Public Health Extended Service Specification: Smoking Cessation Services based in Community Pharmacies

Transcription

1 Public Health Extended Service Specification: Smoking Cessation Services based in Community Pharmacies Contents: 1. Introduction 2. Period of Service 3. Aims of Service 4. Essential Criteria and Quality Indicators 5. Service Outline 6. Audit and Review 7. Agreement Termination 8. Agreement Variation 9. Financial Arrangements Appendix 1: Appendix 2: Appendix 3: Appendix 4 Appendix 5 Appendix 6 Appendix 7 Service Agreement (to be signed and returned) Payment schedule Definition of a quit Declaration (to be signed and returned) Consultation pro-forma - Client record form Pharmacy client information sheet Competency framework pro-forma TREATMENT GUIDE TO NRT (PHARMACY) 1

2 1.0 Introduction 1.1 Public Health pharmacy smoking cessation services deliver increased choice and easier access to cessation support for smokers across Stockport. This Public Health scheme provides an opportunity for pharmacists to target activities and support people in local, nonclinical and accessible settings. The scheme compliments services provided from Healthy Stockport 1 and GP practices. 1.2 This service specification details the pharmacy element of Stockport Council s Public Health smoking cessation service provided in selected pharmacies across Stockport. This specification is designed to cover aspects of service provision which are beyond the scope of pharmacy essential services. No part of this specification by commission, omission or implication defines or redefines pharmacy essential or advanced services. 1.3 There are two key elements of Stockport Council s pharmacy smoking cessation scheme 1. Programme coordination commissioned via Healthy Stockport Service 2. Service delivery via authorised pharmacy sites 1.4 As Stockport Council also commissions the Healthy Stockport Service the Healthy Stockport Service Specification contains details regarding element one (1) above including quality, performance and productivity outcomes for the Healthy Stockport Service. In summary element 1 includes: Providing on-going professional advice to commissioned pharmacy staff concerning good practice within pharmacy smoking cessation services at authorised pharmacy sites Information concerning products available and product changes to authorised pharmacists, using the treatment guide for NRT. See Appendix 9 Supporting pharmacists and their staff to provide comprehensive monitoring data, to DH standards, for all the clients they support. Verifying activity and financial claim forms returned by authorised pharmacies so that this can be paid by the Council. Supply, training on the use of and maintenance of CO monitors loaned to pharmacies on the scheme. Recruiting new pharmacies onto the scheme and supporting them through the selfassessment and accreditation process (see section 3.1) In addition, providing approved training alongside agreement of pharmacy competencies to deliver the service (see section 4.3) Maintaining a local register of accredited pharmacists skills and competencies to the levels (intermediate, level 2 unless otherwise stated) agreed with commissioners. 1.5 This specification from this point forward concerns element 2 above i.e. service delivery via authorised pharmacy sites only. 2.0 Period of Service 2.1 Services will be commissioned as detailed in this specification and with regard to Stockport Councils Standard Contract unless there is significant revision in the service level agreement by any future commissioning body. 1 Healthy Stockport is the new integrated lifestyle service for Stockport, providing behaviour change support including smoking cessation support. 2

