Pharmacy Details To be completed and returned with signed specification Name of Pharmacy

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1 Smoking Cessation Service Acceptance of Service Specification Agreement (Pharmacy): Signed on behalf of the Pharmacy Contractor: Signature Name (print) Date Position Pharmacy Details To be completed and returned with signed specification Name of Pharmacy Address of Pharmacy Phone No. Fax No. Name of HAG Accredited Pharmacist Name of Trained Staff Days/times when smoking cessation service available Signed on behalf of Warwickshire County Council: Signature Name: Paul Hooper Date Position: Smoking Cessation Commissioner A signed copy of this agreement will be kept by the Pharmacy and Warwickshire County Council. Pharmacy Stop Smoking Service Specification Page 1 of 12

2 Specification for Pharmacy Stop Smoking Scheme Service Specification Agreement between: Service Provider: Community Pharmacies in Warwickshire Commissioner: Warwickshire County Council Contents Page 1. Commencement Date 3 2. Expiry Date 3 3. Warwickshire LPC Endorsement 3 4. Background 3 5. Rationale 3 6. Aims of the Service 3 7. Description of Enhanced Service 3 8. Responsibilities and Roles: Pharmacy Responsibilities: Training Delivery of Intensive Support Consultation Area Availability of Service Supply of NRT Monitoring Advertising and Promotion of Service Continuation of Scheme Non-Delivery of Service Audit Standard Operating Procedure Record Keeping Supporting Principles Quality Standards Warwickshire County Council Warwickshire Stop Smoking Service Responsibilities: Make Payment for Services Provided Provide Training Specialist Support 10 Appendix 1 NRT Claim Form Commencement Date: 1 st April Expiry Date: 31 st March 2014 with an option to extend for up to a further 12 months. Pharmacy Stop Smoking Service Specification Page 2 of 12

3 3. Warwickshire LPC Endorsement This Service Level Agreement was originally endorsed as an SLA by Warwickshire Local Pharmaceutical Committee. 4. Background: Warwickshire Stop Smoking Service is funded via Warwickshire County Council to develop, deliver, monitor and evaluate smoking cessation services across the county. 5. Rationale: There is good deal of opportunity to reach smokers via pharmacies. Helping smokers stop is effective and cost-effective. A combination of support from a trained Smoking Advisor along with a stop smoking medication means that a smoker is up to four times more likely to succeed that going it alone. 6. Aims of the Service: a. support the development of stop smoking services outside of GP surgeries. Whilst most GP surgeries in Warwickshire provide intensive support to smokers who wish to quit and this has proved an effective way of helping smokers to quit, there are smokers who may prefer to access stop smoking support in a different setting, eg. Pharmacy, school, community centre, etc. Use of this Service will increase the range of settings where intensive stop smoking support can be provided. b. enable supply of nicotine replacement therapies by appropriately trained nonphysician health care professionals. Where an appropriately trained health care professional is offering intensive stop smoking support they can supply nicotine replacement therapy direct, rather than rely on access to a medical practitioner. This will enable convenient and timely provision of NRT to patients. Anyone in the pharmacy who has attended the WSSS 2 day training course can supply NRT. c. enable non-health care professionals who are offering intensive support to smokers to access nicotine replacement therapy as part of the support package. Where appropriately trained non-health care professionals who are offering intensive support to smokers this Service will allow them to issue a letter of recommendation to supply that the patient can take to the pharmacy to obtain NRT. Anyone in the pharmacy who has attended the WSSS 2 day training is able to issue NRT. This specification outlines the responsibilities and actions required by the Pharmacy and Warwickshire Stop Smoking Service for this scheme. 7. Description of Enhanced Service: Intensive one-to-one support to smokers who want to quit and set a quit date, over a 4-6 week period (approx. 1 ½ hours total) Monitoring and follow-up of clients 4 weeks after the quit date (as per Dept of Health requirements) Full completion and prompt return of monitoring database (QuitManager) or monitoring forms Supply of Nicotine Replacement Therapy (NRT). 8. Responsibilities and Roles: 1.1 Pharmacy Responsibilities: Training Pharmacy Stop Smoking Service Specification Page 3 of 12

