Local Enhanced Service for Smoking Cessation Level 2
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East Sussex Downs and Weald
Hastings and Rother
Local Enhanced Service for
Smoking Cessation
Level 2
1. Service Model Priorities
The purpose of the proposed enhanced services for Smoking Cessation is to implement a new 3-
tier approach to smoking cessation services across the PCT. Tiers 1 and 2 will be delivered via
Locally Enhanced Services.
The purpose of this LES is to implement a new 3-tier approach to smoking cessation services
across the PCT. This service will be available to all residents in ESDW and H&R and will replace
previous smoking cessation LES initiatives. The PCT is keen to target areas of highest need, that
is, those wards with the highest smoking levels (and lowest life expectancy) and intends primary
care practitioners in deprived areas to help drive this forward this key health improvement initiative
in the 1st instance. The model proposes higher levels of engagement of primary care practitioners,
increased services for smoking cessation provided by primary care practitioners and a new annual
Smokers Health Check for all smokers. This new enhanced service will focus activity at prevention
within practices, and any other suitable primary care service providers, and will reward for each
element of activity for each patient. The smoking cessation services could also be delivered on a
clustered or geographic basis.
This document, Smoking Cessation (Level 2), outlines service requirements & remuneration for
Smoking Cessation Tier 2 only. The LES in respect of Level 1 services will be handled separately,
and is currently still subject to negotiation with the ES Group.
It is proposed to develop a new 3 tier, managed service; simplistically this can be seen as overleaf:
Quitting
with support
Smoking Cessation Advisory
&support Services (including Public
Health)
Monitoring of smokers and annual smokers health
check & information sessions
The service details are shown in the following chart, together with the details of potential, new and
expanded, multi agency providers:
Smoking Cessation LES 1
Version: Sonar March 2011East Sussex Downs and Weald
Hastings and Rother
Level Details of service Potential Service
Provider
1 Ensure patient level data is updated annually to provide GP practice
accurate information on smokers within the population
Each smoker to be invited to attend an annual 1:1 health
check, to focus on their health, and also the effects of GP practice
smoking, with an aim to onward referral to a smoking
cessation adviser
Level 1 Smoking Cessation
is detailed the Smoking Cessation LES (Level 1)
2 Smoking cessation service – advice to patient, Pharmacy Enhanced
support (1:1 and on-going help sessions (and Service, or
networking). Prescriptions issued where appropriate GP cluster scheme, or
(free where individual is exempt from prescription Specialist Smoking
charges) Cessation Team
DETAILED IN THIS LES
3 Public Health (PH) Specialist Smoking
Targeted information schemes aimed directly at the Cessation Team (PH
populations particularly in the 20 wards. Specific central)
emphasis on teenager/young people, smoking &
pregnancy, the BME population, and cannabis cessation
services. Working age (particularly manual worker
groups), disease groups e.g. COPD, and then older
adults
Monitoring of progress from QOF and from service (key
performance indicators) from above
Training and advice/ support to practice staff and
smoking cessation service providers
Level 3 Smoking Cessation
is not detailed in this document
Smoking Cessation LES 2
Version: Sonar March 2011East Sussex Downs and Weald
Hastings and Rother
This service may be provided by a Pharmacy Enhanced Service, or GP practice, or via a GP
cluster scheme or any other suitable provider that can demonstrate competence to provide the
service
TIMETABLE & PAYMENT SCHEME FOR LEVEL 2 SMOKING CESSATION
SERVICE
Stage Service Specification Provider Time £
Appt 1 Initial assessment GP practice or 30 £20.37
identify readiness to quit and commitment to Pharmacy – mins per
attending one to one sessions accredited person
Agree and sign client contract (see Appendix Practice Nurse
1) or accredited
Take carbon monoxide (CO) reading Pharmacist/
Set a quit date Specialist
Discuss NRT / Champix options. Advisors
Organize next appointment (if Champix is
used, quit day appt needs to be 1 week after
they have started on Champix)
Complete 1st section of monitoring form
Appt 2 Quit day (set by patient) GP practice or 15 mins £10.17
Coping mechanisms Pharmacy
How are they getting on with NRT Plan for the – accredited
week ahead – any social occasions? HCA/
Keep motivated Specialist
CO reading Advisors
Date of next meeting
Appt 3 This can be a phone call or an appointment GP practice or 10 mins £0
Coping mechanisms Pharmacy –
Keep motivated accredited
CO reading (if appointment) HCA/
NRT / Champix – any issues / problems Specialist
Date of next meeting Advisors
Appt 4 Same as appt 3 GP practice or 10 mins £0
Date of next meeting Pharmacy –
accredited
HCA/
Specialist
Advisors
Appt 5 Same as appts 3 and 4 GP practice or 10 mins £0
Date of next meeting Pharmacy –
accredited
HCA/
Specialist
Advisors
Appt 6 Four weeks follow up (i.e . 4 weeks after GP practice or 20 mins £40.70
appointment 2) Pharmacy –
Must be one to one meeting accredited
Take CO validation reading Practice Nurse
Does CO validate non-smoking status? or accredited
CO verification must be taken for final £40.70 Pharmacist/
payment to be made Specialist
Advisors
Total A patient who has had 2 unsuccessful Max £71.14
quit attempts should be referred to a 1hr 40m
Level 3 Specialist Smoking Cessation
Service at the PCT
NRT is available to all participants where applicable. Prescription charges apply.
