1archive.psnc.org.uk/services_db/docs/123/pharm_stop_s… · web viewif considered appropriate,...

LOCAL ENHANCED SERVICE FOR STOP SMOKING SERVICE

Service Level Agreement (SLA) 2010-12

1. Introduction.........................................................................................................12. Signatures...........................................................................................................13. Aims and Objectives...........................................................................................24. Service Outline...................................................................................................25. Service Specification...........................................................................................26. Quality Indicators Pharmacy Contractors...........................................................47. Quality Indicators PTC........................................................................................58. Financial Details.................................................................................................69. Monitoring Arrangements....................................................................................610. Termination of Contract......................................................................................6

Appendix A – Service Protocol........................................................................................7Appendix B – Smoking in Pregnancy NRT Assessment and Consent Forms...............10Appendix C – Sample Monitoring Form.........................................................................12Appendix D – Claim Form.............................................................................................14

1. IntroductionThis agreement set outs the framework for the Stop Smoking Service by 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.

2. SignaturesThis document constitutes the agreement between the pharmacy contractor and the PCT in regards to the above Service Level Agreement for the 24 months from 1st April 2010 to 31st March 2012. We agree to abide by the conditions laid out in the agreement:

Pharmacy Name:

Signature on behalf of the Pharmacy contractor

Name (please print) Date

Signature on behalf of Swindon PCT

Name (please print) Date

of 16

Local Enhanced SLA for Stop Smoking Service in Swindon PCT

3. Aims and Objectives

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

3.2. To reduce smoking related illnesses and deaths by helping people to give up smoking.

3.3. To improve the health of the population by reducing exposure to passive smoke.

3.4. To help service users access additional treatment by offering referral to specialist services where appropriate.

4. Service Outline4.1. The Stop Smoking Service is one in which pharmacies will provide one to

one support and advice to people who want to give up smoking, for a maximum of 8 weeks.

4.2. When commissioned, the service will help to increase choice and improve access to NHS Stop Smoking Services.

4.3. The pharmacy will refer to specialist services if necessary.

4.4. The pharmacy will help facilitate access to, and where appropriate supply, appropriate stop smoking drugs and aids.

4.5. This enhanced service reflects the provision of one to one NHS stop smoking support and is to be provided in addition to the Essential Service ‘Promotion of healthy lifestyles (Public Health)’ (ES4).

4.6. The pharmacy contractor agrees to ensure that there is a trained stop smoking advisor engaged in the pharmacy for the majority of the time that the pharmacy is open.

4.7. If the only trained stop smoking advisor leaves the pharmacy, the pharmacy contractor will need to notify the PCT immediately. The pharmacy contractor will have three months to ensure that a trained advisor is available for the service

5. Service Specification5.1.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.

of 16


5.2.Access routes to this service will be determined locally, and could include:

5.2.1. pharmacy referral as a result of the ‘NHS Health Checks, Promotion of Healthy Lifestyles (Public Health)’ or ‘Signposting’ Essential Services;

5.2.2. direct referral by the individual or NHS Swindon Stop Smoking Service helpline.

5.2.3. referral by another health or social care worker;

5.3.The pharmacy would have to confirm the eligibility of the person to access the service, based on local guidelines, and protocol as covered in the local training.

5.4. If considered appropriate, the pharmacist may supply Nicotine Replacement Therapy (NRT), at the cost of an NHS prescription charge for each item dispensed (or free of charge for service users that are exempt from charges) according to the protocol in Appendix A. The prescription charge(s) should be taken at the initial consultation and then every 2-4 weeks thereafter.

5.5.Service users who are exempt from prescription charges should sign the exemption certificate on a standard prescription. A copy of this signed exemption certificate must be included with the pharmacies payment claim form. (Appendix B)

5.6.Combination NRT has been shown to have an advantage over using just one product and is also considered to be cost effective. It can therefore be used when considered clinically appropriate. When using combination therapy please ensure that the quantity supplied of the supplementary NRT product meets their clinical need. (The majority of patients will not require the full dose).

5.7.Support will be given at weekly visit to the pharmacy for the first 4 weeks and then fortnightly for a further 4 week period according to the protocol in Appendix A. Alternatively, clients can be referred to the NHS Swindon Stop Smoking Service for further support following the 4-week follow-up appointment.

5.8. It is expected that any stop smoking advisor dealing with clients under 18 years old will have a valid Clinical Records Bureau (CRB) certificate and will have undertaken foundation child protection training. The NHS Swindon Stop Smoking Service has a specialist stop smoking advisor for young people.