4 All pharmacy staff delivering intensive support and supplying NRT to smokers will attend the Warwickshire Stop Smoking Service 2 day training course, which operates to national training standards. In addition, the Pharmacist responsible for delivery of this SLA will complete: CPPE Stop Smoking Part 2 module CPPE Safeguarding Children module (as this service is available to under 16 year olds) NB. Completion of this training and assessment will provide the underpinning knowledge required for the Harmonisation Accreditation Group (HAG) which may allow the pharmacist to provide a similar service in other areas. Existing service providers should complete the above within 6 months of receipt of this document. New service providers should complete the above before or within 3 months of starting the service. Accreditation is proved by possession of a current, expiry dated certificate provided by the accrediting organisation which bears the standard mark of the Harmonisation of Accreditation Group. It is recommended that any other eligible staff in the pharmacy who haven t attended the 2 day training complete the CPPE Part 1 Smoking Cessation training, so they can support a whole pharmacy approach to delivering the stop smoking service. A one-off payment of 300 per pharmacy is available for locum cover for staff to attend training this will be paid on receipt of monitoring forms for 10 x 4-week quitters. No additional payment for training is available. Initially, training is available for 2 staff per pharmacy one must be a regular Pharmacist (who is also HAG trained for smoking cessation), the other can be a dispensary or medicines counter assistant. However, as many staff as appropriate can be trained. 5.1 Competence to Practice To ensure that trained staff continue to be competent to deliver the service they should: a. Attend refresher training every 2 years (1 day delivered by WSSS) b. Undertake an additional measures to ensure skills and knowledge are kept up-to-date, e.g. Networking sessions, meetings with Specialist Smoking Cessation Advisor NOTE: In order to maintain quality of service provision we may require that all trained staff who are delivering the service aim to see at least 6 patients per year who set a quit date or are in a position to demonstrate that they have actively been involved in the provision of service to the patients receiving a service at their pharmacy Delivery of Intensive Support Implement one-to-one intensive support to smokers who want to quit. Full details on how to deliver quality intensive smoking cessation interventions and data requirements are provided in Warwickshire Smoking Cessation Guidelines. In summary, it is expected the following guidelines will be fulfilled by in-house services: a) A service provider offering intensive smoking cessation support should have received appropriate training for their role. b) Service providers must offer weekly support for at least the first four weeks of a client s quit attempt to ensure continued monitoring, client compliance and on-going access to Pharmacy Stop Smoking Service Specification Page 4 of 12

5 medication. Summary of service delivery (refer to WSSS Guidelines for further information): o Contact 1 approx. 30 mins, plan strategy for quitting, including assessment for drug therapy, face-to-face visit o Contact 2 (possible quit date) approx mins, face-to-face visit o Contact 3 approx.10-15mins, support/progress, ideally face-to-face/can be by phone o Contact 4 approx mins, support/progress, ideally face-to-face/can be by phone o Contact 5 (4 week follow-up) approx mins, ideally face-to-face o Support/supply of NRT should be continued on a regular basis where appropriate up to 12 weeks, with a maximum of 4 weeks supplied at a time (refer to Warwickshire Smoking Cessation Guidelines for more details).contact 6 12 week follow-up approx mins, ideally face-to-face (optional) o Contact 7 52 week follow-up (optional) Note: All clients should be offered all of the above (except 52 week follow-up), but no penalties will be incurred by the Pharmacy if the client does not attend for interim support appointments Consultation Area Undertake consultations in a consultation area as defined in the Pharmacy Contract for Advanced Services Availability of Service The service should be available for a minimum of 50% of normal pharmacy opening hours Supply of NRT a) NRT can be supplied by anyone who has attended the 2 day training, provided that they are competent and confident to do so. b) NRT will be supplied to clients accessing other stop smoking services in Warwickshire, upon receipt of a letter of recommendation. This supply will be at the professional discretion of the pharmacy. In this case payment is 3 supply fee for NRT (generally up to max. 6 claims per person where one product is supplied, up to max. 12 claims where dual therapy is supplied, but more can be supplied for Cut Down to Stop clients or where the initial product has not been suitable). The Pharmacy must collect a prescription charge from non-exempt patients. This should be declared on the claim form. Submit appropriate data to Warwickshire Stop Smoking Service by the 5 th of each month to ensure reimbursement of drugs cost and payment of supply fees in the following month Monitoring a. Four-week quit smoking rates are reported to the Department of Health. They also provide a useful performance measure for NHS Stop Smoking Services and a means of tracking service performance. The use of the four-week point as a measure of clinical outcome (stop smoking success) has been questioned, but if the quality of smoking status data at four weeks is good (and is supported by high rates of CO validation) then longer-term success rates can be calculated with a high degree of accuracy. This is because relapse rates are predictable and well documented in the research literature. Pharmacy Stop Smoking Service Specification Page 5 of 12