3 3.0 Aims of Service 3.1 The aim of the scheme is to address proactively the needs of people age 18 and over who want to stop smoking by ensuring they receive high quality pharmacy smoking cessation support including managed nicotine replacement therapy (NRT). New pharmacies will only be invited to join the scheme if they are based in deprived areas (JSNA) where smoking prevalence is high or areas where there is an identified need for smoking cessation support in the locality. The identified need must be discussed and agreed between the commissioner and the Healthy Stockport service with reference to the Pharmacy Needs Assessment (currently in development for 2014/15). 4.0 Essential Criteria and Quality Indicators 4.1 All participating pharmacies must be able to demonstrate: 4.2 A suitable consultation area that ensures client confidentiality. 4.3 The commitment to staff training to the appropriate levels agreed with commissioners. All staff participating in the scheme must complete and register as maintaining their skills and competencies as part of an agreed self-assessment process. This includes maintaining skills for the management of single and/or dual therapy treatments (for a maximum of 12 weeks) in accordance with NICE guidance. A review of training is currently underway. Participating pharmacies will be notified of any changes they need to implement. In the meantime the standards below will apply: Accredited CPPE / NCSCT (online Stage 1 & 2) courses as specified by Healthy Stockport & LA Commissioners, this may also include - Attendance at approved training and locally organised communication events (annually). In addition to pharmacists the above applies to any locum pharmacists and any support staff nominated to deliver the consultation under supervision of the pharmacist. 4.4 Sufficient resource to deliver the service, where customers are able to make appointments at all times the pharmacy is open, including weekends and evenings. 4.5 A commitment to complying with the Department of Health standards for the delivery of smoking cessation services (LINK) 4.6 A good knowledge of and commitment to effective liaison with Healthy Stockport Service. 4.7 Pharmacists must be fully informed about the products that are funded under the scheme. Healthy Stockport Service will inform pharmacists on the scheme of any changes to products included within the scheme. 4.8 Advice given to clients during consultation must be in line with the Treatment Guide for NRT. 4.9 A commitment to keeping accurate and timely records of consultations and sharing outcomes data with the Healthy Stockport service and on request by commissioners. NB. Pharmacies will not receive payment for smoking cessation work unless monitoring data has been shared with the Healthy Stockport service. See section That the PharmOutcomes web-based system is used to collate data on clients and meet local information governance guidelines. 3

4 4.11 That the lead pharmacist signs the invoice declaration and Enhanced Service Specification for Smoking Cessation Service based in Community Pharmacies on joining the scheme (see appendices 1 and 5). 5.0 Service Outline The following points are given as a brief description of the key elements that are integral to the service and are detailed in appendix 1). An initial consultation A second consultation (2 weeks after quitting and/or setting a quit date) Third consultation (4 week follow up) A fourth fifth & final consultation Monitoring and reporting on all clients, including those lost to follow-up Completion and submitting of monitoring forms Data collection and filing arrangements 6.0 Audit and Review 6.1 A review of all active service sites will be made by the Healthy Stockport Service at least annually or more frequently where there are concerns regarding delivery or performance in liaison with PH Commissioner to include: a. Service uptake. b. Successful quitters. c. Unsuccessful quitters. d. Financial review. e. Feedback of activity. 6.2 Inactive sites will be informed of the importance of maintaining skills and competencies and offered support by Healthy Stockport Service. Commissioners will be made aware of pharmacy sites that remain inactive for longer than 6 months and withdrawal from the scheme will be considered. 7.0 Agreement Termination 7.1 The Commissioner and the provider may agree, in writing, to terminate the contract and, if agreement is reached, the date on which the termination should take effect, with a minimum notice period of 30 days. 7.2 The Commissioner will have the right to suspend or terminate delivery of the service if the provider fails to meet the terms of this agreement, including accredited pharmacist status. 8.0 Agreement Variation 8.1 Stockport Council as the commissioner reserve the right to vary any part of this agreement at any time as a result of any Act of Parliament or direction of Central Government or outcome of review of audit, providing that no less that 30 days-notice to this effect is given. 9.0 Finance Arrangements 9.1 Payments are made to the pharmacy contractor who employs an accredited pharmacist to provide the service from a pharmacy commissioned to provide the Smoking Cessation enhanced service. They are as follows: Full reimbursement of the TRADE price (as described by C&D price list) of NRT products dispensed plus VAT (less cost of prescription if client not entitled to free prescription). 4