5.9.The NHS Swindon Stop Smoking Service has a specialist advisor for pregnant women who supports women in their own home. Pregnant women should be referred to the specialist advisor when appropriate. If supporting a pregnant woman, please use the NHS Swindon Stop Smoking Service “Assessment for supplying NRT in Pregnancy” and “Consent form for supplying NRT in pregnancy” forms. (Appendix C). Pregnant women should only receive a single form of NRT.

of 16


5.10. Pharmacists will need to share relevant information with other health care professionals and agencies, in line with locally determined confidentiality arrangements. At the first stage in their consultation all clients should be made aware that the details of their quit attempt will be passed in confidence to NHS Swindon for monitoring purposes only.

5.11. The pharmacist will request consent to allow contact by the NHS Swindon Stop Smoking Service and obtain patients signed consent accordingly.

5.12. The pharmacy must maintain appropriate records to ensure effective ongoing service delivery and audit. Records and documentation will be confidential and should be stored securely whilst at the pharmacy premises.

5.13. 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 NHS Swindon Stop Smoking Service Monitoring Form. (Appendix D)

5.14. All documentation (including claim form), with the exception of the summary sheet, is sent on, confidentially, to the NHS Swindon Stop Smoking Service at Swindon PCT.

5.15. Copies of the monitoring form may be taken by the pharmacy for their records.

5.16. All records and forms should be retained in line with national governance standards.

6. Quality Indicators Pharmacy Contractors6.1.Participating pharmacist/pharmacy technician must have successfully

completed the following training:-

6.1.1. The Level 2 Stop Smoking Advisor training (Swindon).

6.2.Participating stop smoking advisors must ensure that they maintain and update their stop smoking expertise through the various sources made available to them by the NHS Swindon Stop Smoking Service.

6.3.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.

6.4.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.

6.5.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.

of 16


6.6.The pharmacy has details of relevant referral points which pharmacy staff can use to signpost/refer service users who require further assistance

6.7.The pharmacy contractor reviews its Standard Operating Procedures and the referral pathways for the service on an annual basis.

6.8.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.

6.9.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 NICE guidance [Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities. National Institute for Health and Clinical Excellence, February 2008.]

6.10. 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.

7. Quality Indicators PTC7.1.The PCT will provide the following local training requirements.

7.1.1. Level 2 Stop Smoking Advisor Training.

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

7.3.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.

7.4.The PCT will support the promotion of the service locally, including the provision of publicity materials, which pharmacies can use to promote the service to the public.

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

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

of 16


8. Financial Details8.1.The pharmacy contractor will received the following payments per service

user:

8.1.1. Initial Assessment £15

8.1.2. Week 1-3 Follow-Up Assessments (maximum of 3) £5

8.1.3. Week 4 Week “Quit” Assessment £5

8.1.4. Week 5-8 Follow-Up Assessments (maximum of 2) £5

8.1.5. Maximum for 8-weeks course £45

8.2.The PCT will reimburse the pharmacy for the cost of NRT supplied including the VAT costs.

8.3.The materials and equipment required, including CO monitors and disposable mouthpieces, are supplied free of charge to the pharmacy by the PCT.

9. Monitoring Arrangements9.1.The Stop Smoking Service at Swindon PCT will monitor the service and will

feedback performance at quarterly network meetings. Any pharmacy whose results fall outside the standard range may be contacted to identify reasons.

9.2.The pharmacy contractor may be requested to participate in an audit or service users’ survey of the by the NHS Swindon Stop Smoking Service.

9.3.The pharmacy contractor may be requested to provide a copy of their patient medication records to assist in the monitoring arrangements.

10. Termination of Contract10.1. This agreement will run for a period of 24 months, however during this

period, it may be terminated by either party by giving three months written notice.

of 16


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 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. Identify treatment options that have proven effectiveness. A description of what a typical treatment programme might look like, its aims,

length, how it works and its benefits; maximise commitment to the target quit date.

Application of appropriate behavioural support strategies to help the person quit; and conclude with an agreement on the chosen treatment pathway.

Ensuring the person understands the ongoing support and monitoring arrangements.

An explanation that the Nicotine Replacement Therapy (NRT) will be provided weekly for the first 4 weeks of treatment, and then fortnightly for a further 4 weeks if considered appropriate.

Obtaining consent for the weekly visits for 4 weeks and the 52 week follow-up by the NHS Swindon Stop Smoking Service.