6 b. The purpose of the monitoring system is to monitor and evaluate the effectiveness and reach of stop smoking services in Warwickshire. It also triggers payment for the service delivered. c. The monitoring criteria and procedures are taken from the NHS Stop Smoking Services Service and Monitoring Guidance, March and are adapted from the Russell Standard, originally developed for use in clinical research. It is essential that all services adhere to these definitions when recording the numbers of smokers entering treatment and the numbers successfully quit at 4 weeks. Pharmacies are encouraged to use the web-based monitoring database (QuitManager) where possible. Training is available through the Locality Specialist Smoking Cessation Advisors) however, it is not mandatory to use the QuitManager database at this time, although this may change in the future. d. A WSSS monitoring form or record on QuitManager should be completed for each treated smoker. A treated smoker is a smoker who has received at least one session of a structured, multi-session intervention (delivered by at Stop Smoking Advisor) on or prior to the quit date, who consents to treatment and sets a quit date with a Stop Smoking Advisor. Smokers who attend a first session but do not consent to treatment or set a quit date should not be included. e. Monitoring forms should be completed fully and returned within 6 weeks of the quit date for accurate reporting to Dept of Health. f. Follow up at 4 weeks following the quit day should be attempted for all clients. g. A CO Verified 4-week quitter is defined as: a treated smoker whose CO reading is assessed 28 days from their quit date (-3 or +14 days) and whose CO reading is less than 10 ppm. The 3 or +14 day rule allows for cases where it is impossible to carry out a face-to-face follow-up at the normal four-week point (although in most cases it is expected that follow-up will be carried out at four weeks from the quit date). This means that follow-up must occur 25 to 42 days from the quit date (Russell Standard). CO verification should be conducted face-to-face and carried out for at least 85% of selfreported four-week quitters. h. A self-reported 4-week quitter is defined as: a treated smoker whose quit status at four weeks from their quit date (or within 25 to 42 days of the quit date) has been assessed either face-to-face or by telephone, text, or postal questionnaire. i. Three attempts should be made to reach a client by phone/letter if they do not attend the 4 week follow-up appointment if there is still no response the client is classed as lost to followup. j. A client is counted as having successfully stopped smoking if he/she has been completely abstinent from smoking for a period of 2 weeks since 2 weeks after the quit date. The rationale behind this definition is to allow a period of grace in recognition of the fact that some smokers initially struggle but then are successful in their quit attempt. k. Spontaneous Quitters Smokers who have already stopped smoking when they first come to the attention of the service may be counted as having been treated only if they have quit within the 14 days prior to coming to the attention of the service and have attended the first session of a structured, multi- Pharmacy Stop Smoking Service Specification Page 6 of 12

7 session treatment plan within 14 days of their spontaneous quit date (which should be recorded as the quit date). Renewed Quit Attempts A quit attempt that takes place immediately following the end of one treatment episode. A new treatment episode should be commenced in the database/service records. A new monitoring form/database record should be completed. l. In line with good practice, all service providers will attempt, wherever possible, to confirm the smoking status of all clients self-reporting as having quit smoking at 4 weeks (mandatory), at 12 weeks (optional) and then at 12 months (optional) by the use of a carbon monoxide monitor. m. The service provider must complete a record on QuitManager or the Warwickshire Stop Smoking Service Monitoring Form (Appendix 2) fully and accurately and return following agreement of quit date and completion of the 4-week follow-up. Forms should be returned within 6 weeks of the quit date to enable accurate monitoring. n. In addition to the 4-week follow up, service providers may opt to extend their monitoring to include 12 week and 52-week follow up. A client would be classed as successfully quit if he/she has been totally abstinent from smoking for the time since the quit day validated through CO monitoring. No payment is made for the 52 week follow-up. o. Retention of Monitoring Forms All monitoring forms should be retained for a minimum of 2 years to allow for possible auditing. p. Safeguarding against the possibility of fraudulent payment claims All trained staff are required to have signed the following declaration (provided at training or completed retrospectively): I claim payment for the stop smoking services that I have provided which are shown on this form. I 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 Services Authority for the purpose of verification of this claim and the preventing, detecting and investigation of fraud Advertising and Promotion of Service Potential quitters who contact WSSS to get details of their local stop smoking service will be offered a choice of service. Those who choose to attend a pharmacy for the service will be given the pharmacy phone number and asked to phone to make an appointment. However, it should be noted that relatively few potential quitters access local services through this route, and tend to find out about services through local advertising and word of mouth. Therefore, pharmacies have a responsibility to advertise and market their stop smoking service to their local potential market. As a minimum appropriate posters and leaflets must be displayed to ensure clients are aware of the stop smoking service provided by the Pharmacy. These include general service posters and at least one additional poster as supplied by WSSS. Other ideas for advertising and promoting the service can be found in the WSSS marketing pack or via discussion with the Locality Specialist Smoking Cessation Advisor Continuation of Scheme Pharmacy Stop Smoking Service Specification Page 7 of 12

