ࡱ> ]`Z[\ Rbjbj hh}I+dd  4hY^t!!!^^^^^^^V`b^"!|!""^E^%%%"v^%"^%%jUXE]Pod4P#*Z2q^^0^CZcz$BcdE]E]cY]!0!"%!!!!!^^%!!!^""""c!!!!!!!!!d m:  PRIMARY CARE DEVELOPMENT 4.4.13 ENHANCED SERVICES SPECIFICATION FOR STOP SMOKING SERVICE SERVICE OUTLINE 1.1 Somerset Primary Care Trust aims to commission a comprehensive Stop Smoking Service across a range of providers that together meets the needs of those people requesting support in their attempt to quit smoking. 1.2 The diagram below sets out the three tiers in this comprehensive service. It is expected that the majority of quit attempts will be supported in tier two in a range of primary care locations across the county. Structure of Somerset NHS Stop Smoking Service  LEVEL 3 Specialist Level (Intensive Support) Facilitate groups and offer 1:1 support Assist with training and support Advisors Intensive support to deprived populations, high priority and vulnerable groups LEVEL 2 Intermediate Level A registered Stop Smoking Advisor in General Practitioner (GP) surgeries, pharmacies and a range of other settings Need to attend relevant training and updates LEVEL 1 Brief Intervention (opportunistic advice) Offer brief advice to all smokers Refer those who are ready to stop to Stop Smoking Advisor Refer clients who meet criteria to Specialist Service  1.3 This document specifies the enhanced service within primary care as part of the Level 2 Intermediate Level intervention. SERVICE AIMS 2.1 To provide a readily accessible quality service for smokers who want to quit. 2.2 To encourage brief interventions with smokers to be regularly carried out and recorded and appropriate referral of smokers who want to quit. 2.3 For quit attempts not supported by the practice advisor: To ensure relapse prevention support is available to all, the Primary Care Trust wishes Providers to obtain consent for ongoing follow up (to 52weeks) by the Specialist Stop Smoking Service. Provider staff will potentially be involved in supporting clients to quit in a range of ways, including: smokers who quit through brief intervention alone smokers who quit with Nicotine Replacement Therapy support only smokers who have begun the quit process and seek additional support from Providers 2.4 The Primary Care Trust wishes to offer ongoing support to these quitters (but they can no longer be included in Primary Care Trust monthly data returns). A separate, lower, fee will be paid for the provision of information on these quitters, including consent for ongoing follow up by the specialist service, through the monthly Miquest search. 2.5 Somerset Stop Smoking Service will: focus support on high priority groups manual workers, pregnant women, Black and Minority Ethnic and other vulnerable groups - supporting Providers in establishing and maintaining their services and supporting those Providers in more deprived areas. Providers in deprived areas will receive additional support through intensive advertising; and enhanced support to Level 2 advisors within the Provider, particularly with challenging clients continue to provide its current level of support, which includes a Relapse Prevention service for all clients known to be quit from smoking at four week follow-up where Providers do not wish to provide a specialist (Level 2) service (as defined by not signing up to Local Enhanced Service (LES)) the Primary Care Trust Stop Smoking Service will provide clinics. Where this is the case, the registered General Practitioner (GP) practice will be requested to provide a prescription for the relevant Nicotine Replacement Therapy. No fee over and above Quality and Outcomes Framework (QOF) payments would be payable for these quitters however please see Section 11.4 regarding payment for provision of information about patients who have quit outside of the formal requirements of this enhanced service 3 SERVICE REQUIREMENTS 3.1 This enhanced service will enable Providers to: employ one or more trained Support to Stop Advisors with dedicated time to carry out 1 to 1 or group consultations to support smokers who want to quit access training provided by the Somerset Stop Smoking Service for staff not yet trained to provide the Support to Stop Advisor service. In addition one trained advisor from each Provider should attend the regular annual top up training sessions (Providers will be kept informed of available training) ensure that appropriate Provider staff regularly record smoking status of all clients and refer smokers who are ready to quit, to the Providers Support to Stop advisor or to the specialist service at the Primary Care Trust - whichever is more suitable for the client ensure appropriate smoking cessation guidelines are included in written Provider protocols inform clients about nicotine replacement therapy, Champix and Zyban and prescribe as appropriate, to clients being supported by the Support to Stop Advisor arrange appointments for clients who want to quit with the Support to Stop advisor. The initial appointment should last at least 30 minutes and then weekly 10 minute appointments should be offered for at least four weeks after the quit date (purpose and content of advisor consultation are included in Appendix 1) monitor, support and evaluate a quitters progress, particularly at four weeks following the quit date. As a minimum, clients should have the initial appointment and be followed up at four weeks to confirm quit status. Clients who Do Not Attend at any stage throughout the process should be contacted a minimum of three times to encourage their return to the supported quit attempt ensure four-week follow-up occurs between 25 and 42 days from quit date being set validate all successful quit