5 In addition to 9.1 above a maximum of 23 consultation fee per client is available. This includes: 7 per client for the initial consultation/ dispensing 1 st voucher, 8 for two products. 1 per client for dispensing vouchers 2, and 6. 2 for 2 products 5 per fully completed* monitoring form (this is an essential requirement) *In addition, to qualify for the monitoring form payment the pharmacist must ensure that all monitoring fields on the form are completed, including the 4 week follow up. 9.2 The reimbursement for the above costs is via invoice charged to Stockport Council with monies due to be paid via BAC s transfer to the pharmacy Contractors local account. This system may change in light of changes to the financial arrangements for any future organisation commissioning the service. 9.3 The payments detailed above may be subject to a revision dependent on any changes in the fees following negotiations between the Commissioner and the LPC, unless there are national tariff changes to the costs of medication, or services. 9.4 All contractors must submit invoices and quit data in a timely manner. Invoices should be submitted electronically no later than two months after the quit date to Healthy Stockport Service along with the completed monitoring form. See Appendix 2 for timetable for receipt of completed monitoring forms and invoices. The Healthy Stockport Service will forward invoices to Stockport Council. Invoices will be paid one month in arrears. The cost of products will only be reimbursed where they have been redeemed within agreed timeframes (i.e. clients must use their 1 st voucher within four weeks of it being issued, allowing two weeks to set a quit date and consecutive vouchers within two weeks). 9.5 No payments will be made to a pharmacy unless monitoring data have been received. Where clients are lost to follow up after the initial consultation and dispensing of NRT products this must be clearly documented and attempts to follow the client up must be made in accordance with DH guidance. See Appendix 4. 5

6 Appendix 1 Service Agreement PHARMACY ENHANCED SERVICE FOR SMOKING CESSATION Service Agreement The Pharmacy agrees to provide the Pharmacy Enhanced Service for Smoking Cessation and agrees to deliver the requirements as specified in this Service Specification. Pharmacist Pharmacy Name Pharmacy Address Commissioner: Sue Kardahji Public Health Specialist (Health Promotion) Services to People Public Health Town Hall, Stockport SK1 3XE Authorised Signatory on behalf of The Provider Signed Print name Date Please return signed form C/O Andy Dunleavy at the address above or by to andy.dunleavy@stockport.gov.uk 6

7 Appendix 2 Payment Schedule Payments Period in which clients sets a quit dates Monitoring forms submission deadline Invoice deadline Q1 April 1 st - June 30 th August 31 st Sept 30 th Q2 July 1 st - Sept 30 th November 30 th Dec 12 th Q3 Oct 1 st - Dec 31 st Feb last day March 31 st Q4 Jan 1 st - March 31 st May 31 st June 30 th No payments will be made to a pharmacy unless monitoring data has been received as specified in the table above. Where clients are lost to follow up after the initial consultation and dispensing of NRT products this must be clearly documented and attempts to follow the client up must be made in accordance with DH guidance. See Appendix 4. 7

8 Appendix 3 - Guidelines Guidelines for Pharmacy enhanced service for delivering smoking cessation in pharmacies (Jan 2014) Please be active in recruiting people to the scheme by promoting the service to all your customers. The scheme can only operate when the pharmacist who has signed the Local Enhanced Service Specification for Smoking Cessation based in Community Pharmacies is on the premises. Each client can have 2 attempts in any 6 month period, if assessed as ready to quit. If this is not adequate please refer them to Healthy Stockport ( ) or their GP practice for more intensive support. People can only be accepted on the scheme if they are ready to set a quit date within the next 2 weeks. If they are thinking about quitting in the future, provide materials to assist their decision making. e. g. It s so much easier since I quit or I m quitting, one day at a time and leave offer of help open. The pharmacist who has signed the above documentation is responsible for: assessing the client. signing the initial consultation form. dispensing all NRT and signing all vouchers (only one type of NRT product per voucher). Completing a monitoring form and returning it to the Healthy Stockport service in a timely manner. Accurate invoice returns which can be audited. Initial consultation Congratulate the person on making the first step. Explain the scheme a client hand-out is useful here. Discuss what happens after 8 weeks. Obtain consent to record data and share anonymised data with the Healthy Stockport service. Complete initial consultation form (must be signed by the pharmacist who has signed the above documentation).assess motivation to stop using stages of change model. If motivated, agree a quit date which should be within 2 weeks. Discuss NRT and options. Explain use of relevant NRT product. Dispense first 2 weeks of NRT (Products must be dispensed and voucher signed by the pharmacist who has signed the above documentation). Encourage planning e.g. keeping a diary, getting social support and avoiding high risk situations. Fill in the first part of the monitoring form. 8