8 To ensure continuity of services if a Pharmacy is unable to deliver this service due to illness, changes in staff, etc, a period of 3 months will be allowed for additional staff to be trained. If this deadline is not achieved the Commissioner reserves the right to withdraw the service. The Pharmacy will give three months written notice to the Commissioner to leave the scheme. Warwickshire Stop Smoking Service will then collect materials previously supplied Non-Delivery of Service If no data or claim forms are received within a 6 month period the service will be withdrawn unless there are exceptional circumstances Audit Provide an audit trail for 2 patients per year to demonstrate implementation of quality standards, including provision of support appointments, NRT supply, etc Standard Operating Procedure Develop Standard Operating Procedure for this service (template provided by Warwickshire Stop Smoking Service) Record Keeping A record will be kept for each client using the Stop Smoking Record in Appendix Supporting Principles To support the stop smoking service it is suggested that the following principles are put in place in the pharmacy: a) The pharmacy does not promote /advertise/stock any non-nhs/nice approved methods of stopping smoking. This includes hypnotherapy, herbal cigarettes, filters, electronic cigarettes, etc. b) Pharmacy staff are not seen to smoke around the pharmacy building(s) or within an hour of seeing a client Performance Criteria a. Quit Rate National Service Guidance, states that 4-week quit rates (self-reported and CO verified) should fall between 35% and 70%. The benchmark is 50%, which is around the national average for stop smoking services. b. Lost to Follow-up This should be under 20% and ideally under 10%. c. CO Validation National Service Guidance, states that CO verification should be attempted in at least 85% of all treated smokers and any clients who cannot be contacted at 4 weeks (-3 day or +14 days) should be counted as lost to follow-up. d. Return of Monitoring Forms Monitoring forms should be returned within 6 weeks of the quit date. e. Action for Non-Performance If the individual practice data falls outside the above, WSSS will contact the pharmacy for the following: i) Confirmation that all definitions have been followed with regard to the data submitted Pharmacy Stop Smoking Service Specification Page 8 of 12

9 ii) If the pharmacy confirms that the approved definitions have been used, WSSS will carry out a minimum of 3 random checks of smokers treated by the practice, to establish that they met the criteria for self-reported or CO-verified 4 week quits at the 4 week follow-up point and that they have received an approved intervention of the required content and duration as described previously. If the random checks indicate that recorded quits are unreliable, all cases received from this provider will be checked using the approved definitions and the total number of 4 week quits will be re-entered onto the service database. iii) If, after the required checks are carried out, the results are still outside the expected range, an assessment will be carried out of the most likely causes. WSSS will then support the pharmacy to make improvements to achieve results within the expected ranges. A written improvement plan will be agreed between the pharmacy and WSSS. A period of 3 months will be given to make the required improvements. If the results are then still not within the expected range, 3 months notice will be given to withdraw the SLA from the pharmacy, and alternative arrangements for the pharmacy clients who want to stop smoking will be made. 1.2 Warwickshire County Council & Warwickshire Stop Smoking Service undertakes to: Make Payment for Services Provided per client for setting a quit date with agreed date for follow-up per client still quit at 4-week follow-up per client not quit at 4-week follow-up. No payment for those not followed up at 4 weeks 5.15 per client for 12-week follow-up after quit date Max. available per client = Cost price of NRT reimbursed 3 supply fee for NRT (up to max. 6 claims per person where one product is supplied, up to max. 12 claims where dual therapy is supplied) Max. of 300 locum fee for training (one-off payment) Payment for Intensive Support: Service Providers will receive payments ONLY on completion and submission of Warwickshire Stop Smoking Service monitoring data to Warwickshire Stop Smoking Service The above will be paid monthly in arrears on prompt return of the minimum data set to Warwickshire Stop Smoking Service. Payments for intensive support will be made on a monthly basis on receipt of monitoring data/forms. The Stop Smoking Service will check the forms if information is missing the Pharmacy will be contacted to supply this. The cost of the drugs will be reimbursed in line with current cost price for NRT product and a 3 supply fee will be paid (to maximum of 6 claims per person). If the Stop Smoking Service does not receive the monitoring form to match the ID No. on the claim form then the costs for the NRT claimed against that ID No. will be reclaimed from the pharmacy. Payments will be made via PPA (or equivalent) monthly in arrears and will appear as Local Payment No. 2. Pharmacy Stop Smoking Service Specification Page 9 of 12