If considered appropriate, the pharmacist may supply (or supervise the supply of) 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. People not wishing to initially engage may be offered appropriate health

literature or referral to an 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 pharmacy medication record. Consideration should be given to communicating this information to the person’s GP where clinically appropriate.

of 16


Week 1-3 Follow-Up Assessments

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

The follow-up assessments should include:-

Continued application of appropriate behavioural support strategies to help the person quit;

Ensuring the person understands the ongoing support and monitoring 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 to an alternative stop smoking service.

Making an appointment for follow-up in one week’s time. Completion of the monitoring form.

The Week 4“Quit” Assessment

The Week 4 assessment 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

person quit; Completion of the monitoring form. Advise on the next steps:

o Client continues to see the pharmacy stop smoking advisor for a further 4 weeks

o Client referred to the NHS Swindon Stop Smoking Serviceo Client continues with a self maintenance programme.

The completed monitoring forms for all clients seen should be returned as soon as possible after 4 Week “Quit” Assessment 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 NHS Swindon Stop Smoking Service, NHS Swindon, North Swindon District Centre, Thamesdown Drive, Swindon, SN25 4AN, 01793 708751. They can also be sent to the PCT Safe Haven fax on 01793 704583. The NHS Swindon Stop Smoking Service must be notified before they are sent.

of 16


The Week 5-8 Follow-Up Assessments

Where appropriate, the quitter can be seen fortnightly for two further visits (up to 8 weeks from initial quit date) if further support seems necessary. The format of the visits should be the same as the Week1-3 Follow-Up Assessments, and two weeks supply of NRT may be supplied at each visit.

If, at the final assessment, the client requires further stop smoking support, he/she should be referred to the NHS Swindon Stop Smoking Service.

of 16


Appendix B –Smoking in Pregnancy NRT Assessment and Consent Forms

Assessment for supplying NRT in Pregnancy

Patient Name _____________________________ DOB ______________

Patient Address ________________________________________________

________________________________________________

Has the patient:1. Had a heart attack within the last 4 weeks? YES/NO2. Got heart failure? YES/NO3. Got unstable angina? YES/NO4. Got cardiac arrhythmia? YES/NO5. Had coronary artery bypass graft within last 4 weeks? YES/NO6. Had angioplasty within the last 4 weeks? YES/NO7. Had a stroke/TIA within the last 6 weeks? YES/NO8. Got serious liver or kidney disease? YES/NO9. Got a stomach ulcer? YES/NO10.Got an overactive thyroid? YES/NO11.Got high blood pressure? YES/NO12.Got any sensitivity to nicotine replacement therapy? YES/NO13.Got diabetes? YES/NO14.Got any generalized skin conditions? YES/NO

(only excludes nicotine patches)

If the answer is YES to any of the above , refer to the GP or consultant.

Have you discussed all the NRT options? YES/NO

Client’s NRT treatment choice ________________________________

Carbon monoxide reading ____________________________ppm

Number of cigarettes smoked per day ________________________________

Time of first cigarette on waking ________________________________

Is the client sufficiently motivated to stop smoking? YES/NO

Is the use of NRT appropriate in this instance? YES/NOIf NO, please state why ________________________________

Type of NRT prescribed ________________________________

Name of NHS Swindon Stop Smoking Advisor: ________________________

Signature: _________________________________ Date: _________________

of 16


NHS SWINDON STOP SMOKING SERVICE

Consent form for supplying NRT in pregnancy

This must be completed before NRT can be supplied.

Name _____________________________________________________

Address _____________________________________________________

_____________________________________________________

DOB _____________________________________________________

Please sign below to say that you understand the information that has been given to you.

1. The Advisor has completed an assessment form

2. I have been advised not to exceed the recommended dose of NRT

3. I understand that I should not smoke whilst taking NRT

4. I have been given the opportunity to ask questions

5. I have received clear instructions about the correct use of NRT

6. I agree to the Advisor passing information to my consultant/GP/Midwife and the NHS Stop Smoking Service if necessary

7. I agree to be supported by the Advisor throughout the course of treatment

Client Signature_______________________________ Date _________________

Stop Smoking Advisor (Print Name______________________________________

Signature____________________________________ Date _________________

of 16

Appendix C – Sample Monitoring Form

SWINDON NHS STOP SMOKING SERVICE, North Swindon District Centre, Thamesdown Drive,Swindon SN25 4AN, Tel: 01793 708750

Note: All patient data will be kept securely and in accordance with Caldicott guidelines. Information can only be passed to another healthcare professional if this contributes to the provision of effective care.ADVISER DETAILS:Name Job Title

Place Client Seen Client’s GP Practice

CLIENT DETAILS:Surname First Name Mr/Mrs/Miss/Ms/Other

Address

Postcode Gender Male / Female

Date of Birth Day time tel no.