9 Explain about the 4 week follow up and obtain appropriate contact phone number. Discuss confidentiality issues around telephoning and leaving messages. Arrange 2 nd appointment 2 to 3 days before NRT runs out. Encourage person to come back sooner if product not suitable or they need additional support. Offer Carbon Monoxide (CO) reading if equipment available. Complete invoice record. Second consultation (usually around day of quit; middle of week 2) Establish whether client has quit. Validate with CO monitor if available. If person has not smoked since quit date: Congratulate success and re-motivate. Assess suitability of NRT product. Discuss side effects, symptoms of recovery, cravings, and any difficulties. Dispense next 2 weeks of NRT (Products must be dispensed and vouchers signed by the pharmacist who has signed the Pharmacy Enhanced Service for Smoking Cessation. Arrange 3 rd appointment 2 to 3 days before NRT runs out. If person has smoked since quit date assess readiness to now be totally abstinent. If ready to be totally abstinent, proceed as above (see also definition of quit ). If not ready to be totally abstinent, this quit attempt is finished. Do not issue any further vouchers, complete monitoring form as not quit, leave offer of help open in the future. Third consultation (try to arrange on or after day 25 of the quit, middle of week 4). Establish whether client has quit. Validate with CO monitor if available. If person has not smoked within the last 2 weeks: Congratulate success and re-motivate. Assess suitability of NRT products. Discuss side effects, symptoms of recovery, cravings, and any difficulties. Dispense next 2 weeks of NRT (Products must be dispensed and vouchers signed by the pharmacist who has signed the above document). Arrange 4 th appointment 2 to 3 days before NRT runs out. If this consultation takes place on or after day 25 complete 4 week follow up as quit if person has not smoked at all in the last 2 weeks If person has smoked in the last 2 weeks but it occurred between days 1 and 14 of the quit attempt proceed as above if they are ready to be totally abstinent. It is too soon to complete the monitoring form if they smoked days on days of the quit attempt. 9

10 If the person smoked on or after day 15 do not issue any further vouchers. Complete the monitoring form as not quit. Leave offer of help open in the future. This is the end of this quit attempt. [The monitoring period is for 28 days (minus 3, ie day 25 or plus 14, ie day 42) from the quit date. The person cannot set a new quit date within this time. Each client can have 2 attempts in any 6 month period, if assessed as ready to quit. ]. Fourth, Fifth and FINAL consultation of this quit attempt: Establish whether client has quit. Validate with CO monitor if available. If person has not smoked since day 15 from their quit date: Assess suitability of NRT products. Discuss side effects, symptoms of recovery, cravings, and any difficulties. Congratulate success and re-motivate. Dispense 2 weeks of NRT (Products must be dispensed and voucher signed by the pharmacist who has signed the Pharmacy Enhanced Service for Smoking Cessation). Complete 4 week follow up as quit if the person has not smoked at all in weeks 3 and 4 of their quit and the monitoring form was not already completed at third consultation Advise on how to obtain further supplies of NRT after week 12 if required. If the person has smoked during weeks 3 and/or 4 of the quit attempt congratulate on the success they have achieved and leave offer of help open in the future. Complete the monitoring form as not quit. If the person was not smoking in weeks 3 or 4 but has smoked since congratulate on the success they have achieved and leave offer of help open in the future. [The monitoring period is for 28 days (minus 3, ie day 25 and plus 14, ie day 42) from the quit date. The person cannot set a new quit date within this time. Each client can have 2 attempts in any 6 month period, if assessed as ready to quit. ]. See below for managing clients lost to follow up. 10