10 A one-off payment of 300 per pharmacy is available for locum cover for staff to attend training this will be paid on receipt of monitoring data for 10 x 4-week quitters Provide Training The required 2 day training course will be provided as detailed above. Contact Warwickshire Stop Smoking Service for details of the current training programme Free refresher training is also available Specialist Support Once training is completed Service Providers will receive support from Warwickshire Stop Smoking Service and locality based Specialist Smoking Cessation Advisors: a. Specialist advice and support. It is a requirement of this LES that a visit is made by the Specialist Smoking Cessation Advisor every 6 months. b. All resources/materials and training required to assist Service Providers carrying out brief interventions with smokers and clear referral pathways. c. Warwickshire Smoking Cessation Guidelines Pack d. All resources/materials required to support the Service Provider to deliver intensive one to one smoking cessation support, including support with developing new materials if appropriate. This will include monitoring and other forms, freepost envelopes, carbon monoxide monitors, etc. e. Assistance to Service Providers in developing in-house services, including implementation of guidelines and quality standards, development of in-house protocols, advice and support on challenging clients, etc. f. Support with recruiting clients to the service, including mailshots, advertising and promotion within the local community, networking with other agencies/professionals. g. Specialist advice and information about smoking issues. h. Feedback to Pharmacies on own progress and that of the service. Pharmacy Stop Smoking Service Specification Page 10 of 12

11 Warwickshire Stop Smoking Service Smoking Cessation Claim Form NRT Month: Year: Please return by 5 th day of following month to Warwickshire Stop Smoking Service FREEPOST MID23827 LEAMINGTON SPA CV32 5BR Warwickshire Primary Care Trust Market Street Warwick CV34 4DE Tel: Ext 260 Fax: For information: a. NRT is reimbursed at cost price as per current Chemist and Druggist b. Fee for intensive support is reimbursed on receipt of Warwickshire Stop Smoking Service monitoring form No Date of NRT Supply ID No (on monitoring form) NRT Supplied Cost of NRT (Chemist & Druggist) Script Charge Collected Supply Fee Brand No. (shown Quantity on Pricing sheet) 1 Y / N 3 2 Y / N 3 3 Y / N 3 4 Y / N 3 5 Y / N 3 6 Y / N 3 7 Y / N 3 8 Y / N 3 9 Y / N 3 10 Y / N 3 11 Y / N 3 12 Y / N 3 13 Y / N 3 14 Y / N 3 15 Y / N 3 16 Y / N 3 17 Y / N 3 18 Y / N 3 19 Y / N 3 20 Y / N 3 Please use more than one sheet if required Sub Total Total No. of 7.40 to be deducted TOTAL Declaration The supplies listed were undertaken as stated above by authorised pharmacists following the Warwickshire PGD for NRT. I hereby claim the stated monetary amounts as above for NRT. I declare that information given on this form is true to the best of my knowledge I understand that action maybe taken against me if I make an incorrect claim. I consent to the disclosure of relevant information on this form for the purposes of fraud prevention, detection and investigation. Pharmacist Signature: Pharmacist Name: GPhC number: Pharmacy address stamp For accurate payments, please ensure that this stamp is legible Date of Declaration: Pharmacy Stop Smoking Service Specification Page 11 of 12

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