Where Champix has been prescribed or issued, the provider must ensure a 12-week check up
appointment with an appropriately trained member of staff; this is included within the above
costing.
Smoking Cessation LES 3
Version: Sonar March 2011East Sussex Downs and Weald
Hastings and Rother
Where this service is provided by Community Pharmacies, medication costs will be covered by the
dispensing budget. Service delivery costs will attract an additional payment of 5% VAT when
appropriate.
Please note: The dispensing of Champix under PGD from pharmacists has yet to be approved by
the Medicine Policy Review Group and would entail appropriate PGD, training plus signing off by
an appropriate clinical lead. The clinical lead for Investing in Life is the PEC Chair Dr Gregory
Wilcox and the pharmacy lead is Sue Mills.
The following criteria for this service will apply:-
1.1.1. All patients who present should have their smoking status recorded (Level 1) and their
suitability assessed to progress to Level 2 of the programme.
1.1.2. If a patient is still smoking 2 weeks into the programme, though still trying to quit, a further
week of NRT will be prescribed and appropriate advice given.
1.1.3. If at 3 weeks into the programme, total abstinence from smoking has not occurred, NRT,
Advice and Support will be withdrawn. A discussion to re-evaluate the patient’s motivation
to quit will take place at this point.
1.1.4. If more than 4 weeks of NRT is prescribed and the patient has not quit, they will be able to
ask for further NRT after 6 months following their last quit date (Advisers can use their own
discretion with regards to individual cases according to personal circumstances)
1.1.5. Non-attendees should not be issued prescriptions if they fail to attend 2 consecutive clinics.
1.1.6. A patient who has had 2 unsuccessful quit attempts should be referred to a Level 3
Specialist Smoking Cessation Service at the PCT
1.1.7. A patient who “quits” smoking but restarts again can be re-entered into the Smoking
Cessation programme and receive further NRT/Champix after a 3 month period
1.1.8. Each monitoring form must be patient identifiable and a unique number given to each
individual client. It is recommended that the Gold Standard Monitoring form is used (as
found on the Sonar Informatics system)
1.1.9. Community Pharmacy should complete the relevant monitoring information by using the
PCTs web based reporting system (Sonar Informatics). This will negate the need to submit
the appropriate paperwork to the PCT on a monthly basis.
1.2. Training & Accreditation
1.2.1. General
Staff involved with the care of these patients must be appropriately trained and maintain
their competence. Details and evidence of staff training and education relevant to the
management of people undergoing smoking cessation initiatives, in accordance with
training identified in section 6.2.2 and 6.2.3, must be provided at the time of sign up to this
enhanced service. The PCT will not make payment for any services where they were
delivered by any staff that have not completed this training.
1.2.2. Level 2 Smoking Cessation Training for Pharmacists
Pharmacists will be required to Competencies and Training Framework as established by
the Harmonisation of Accreditation Group. The training includes the completion of a Centre
for Pharmacy Postgraduate Education (CPPE) Stop Smoking CD Rom open learning
programme which provides pharmacists with the necessary knowledge to underpin the
provision of this enhanced service:
Smoking Cessation LES 4
Version: Sonar March 2011East Sussex Downs and Weald
Hastings and Rother
The CPPE Stop Smoking CD Rom should be completed before or within 3 months of
attending the PCT’s workshop. A record of completion of this pack must be kept and a copy
sent to the PCT.
Pharmacists should also read:
• “Helping smokers to stop: advice for pharmacists in England” (ISBN 1-84629-035-X)
published by NICE, RPSGB and PharmacyHealthLink. A copy can be downloaded from
www.nice.org.uk/download.aspx?o=517943.
• “Brief Interventions and Referral for Smoking Cessation in Primary Care and other
Settings (Public Health Intervention Guidance No 1)” published by NICE. A copy can be
downloaded from www.nice.org.uk/phi001.
It is also necessary to attend a PCT Workshop to enable Community Pharmacists to
become competent to provide a Smoking Cessation Service at intermediate level,
understanding the clinical, ethical, cultural and legal aspects of this work.
1.2.3. Level 2 Smoking Cessation Training for Specialist Advisors
This is a 2-day course, incorporating pharmacological and behavioural therapies to enable
staff to work with clients who want to stop smoking. This is available through the PCT’s
Learning and Development Department. This course must be completed prior to
commencing Level 2 service delivery. A 2-hour annual update session must be attended to
maintain best practice in smoking cessation.
1.3. Record Keeping
Providers will maintain records by using the Sonar Informatics web based monitoring
system. This will provide the required data set identified by the PCT to monitor demand,
volume, cost, KPI’s and their associated quality outcome indices in accordance with data
requirements as detailed below.