11 Appendix 4 Jan 2014 Review Sept 2015 Definition of a Quit According to Department of Health guidance a quitter is defined as a client who having attended at least one session of intervention and having set a quit date has not smoked in the immediate 2 weeks prior to being followed up by the adviser. Follow up can take place between day 25 and day 42 following the quit date. If possible a carbon monoxide reading should be taken at this time and recorded. Example: Joe Blogs is seen on 1 st April and sets a quit date as 1 st April. His 4-week follow up can take place anytime from 25 th April to 11 th May (day 25 to day 42). He finds it difficult initially and smokes 2 cigarettes on the 8 th April. From his 2 cigarettes on 8 th April up until his 4 week follow up on the 25 th April he does not smoke he is therefore recorded as a Quitter at 4 weeks because he has been smoke free for at least the last 2 weeks prior to contact which was conducted within the specified time frame (see above). Not quit: Client to be totally abstinence 14 days prior to being followed up. (Day 25 to day 42). Lost to follow up: Up to 3 attempts should be made to reach a client by telephone, one of which should be in an evening. A letter may also be sent. If they cannot be contacted then they should be recorded as lost to follow up for monitoring purposes. Invoices must be returned by 6 th of every month to the Healthy Stockport Service. They will be paid one month in arrears. Cost of products dispensed will only be reimbursed where they have been used within agreed timeframes (i.e. clients must use their 1 st voucher within four weeks of it being issued, then vouchers 2,3,4, 5 and 6 consecutively every two weeks, maximum of 12 weeks on scheme). Jan 2014 Review Sept

12 Appendix 5 - Declaration Healthy Stockport Floor 1 Kingsgate Wellington Road North Stockport SK4 1LW Tel: Fax: snt-tr.healthystockport@nhs.net Date. Dear The Commissioners and Providers of smoking cessation services are required to adhere to the principles of good financial practice, which include a system to protect against incorrect invoice claims. All involved pharmacists are required to sign and return a declaration about returning accurate invoices which can be audited. I have enclosed a copy for you to sign and return to me as soon as possible. Please note that no payments can be made until a signed copy of this declaration has been received. Thank you for your hard work on the scheme. Regards Belinda Pryke Stop Smoking Nurse Adviser / Pharmacy Lead Healthy Stockport 12

13 The NHS Stop Smoking Services service delivery and monitoring guidelines 2011/12 contain quality principles for good financial practice for services provided as part of a local enhanced scheme. Stockport commissioners and service providers are committed to implement these principles: The service level agreement should be verified verbally and in writing. Deviations from the agreement are not permitted Third party providers should be required to keep all relevant financial records for a minimum of 2 years, to allow for possible audit. Providers of local enhanced scheme may not subcontract service provision to other parties. Claims made on this basis will not be paid. To safeguard the service against possibility of fraudulent claims, third party providers should sign and date the following declaration: The claim for payment for smoking cessation services delivered in pharmacies via the locally enhanced scheme is the responsibility of the pharmacist who has signed the local enhanced scheme specification smoking cessation service based in community pharmacies. I claim payment for the stop smoking services that have been delivered in this pharmacy (...). I confirm that the information given on the invoices is true and complete. I understand that if the information provided on the invoice is false or misleading information I may be liable to prosecution or civil proceedings. I understand that the information on the invoice forms 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. Signed.... Print name.. Designation Date.... Jan 2014 Review Sept

