoring arrangements.
A carbon monoxide (CO) test and an explanation of its use as a motivational aid, if wanted by the service user.
A further supply of one week of NRT treatment should be made at these consultations.
Service users who choose not to complete the programme should be offered appropriate health literature or referral toan alternative stop smoking service.
Making an appointment for follow-up in one week’s time.
Completion of the monitoring form.

The Final 4 Week assessments

The final 4 week assessment follow up consultation should include:-

Self-reported smoking status.
A CO test for validation.
A successful quitter is as defined by the DH stop smoking guidelines, as one who has not smoked at all in the 2 weeks prior to the 4 week follow up visit.
Continued application of appropriate behavioural support strategies to help the personquit;
Advise on the continued purchase of NRT from the pharmacy.
Completion of the monitoring form.

The completed monitoring forms for all clients seen should be returned as soon as possible after follow-up has been completed and within a month of the last visit. Forms should still be returned for all clients assessed who do not take up the service.

Monitoring forms and claim forms should be sent to Smoking Cessation Co-ordinator, Swindon Primary Care Trust, North Swindon District Centre, Thamesdown Drive, Swindon, SN25 4AN, Tel 01793 708700/708751.

Page 1 of 11

J:\PCandC\PRIMARY CARE\Community Pharmacy\Enhanced Services\smoking cessation\2008-09\smoking project SLA 08-09.doc

Local Enhanced SLA for Stop Smoking Service in Swindon PCT

Appendix B – Summary Form for the Supply of NRT from Community Pharmacies

Summary of Supply of NRT from Community Pharmacy

PMR No / Name / Type of NRT Supplied / Date Visit 1 / Date Visit 2 / Date Visit 3 / Date Visit 4 / Date Visit 5 / Quit
Yes or No / Payment Claimed

LTFU = lost to follow upPage of

This form should be kept for a minimum of two years after the last entry.

Page 1 of 11

J:\PCandC\PRIMARY CARE\Community Pharmacy\Enhanced Services\smoking cessation\2008-09\smoking project SLA 08-09.doc

Local Enhanced SLA for Stop Smoking Service in Swindon PCT

Appendix C – Sample Monitoring Form – this will be on special headed paper AND WILL BE UPDATED IN APRIL 2008

Monitoring Form

CONFIDENTIAL

First name ………………………………… Surname………….…………………………………… D.o.B …..………………….. Age

Address …………………………………………………………………………..………………………………………………Postcode

Occupation………………………………………..Email………………………………………………………GP Surgery

Tel(home) ……………………………………. Tel (work)… ……………………………….. Mob…………………………………………………………..

Male Female Pregnant? Yes  No 

Ethnic Group (please tick one square only) – ethnic information is collected to help develop and improve access to services for all individuals in the PCT area

White / Mixed / Asian or Asian British / Black or Black British / Other Ethnic Group
British / White & Black Caribbean / Indian / Caribbean / Chinese
Irish / White & Black African / Pakistani / African / Any other Ethnic Group
Any other white background / White & Asian / Bangladeshi / Any other black background
Any other mixed background / Any other Asian background

How did the client hear about our service?(please tick more than one box if applicable)

GP/Nurse  TV advert  Leaflet  Local Radio  Used service before  Word of mouth  Promotional stand  Other

Support Sessions / Date / CO reading / Phone Contact / Comments
Assessment
Session 1
Session 2
Session 3
Session 4 – please complete

Quit Date ………………………… Quit Date Not Set  Reset? ……………………………..

Has client quit smoking? (i.e has not smoked in the last 2 weeks before 4 week follow up)

Yes  CO validation ……………… If not taken please state rreason……….…………………………………………………….

No  Unknown  ……………………………………………………………………………………………..

Nicotine Replacement Therapy used ------Trade Price + VAT------

CONFIDENTIAL

*Signature for Consent to be contacted

Please note that data collected will be forwarded to the Swindon NHS Stop Smoking Service Secretary for local monitoring and evaluation, and anonymised summary data will be forwarded for regional and national evaluation. Please sign to give your consent for us to contact you 4 & 52 weeks after you started using this service. Please note that you may be contacted by someone else other than your original Stop Smoking Adviser.

I have read the details overleaf and consent to 4 and 52 week follow-ups By not giving consent in no way precludes you form obtaining support from the Stop Smoking Service.

I hereby give my consent for:

Follow-up at 4 weeks with CO validation YesNo

Follow-up at 52 weeks YesNo

Signature…………………………………………………………………………………...Date………………………

***************************************

Comments……………………………………………………………………………………………………………………………

PLEASE COMPLETE ALL SECTIONS OF THIS FORM AS THIS INFORMATION IS REQUIRED BY THE STRATEGIC HEALTH AUTHORITY

Data submitted to the SHA will remain anonymous but we’d appreciate full contact details of your client we may follow them up as appropriate

Please return forms for all clients seen as soon as possible after follow-up has been completed to:

Nicola Strange

NHS Stop Smoking Service Secretary

Swindon PCT,

North Swindon District Centre

Thamesdown Drive

Swindon SN25 4AN

Appendix D – Claim Form

CLAIM FOR PAYMENT Stop Smoking Service

Address of pharmacy

The following patients have completed the project and the monitoring forms have been forwarded to the Smoking Cessation Team

Patients Initials / Visit / Amount Claimed / Trade Cost of NRT Supplied including VAT
Visit 1 (£15)
Visit 2 (£5)
Visit 3 (£5)
Visit 4 (£5)
Visit 5 (£5) / NHS CHARGE / TOTAL CLAIMED
TOTALS
Patients Initials / Visit / Amount Claimed / Trade Cost of NRT Supplied including VAT
Visit 1 (£15)
Visit 2 (£5)
Visit 3 (£5)
Visit 4 (£5)
Visit 5 (£5) / NHS CHARGE / TOTAL CLAIMED
TOTALS
Patients Initials / Visit / Amount Claimed / Trade Cost of NRT Supplied including VAT
Visit 1 (£15)
Visit 2 (£5)
Visit 3 (£5)
Visit 4 (£5)
Visit 5 (£5) / NHS CHARGE / TOTAL CLAIMED
TOTALS

This claim form should be posted with the monitoring forms to the smoking cessation team, who will forward them for payment.