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1st April 2009 – March 2010
A local enhanced service between South East Essex PCT and General Practice
1. Introduction
Smoking is the UK’s single greatest cause of preventable illness and early death. The most recent estimates show that around 114000 people in the UK are killed by smoking every year, accounting for one fifth of all UK deaths, with smoking contributing to a wide range of illnesses, including various cancers, respiratory diseases and heart disease. Smoking costs the NHS between £1.4 and £1.7 billion each year. Evidence suggests that people wishing to make a quit attempt are more likely to be successful when supported by appropriate medication and motivational support provided by a trained stop smoking advisor. Provision of stop smoking services in a community based setting, such as general practice and community pharmacy, increase access to services and thus attracts greater number of would be quitters. Brief advice to stop smoking works, can be given quickly and easily, and can be provided to all smokers irrespective of whether they express a wish to stop smoking or not. Brief advice appears to work by triggering a quit attempt, so wherever possible it should be followed by referral to a smoking cessation service and a recommendation to use pharmacotherapy. Service description

The provision of stop smoking services in General Practice. These services will
be provided on both an opportunistic basis and as a planned intervention with
clients wishing to make a supported quit attempt.
3. Eligibility

Currently we recommend pregnant smokers are referred into the specialist
services (Smoking & pregnancy co-ordinator) All other persons visiting a practice
operating the Local Enhanced Service for Stop Smoking Services may receive
support through a quit attempt.
Aims and Intended Outcomes
To increase public awareness about the full range of stop smoking services by targeting smokers in General Practice and providing a full range of promotional material. To increase access to both brief interventions aimed at raising awareness amongst smokers of the inherent risks in continuing to smoke and provide referral routes to specialist services if appropriate. To provide a stop smoking support for clients who wish to make a quit attempt. Service Outline
Brief and opportunistic interventions
5.1.1. Appropriately trained practice staff shall give brief opportunistic advice to clients identifying themselves as smokers, or who are identified by the practitioner as a result of a brief intervention. This will include information relating to the risks involved in smoking and its impacts on health. The details of individuals trained will be maintained within the PCT on a register. 5.1.2. This advice will be given verbally but may be backed up by the provision of written information e.g. leaflets, and a referral to other sources of advice and assistance, including local NHS Stop Smoking Services. 5.1.3. Practices are encouraged to record the advice given to patients on their medical record to facilitate future follow up and audit of patients. Such records will also help practices to fulfil some of their QOF targets. 5.1.4. Providers should have systems in place to ensure appropriate advice is given to patients and should participate in approved training updates. 5.1.5. The PCT will provide appropriate materials from time to time to support national campaigns e.g. patient literature, posters. However practice staff can access other support materials and literature via www.smokefreeengland.co.uk Intervention for clients wishing to make a quit attempt
5.2.1 Community staff shall support clients wishing to make a quit attempt through the provision of 1:1 support and pharmacological intervention as appropriate. 5.2.2 Patients wishing to utilise Primary Care based NHS stop smoking services must be assessed by an appropriately trained Stop Smoking practitioner and fully advised of the aspects of making a quit attempt. 5.2.3 Practices must utilise the Gold Standard Monitoring Form provided by the PCT to record all relevant details, and must retain the top copy for monthly collection ensuring, where possible, a note is made in patients’ records whatever the outcome. 5.2.4 Patients will need to sign the provided ‘Information and Consent Form’. A copy of this consent form will need to be returned with the monitoring form to the Stop Smoking Service. 5.2.5 Patients mobile numbers must be recorded (where applicable) so that 26 and 52-week follow ups can take place. 5.2.6 Practitioners should discuss the full range of Nicotine Replacement Therapy (NRT) with clients who identify this as part of their quit attempt to ensure that clients make an informed choice of product. NICE guidance is that “in deciding which of the available therapies to use and in which order they should be prescribed, practitioners should take into account: • Intention and motivation to quit, and likelihood of compliance The availability of counseling or support Previous usage of smoking cessation pharmacological treatment Contraindications and potential for adverse effects 5.2.7 Clients who decide to use NRT may have this supplied as part of the quit attempt via prescription. NRT, Bupropion or Varenicline should be given to those people who have set a quit date and subsequently stop smoking. 5.2.8 NICE Guidance recommends that clients should only be prescribed enough treatment to last for 2 weeks after the target stop date. For NRT this would equate to an initial prescription for 2 weeks, whilst for Bupropion would be for 3-4 weeks as clients need to start taking one week before their quit date. 5.2.9 The PCT will provide appropriate support including patient documentation, patient literature and training. Quality Standards
The initial consultation should usually last 20 – 30 minutes, involving assessment of motivation and readiness to quit, agreement on a quit date, and advice on and provision of pharmaceutical aids as appropriate. Weekly support should be offered for at least the first four weeks of a
quit attempt. This support may take the form of a face-to-face contact or as
a telephone contact, as agreed with patient. It is considered best practice to follow up clients after 4 weeks. This should include CO validation. It is recommended that staff involved in the provision of stop smoking services should be appropriately trained to Health Development Agency-Standards for Training in Smoking Cessation Treatments 2003. DH minimum data set is needed for each client, to include information about age, gender, ethnicity and socio-economic status. Incomplete forms will be returned to Practitioners for completion, as there is a minimum data requirement by the Department of Health. Smoking status should be confirmed by carbon monoxide (CO) validation and this must be recorded on the Gold Standard Monitoring Form.
7. Reimbursement
1. £30 for each completed Gold Standard Monitoring Form received, regardless of whether the quit attempt has been successful or not. (This form should be submitted to NHS Stop Smoking Service, Mapline House, 14 Bull Lane, Rayleigh, Essex SS6 8JD.) 2. An additional payment of £30 will be made for each successful 4-week quitter upon the validation of CO readings as required on the form. A successful quit attempt can be recorded if the client has successfully
maintained the quit attempt for a period of a least four weeks and has not
smoked in the last 2 weeks.