14 Appendix 6 INITIAL CONSULTATION PROFORMA (To be completed by the pharmacist with the client for initial supply of NRT only) Pharmacy: Clients Name: Criteria for Exclusion Refer to GP Exclude if: Pregnant women only Refer back to midwife or GP if they have: Client s Scheme Number: Criteria for inclusion Include if: Aged years. Using theophylline, aminophylline or flecanide. NRT, amfebutamone or buproprion (Zyban). Have uncontrolled hypertension. Have had previous adverse reaction to nicotine or any other NRT product ingredient. Hypertension (pregnancy induced or essential). Cardio-vascular disease. Peripheral vascular disease. Heart Failure. Over active thyroid or diabetes. No contraindications for inclusion in the scheme. Client sufficiently motivated to stop. Explained scheme. Within last 4 weeks had a cardiovascular event or hospitalisation for stroke; transient ischaemic attack. MI; unstable angina; cardiac arrhythmia; coronary artery bypass or angioplasty. Uncontrolled diabetes or are pregnant with diabetes. Kidney or liver disease. Stomach ulcers. Skin disease e.g. psoriasis. Taking Warfarin or nicoumaline tablets. Severe Hepatic and/or renal impairment. Other problems associated with pregnancy. Phaeochromocytoma. Other reason for exclusion (see left). Patches only chronic generalised skin disease or a previous reaction to transdermal patches. Explained the use of NRT in pregnancy. Nasal spray only chronic nasal disorder. To the best of my knowledge the above information is correct. (Revised April13) Client s signature Pharmacist s signature Date Jan 2014 Review Sept

15 Client Record Client Name Client Scheme No Client Date of Birth CLIENT CONSENT All client data will be kept in accordance with the Caldicott guidelines. Client consents to treatment, follow-up, and data passing to SMBC and Healthy Stockport. Contact from pharmacy representative by use of the address and telephone numbers given. Contact with a client s GP may be necessary to commence or continue treatment and this will be discussed with the client beforehand. please tick Date Completed. Smoking History Cigarettes smoked per day? How long smoked this amount?.. How soon on waking do you smoke?.... Tried to give up/given up before?... Quit for how long?. Methods / treatments previously tried?. Any comments... Reason for relapse?.. Why do you want to stop now?... Other information

16 Client Name Scheme No Date of birth Fagerstrom Test for Nicotine Dependence (Fagerstrom Tolerance Questionnaire 1991) 1. How soon after you wake up do you smoke your first cigarette? After 60 minutes (0) minutes (1) 6-30 minutes (2) Within 5 minutes (3) 2. Do you find it difficult to refrain from smoking in places where it is forbidden? No (0) Yes (1) 3. Which cigarette would you hate most to give up? The first in the morning (1) Any other (0) 4. How many cigarettes per day do you smoke? 10 or less (0) (1) (2) 31 or more (3) 5. Do you smoke more frequently during the first hours after waking than during the rest of the day? No (0) Yes (1) 6. Do you smoke even if you are so ill that you are in bed most of the day? No (0) Yes (1) 0-2 Very low dependence 6-7 High dependence 3-4 Low dependence 8-10 Very high dependence 5 Medium dependence Fagerstrom score Initial CO reading Quit date NRT product/s supplied... Completed by: NAME (signature).. NAME (print) Designation.. Date & time 16

17 Client Name Scheme No Date of birth Follow up appointments Date Time. CO reading Quit date Product/s used.. Progress.. Outcome: attended quit not quit relapsed lost to follow-up NAME (signature) Name (print)... Designation. Date Time. CO reading Quit date Product/s used.. Progress.. Outcome: attended quit not quit relapsed lost to follow-up NAME (signature) Name (print)... Designation Date Time. CO reading Quit date Product/s used.. Progress.. Outcome: attended quit not quit relapsed lost to follow-up NAME (signature) Name (print)... Designation. Date Time. CO reading Quit date Product/s used.. Progress.. Outcome: attended quit not quit relapsed lost to follow-up NAME (signature) Name (print)... Designation. 17