Mobile number Alternative tel no

Exempt from prescription charge Y / N Pregnant Y / N Breast feeding Y / N

Occupation code(see attachedfor further information)

Full-time student Never worked/long term unemployed Retired Home carer Sick/disabled and unable to Managerial/

Intermediate Routine & manualOccupation (if not able to code) ……………………………….. code)code:

ETHNIC GROUP: (please tick relevant group)a] White b] Mixed c] Asian or Asian British British White and Black Caribbean Indian Irish White and Black African Pakistani Other white background White and Asian Bangladeshi

Other mixed groups Other Asian background

d] Black or Black British e] Other ethnic groups f] Other group ………………………. Caribbean Chinese Not stated African Other ethnic group Other Black backgroundHOW CLIENT HEARD ABOUT THE SERVICE: (please tick relevant box)GP Friend/relative PharmacyOther health professional Advertising Other (please specify)

……………………………………….Word of mouth NHS Health Check ReferralClient signature (indicating consent to treatment and follow-up and pass on of outcome data to GP)

………………………………………………………………………………….

Agreed quit date Date of last tobacco use 4 wk follow-up date

TYPE OF INTERVENTION DELIVERED: (see notes)Closed groupOpen (rolling) groupOne to one support

Telephone support Couple/familyDrop-in clinic

Other (please specify) ………………………….....

TYPE OF PHARMACOLOGICAL SUPPORT USED: (please tick all relevant boxes. Use 1 or 2 to indicate consecutive use of more than one medication – e.g. Champix followed by NRT product)NoneNRT – LozengeNRT – Microtab

ZybanNRT – InhalatorNRT – Spray

NRT – GumNRT – PatchChampix

TREATMENT OUTCOME:Quit CO verified Quit self report Not Quit Lost to follow up

ADVISOR’S SIGNATURE …………………………………………………………………

Date Week Co reading Products used Comments Advisors initials

Follow ups attempted (for clients who DNA appointments):

Date Phone call? Time of call Letter sent? Outcome/comments

Additional Comments .………………………………………………………………………….

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Please return this form by the specified deadlines to:

NHS Swindon Stop Smoking ServiceSwindon PCT North Swindon District CentreThamesdown DriveSwindon SN25 4AN

If you have any queries please contact Nicola Strange on 01793 708750 or email

[email protected]


Appendix D – Claim Form

CLAIM FOR PAYMENT Stop Smoking Service

Pharmacy Name:..................................................................................................................

Address:................................................................................................................................

Tel:.........................................................................................................................................

Payment Ref:........................................................................................................................(payment reference will be included in remittance advice)

Total number of clients this claim

Monitoring forms Attached □Sent previously □

Total consultation cost £ .

Total NRT cost £ .

Total Amount claimed £ .

This claim form should be posted with the monitoring forms to the NHS Swindon Stop Smoking Service, who will forward them for payment.

I claim payment for the stop smoking services that I have provided which are shown above. Confirm that the information given on this form is true and complete. I understand that if I provide false or misleading information I may be liable to prosecution or civil proceedings. I understand that the information on this form may be provided to the Counter-Fraud and Security Management Service, a division of the NHS Business.

Remittance to Pharmacy □

Remittance to Other □

Details:

Signed:............................................................... Date:.........................................


Pharmacy Name:.................................................................................................

Payment Ref:........................................................................................................

The following patients have received stop smoking support and their monitoring forms have been forwarded to the NHS Swindon Stop Smoking Service.

Patient’s name Visit Amount Claimed

Trade Cost of NRT Supplied including VAT

NHS charge(s) taken

NRT Cost to be reimbursed

Visit 1 (£15)

Visit 2 (£5)

Visit 3 (£5)

Visit 4 (£5)

Visit 5 (£5)

Visit 6 (£5)

Visit 7 (£5)

TOTALS £ £ £ £



NHS charge(s) taken


Visit 1 (£15)

Visit 2 (£5)

Visit 3 (£5)

Visit 4 (£5)

Visit 5 (£5)

Visit 6 (£5)

Visit 7 (£5)

TOTALS £ £ £ £



NHS charge(s) taken


Visit 1 (£15)

Visit 2 (£5)

Visit 3 (£5)

Visit 4 (£5)

Visit 5 (£5)

Visit 6 (£5)

Visit 7 (£5)

TOTALS £ £ £ £

1archive.psnc.org.uk/services_db/docs/123/pharm_stop_s… · web viewif considered appropriate,...

Documents