Failure to complete the forms fully, evidencing a reduction in CO levels, may
result in non-payments of claim.
Monitoring forms should be completed for each patient during the 4-week quit
attempt. Forms should be prepared for the monthly collection by the PCT,
regardless of whether quitter is successful or not. This will trigger payment of
appropriate fees.
CO validation can be recorded weekly but MUST be recorded at the 4-week
follow up stage.
This process permits ALL data to be recorded and not lost after the
submission dates.

Monitoring Arrangements

The PCT may periodically review the practice arrangements for complying with
this agreement including monitoring visits by the contract monitoring teams. This
information may be validated by audit of patients’ clinical notes and that the PCT
retains the right to re-claim any over-payments made against activity levels.
Protecting Patient Confidentiality
Caldicott Guardianship is based upon being thoughtful about the way in which patient information is handled, protecting data, using it appropriately and minimising or eliminating the risk of inappropriate disclosure .All patients need to sign documentation for informed consent. Termination of Agreement
Both the practice and the PCT may terminate this agreement by giving not less than one months notice in writing to the other party. 11. Variation
The PCT may vary this agreement by giving not less than one months notice in
writing to the provider, unless required to do so under national policy.
For Further Information
DH guidance document on Stop Smoking can be located on: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079644 For any further information regarding the Local Enhanced Services for Smoking Cessation, providers should contact: - Stop Smoking Services
Mapline House, 14 Bull Lane, Rayleigh, Essex SS6 8JD

Tel: 01268 798634
South Essex Stop Smoking Service
Primary Care
Information & Consent Form
This service has been set up to help smokers who would like to give up. The service you will receive is based on what has worked well in other places. All the staff that gives advice and support to smokers within this service have received training. When you talk your stop Smoking Advisor about smoking, they will need to take down some information about you for the following reasons: - What we would like to know?
Why do we ask for this Information?
This will help us decide how to advertise the service in We will want to contact you again after a year to see how you are getting on and if you would like to access the service again. If you are willing, we may also contact you sometime in the future to find out if you were satisfied with the service. We would also like to share information regarding your quit attempt and follow up. If you do not want this, please indicate this on the consent form. This will help us know if we are reaching all kinds of smokers throughout South Essex. Your postcode/occupation will help us to see what areas smokers are from and what occupation they do. This helps us give you advice about Nicotine Replacement Therapy (NRT), Zyban and what might work best for you. If you are, you need to discuss this with your local We want to know how many pregnant smokers we are seeing, because targeting pregnant smokers is a high priority nationally and locally. Your information will be sent to the Stop Smoking Administrator, who will enter the details onto a
computer database (a system for storing and analysing information). This information will be used to give
reports to the Department of Health about how many people have seen smoking advisers in South Essex and
how many people have given up smoking. This information will be anonymous; none of your personal
details – name, address or phone number – will be used. All staff are bound by confidentiality and
data protection rules within the NHS.

If you have any further questions about the service or about what will happen to the information we collect from you, contact the co-ordinator or administrator on: 01268-464511. I have read and understood this information sheet. I do agree/ do not agree that information on this form can be shared with other health professionals. Patient’s signature ………………………………. Please Return to: South Essex NHS Stop Smoking Service Mapline House, 14 Bull Lane, Rayleigh SS6 8JD Please Return to: South Essex NHS Stop Smoking Service Mapline House, 14 Bull Lane, Rayleigh SS6 8JD SOUTH ESSEX STOP SMOKING SERVICE
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.

Alternative contact number (friend/relative) ETHNIC GROUP: (please tick relevant group)

HOW CLIENT HEARD ABOUT THE SERVICE (please tick relevant box)
SOCIO-ECONOMIC CLASSIFICATION: (please tick relevant box)

TYPE OF INTERVENTION DELIVERED: (please tick one box only)
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)
CO reading before quit date
……. ppm
Quit self report
Lost to follow
CO verified reading (4-week quitter)
……. ppm
Client signature (indicating consent to treatment and ber of home carers – i.e. looking after children, family or home nagerial and professional occupations, examples include: Accountant, artist, civil/mechanical engineer, medical practioner, muscian, nurse, police officer (sergeant or above), physiotherapist, scientist, social worker, software engineer, solicitor, teacher, welfare officer. Those usually responsible for planning, organising and co-ordinating work for finance. 3. Interm Stop les include: Call centre agent, clerical worker, nursery auxillary, office clerk, secretary. 4. Routine and Manual occupations, examples include: Electrician, fitter, gardener, inspector, plumber, printer, train driver, tool maker, bar staff, caretaker, catering assistant, cleaner, farm worker, HGV driver, labourer, machine operative, messenger, packer, porter, postal worker, receptionist, sales assistant, security guard, sewing machinist, van driver, waiter/waitress.

Source: http://www.see.nhs.uk/content/file/GP%20Zone/SmokingCessation.pdf


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