18 Appendix 7 Pharmacy Scheme Client Information Sheet Information on support from your local pharmacy team to stop smoking: This pharmacy based Nicotine Replacement Therapy (NRT) scheme has been set up to offer you maximum support with stopping smoking. Here are a few questions you might like answers to: Can everyone use Nicotine Replacement Therapy (NRT)? For most people NRT is perfectly safe. Your pharmacist will check if it is safe for you. If there is any reason why your pharmacists can t prescribe NRT for you, you will be referred to your GP. How much NRT can I get? You will be offered 12 weeks NRT in total, either free if you don t pay for your prescriptions or at the cost of 12 prescriptions if you normally pay for your prescriptions. You will receive 2 weeks supply at each of your 6 consultations with the person supporting your quit attempt in the pharmacy. What do I have to do to get my supply of NRT? After you have seen the pharmacist they will help you decide on a quit date. You will need to set a date to stop smoking to get your first supply of NRT and to stay stopped to get further supplies of NRT. This is very important, as you should not use NRT products whilst you are still smoking. Can I save my NRT to use later? You should start using your NRT on the first day of your quit attempt and this should be within 2 weeks of first consulting with your pharmacist. Make sure you arrange to see your pharmacist again before your NRT runs out then and then at 2 weekly intervals so your quit attempt will be continuous over the whole 12 weeks. You can t save them to use later because we know from the research that this isn t the best way to try to stop smoking. Do I have to collect the NRT myself? Yes. You can t send someone else in to pick the NRT up for you. What else does this scheme offer me? The benefit of this scheme is that in addition to the NRT you get on-going support from your pharmacist and their staff. At your first session you will be offered lots of advice on how best to stop and stay stopped, you will get lots of information on the best NRT product for you and you may have your carbon monoxide level monitored. After your first appointment you are entitled to five more sessions two weeks apart. You can discuss any problems you have had, receive a further two weeks supply of NRT and may have another carbon monoxide test. There is lots of research to show that if you use NRT and you are supported by a health professional, such as a pharmacist you are much more likely to stop smoking. This is an NHS based scheme and we want you to be able to access the best level of care. What if I miss an appointment? Please try to let the pharmacy know and re-arrange as quickly as possible before your NRT runs out. Is the service confidential? Everything discussed within the one-to-one session will remain confidential. However, there may be occasions when an advisor may need to disclose certain information, but he/she will discuss this with you first. Your pharmacist will retain and store client information in a secure and confidential manner. Jan 2014 Review Sept

19 APPENDIX 8 Public Health Extended Services SMOKING CESSATION BASED IN COMMUNITY PHARMACIES COMPETENCY FRAMEWORK Updated Jan 2014 (Review Sept 2015)

20 Date of Review / meeting Pharmacy / Pharmacist: Pharmacy Name. Pharmacist Name.. Pharmacy Code Signature Outcome / Actions / Comments: Reviewer: Signature. Designation Name (Print). Date (Copy to be retained by Healthy Stockport / Commissioner & individual pharmacy.)

21 SERVICE INDICATOR 1. PREMISES & EQUIPMENT a. The part of the pharmacy used for the provision of the service provides a sufficient level of privacy and safety and meets other locally agreed criteria. EVIDENCE TO CHECK Consultation room (essential for new sites joining the scheme) compliant to allow: Seating for 2 people Provide conversation at normal speaking volume If consultation room not used discuss with staff where service occurs & how public perceptions are managed have any clients chosen to use other service providers VERIFICATION b. The initial consultation and validation of quit should include a carbon monoxide (CO) test (if available). Use of CO monitor, if available Discuss use of monitors and disposable mouthpieces Machine calibrated Infection control resources available c. Participating pharmacies must have adequate and secure record keeping processes in place, which allow easy access for collation of data, whilst confidentiality is maintained. Check lockable storage available Discuss what record management processes are in place (paperwork/electronic data).