1.4. Monthly Reports (Level 2: Stage 2)
The Provider will ensure that data entry to the Sonar Informatics web based reporting
system is accurate to ensure that the PCT is able to generate accurate monthly reports.
The Monthly Report will run from 1st to the 31st (or last day) of each month. The PCT will
require information to help determine which interventions are most effective in improving
health and health outcomes and that represent good value for money. It will contain the
following:
1.4.1. Number of New participants / People Attending
1.4.2. Number of Existing participants / People Attending
1.4.3. Number of drop-in clinics held (general practice only)
1.4.4. Number of workplace clinics held (general practice only)
1.4.5. Referral source
1.4.6. The number of clients entering treatment who have set a quit date
1.4.7. The number of clients who have been recorded as successful four-week quits (quit
– self report / quit - CO verified / not quit / lost to follow up)
1.4.8. Therapy used (NRT, gum, Champix or none)
1.4.9. Above indicators analysed by unique patient identification number, age, sex,
occupation, ethnicity, postcode, prescription exemption
Smoking Cessation LES 5
Version: Sonar March 2011East Sussex Downs and Weald
Hastings and Rother
1.4.10. Quarterly in-house monitoring of SHA returns data to identify all indicators down to
ward level
The provider will use the relevant monitoring form (as found on the Sonar Informatics
Reporting system) and obtaining client consent for future follow up. This would be shown
on the system by checking the appropriate box. This will enable the PCT to conduct audit
work around the impact of interventions and prevalence. Reports will show indicative data
at points in the process to show how many people start the programme, at what point they
drop out, and how many people achieve the 4- week quit target.
This data will be saved to the Sonar Informatics database and will be accessible to
the PCT for audit purposes.
1.5. Annual Report
In addition, the Provider will submit an Annual Report to the PCT (in accordance with
section 6.7). The annual report will cover the twelve month period, from 1st April to the 31st
March, for the previous financial year. It will include the following:
1.5.1.1. An aggregate of the monthly reports.
1.5.2. The finding of a patient’s survey of satisfaction and well-being and any findings
from work involving the public and patients.
1.5.3. Public & Patient Involvement
The provider will ensure systems are in place to gather information on the patient
experience, in line with the patient experience metrics (questions) being
developed in house for South East Coast.
The Report may be checked by the PCT, who retain the right to confirm the accuracy of
information submitted. The PCT also reserve the right to conduct an independent audit of all
findings and results.
1.6. Additional Quarterly Reports to Professional Bodies
The provider may be required to submit additional reports to relevant or professional bodies in
ESDW and Hastings & Rother, as required, on a quarterly basis. This may include:
1.6.1. Enhanced Services Groups
1.6.2. PCT Boards
1.6.3. PEC
1.7. Submission Dates
Monthly reports: On/ by the 15th of each month commencing on the 15th of the following
month from the commencement of the service on the relevant Monitoring Forms
Annual reports: For the period of 1st April to 31st March in any fiscal year by 30th April 2009
(Annual End of Year)
Smoking Cessation Level 2
Submissions will be made to the Primary Care Trust via the Sonar Informatics system
1.8. Formal Review
A full & formal review of this Enhanced Service will be undertaken in
Smoking Cessation LES 6
Version: Sonar March 2011East Sussex Downs and Weald
Hastings and Rother
July 09.
1.9. Finances & Remuneration
The payment scheme is intended to reflect clinical practice, acknowledging that it is not always
possible to have 6 appointments, and the initial assessment, quit day and 4 week follow-up
appointments are most critical.
1.9.1. Payments will be made 1 month in arrears post submission of monthly report
1.9.2. The fee for appointment 1 will be £20.35
1.9.3. The fee for appointment 2 will be £10.17
1.9.4. The fee for appointments 3,4 & 6 will be £40.70 dependent on receipt of CO2
validation but will only be payable for those patients that are 4 week quitters
1.9.5. The fee for recording a patients smoking status will be covered under QOF
1.9.6. Total fee possible per person is £71.22 per annum
1.9.7. Payment will not be made for “did not attends”
1.9.8. Payment for Appointment 1 will be made upon submission of Initial Assessment.
1.9.9. Payment for Appointments 3 – 6 will be made upon submission of the number of
people who have achieved the 4-week quit target and who have a reduced CO2.
1.9.10. Submission of the monitoring form made via Sonar Informatics web based
reporting system will generate appropriate claims at the end of each month.
2. Breach
All contractors are expected to provide essential services they are contracted to provide for all their
patients. The enhanced service specification outlines the more specialized services to be provided.
The specification of this service is designed to cover the enhanced aspects of clinical care of the
patient, all of which are beyond the scope of essential services. No part of the specification by
commission, omission or implication defines or redefines essential services.
Breach of conditions of this contract may result in a reduction or withdrawal of payment and
cancellation of this contract.
3. Equity
This service must be provided in a way that ensures it is equitable in respect of race, creed,
culture, diversity, disability, age, etc.
4. Application Process
Applications are invited to provide and/or deliver this service from general practice, community
pharmacies and any other provider as relevant.
Smoking Cessation LES 7
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