22 SERVICE INDICATOR 2. Procedures and Risks The Pharmacy will provide one to one support and advice to the user and reference to specialist services if necessary. They will facilitate access to and where appropriate supply stop smoking drugs and aids EVIDENCE TO CHECK VERIFICATION a. The Pharmacy has in place a Service Specification and supporting guidelines which are reviewed at agreed timescales. b. The Pharmacy will confirm the eligibility of the person to access the service, based on local guidelines c. Initial consultation should include: Assessment of persons readiness to make a quit attempt Assessment of persons willingness to use appropriate treatments Completion of initial form Carbon monoxide test, if equipment available d. If considered appropriate the pharmacist may supply treatment from an agreed formulary and will advise on its use e. Follow up consultations should be agreed with the person and will include smoking status validation using a CO test, if equipment is available Service specification signed and dated and evidence of annual reviews. Signposting information to specialist services when referral appropriate. Annual revision of service by commissioner and service manager Active recruitment by promotion within pharmacy Guidelines in place Completion of initial form Signature of pharmacist Discussion with staff Client to have given consent to allow consent of data transfer Client has access to up to date verbal and written information Evidence of NRT treatment guide. Agreed formulary products available Appropriate referral on to other services where treatment is outside formulary. If CO monitor available record in clients records and include in monitoring data.

23 EVDIENCE VERIFICATION f. People not wishing to initially engage or those who choose not to complete the programme may be offered appropriate health literature or referral to alternative local support i.e provided by Healthy Stockport or local GP f. The pharmacy has appropriate health promotion material and promotes its literature. Signposting information for other smoking services Leaflets on smoking cessation Posters and/ or leaflets on display Information in consultation room for use during service interventions Supporting CO client resources available h. The % of successful 4 week quits remains within the agreed locally set guidelines [35% minimum] Quit rate obtained from Healthy Stockport quarterly spread sheets Follow up procedures recorded on individual data forms. Data forms returned by deadlines. i. The pharmacy participates in an annual review of the service provision. j. The Pharmacy co-operates with any locally agreed review/assessment of service Agreed PH Extended Service Specification in place Named commissioner and service lead Pharmacy has completed / evidence of fraud declaration documentation Review in place Consultation records kept for minimum of 2 years, unless there are clinical indications to keep them longer

24 SERVICE INDICATOR 3. Knowledge Training and CPD a. The service commissioner, with support from the Healthy Stockport pharmacy lead, 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 EVIDENCE TO CHECK Brief Intervention Workshop Level 1 Intermediate training completed Level 2 PGD for NRT for guidance only CPPE Stop Smoking e-learning assessment, completed within 3 months of attending a workshop [staff may have completed the local workshops] NCSCT online stage 1 & 2 smoking cessation modules copies of certification Awareness of commissioner and Stop Smoking pharmacy lead for scheme VERIFICATION b. The service commissioner, with support from the Healthy Stockport pharmacy lead, 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 c. The Pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service Treatment guide for NRT Attendance at level 2 Smoking training Local workshops and 1:1 support from commissioners and Healthy Stockport pharmacy lead Level of service adequate to maintain CPD competencies RPSGB CPD entries HAG accredited/ reaccredited CPPE new e-learning accreditation. Attendance at update events.

25 4. RECORDS SERVICE INDICATOR EVIDENCE TO CHECK VERIFICATION a. The pharmacy should maintain appropriate records to ensure effective ongoing service delivery & audit b. Supply of treatment must be recorded on the patients medical record Copies of initial consultation form Invoice records Treatment guide for NRT kept on the premises Health questionnaire completed at initial consultation Records kept for 2 years at Pharmacy unless there are clinical indications to keep them longer. The use of CO monitor, the maintenance records including cleaning procedures, calibration records and infection control guidance (provided by the Healthy Stockport) must be available Medication Records for NRT supply Adverse reactions reporting process in place Record keeping procedures in place Jan 2014 Review Sept 2015

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