attempts at four weeks after quitting using Carbon Monoxide (CO) verification and offer this test to all clients attending after quitting complete monitoring details for each client setting a quit date, return them to the Primary Care Trust on a monthly basis, and ensure client records are updated. Miquest data extract is the preferred method of reporting. However, paper forms are also acceptable. The data specification is included in Appendix 2 ensure that smokers motivated to quit do not have to wait more than two weeks for an appointment prominently advertise the availability of the Support to Stop service within the Provider and the specialist Somerset Stop Smoking Service prescribe appropriately to clients seen at the Primary Care Trusts specialist smoking cessation service. Prevalence weighted funding has been included in Provider prescribing budgets specifically for Nicotine Replacement Therapy, Zyban and Champix 4 DATA COLLECTION 4.1 Numbers of clients using the Provider based service will be collected weekly initially (by e-mail) and continue until (this revised service runs effectively). Weekly data collection requirements are outlined in Appendix 3. When Providers are regularly delivering at least 90% of year to date quit target with agreement of both parties, monthly returns will be acceptable. 4.2 The Primary Care Trust requires monthly Miquest reports that include full client information, including consent. This data will used as the basis for Provider payments. Although not the preferred reporting method it is also acceptable for paper forms to be collected and form the basis of payment. Appendix 2 outlines the information requirements. 4.3 The Primary Care Trust will share a report on number of quit attempts and number of clients supported to quit with each Provider each month. 5 QUALITY ASSURANCE 5.1 Successful quit attempts - Service funding is for 1 to 1 or group setting quit attempts, supported by pharmacotherapy as appropriate. This is the evidenced based most effective way to support a quit attempt and should result in regular success. Providers are expected to achieve at least a 45% success rate, measured as a rolling total throughout the year. 5.2 Monthly quit numbers - Each Provider will have an indicative monthly quit schedule based on Provider quit total and service seasonal variation. Providers are expected to remain within 10% of expected quit numbers, measured as a rolling total throughout the year. 5.3 Trained advisors - Providers should not go any two month period without a trained level 2 advisor in place. Providers will be aware of staff departures, and known training course dates will be available. 5.4 Data returns - Quit attempt and quit numbers details will be collected monthly via Providers supplying Miquest data. There will be a routine monthly data request and it is expected that Providers will return Miquest data within five working days. 5.5 Data validation - Provider Miquest returns sometimes result in information on quit attempts where quit status is not clear. The Primary Care Trust will return records to the Provider promptly for validation. It is expected that Providers will validate and return records to the Primary Care Trust within five working days. 5.6 Failure to comply with any of the above Quality Assurance measures two months out of any three will result in a service review meeting. Further failure to meet service standards may result in Provider payments being withheld. 6 ELIGIBILITY 6.1 Payments for quit attempts relates only to those supported by Provider staff who are trained as Support to Stop Advisors. Advisors must have dedicated time to carry out 1 to 1 or group consultations to support smokers who want to quit. 6.2 The initial appointment should last 30 minutes and then weekly ten minute appointments should be offered for at least four weeks after the quit date. As a minimum, clients should have the initial appointment and be followed up at four weeks to confirm quit status. 6.3 For a quit attempt to count four week follow-up must occur between 25 and 42 days from quit date being set. 7 ACCREDITATION 7.1 Accreditation to provide services as a Support to Stop Advisor can only be received after successfully completing Level 2 Support to Stop Advisor training provided by the Somerset Stop Smoking Service. 7.2 Skills must be maintained by at least one advisor per Provider attending an annual skills update day run by the Somerset Stop Smoking Service. 8 SIGNIFICANT/ADVERSE EVENTS 8.1 The Department of Health emphasizes the importance of collected incidents nationally to ensure that lessons are learned across the NHS. A proactive approach to the prevention of recurrence is fundamental to making improvements in patient safety. 8.2 The Provider should be aware of the various reporting systems such as: the National Patient Safety Agency National Reporting and Learning System the Medicines and Healthcare products Regulatory Agency reporting systems for adverse reactions to medication (yellow card system), and accidents involving medical devices the legal obligation to report certain incidents to the Health and Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 8.3 In addition to any regulatory requirements the Primary Care Trust wishes the Provider to use a Significant Event Audit system (agreed with the Primary Care Trust) to facilitate the dissemination of learning, minimising risk and improving patient care and safety. 8.4 In addition to their statutory obligations, the Provider will give notification, within 72 hours of the information becoming known to him/her, of all emergency admissions or deaths of any patient treated by the Provider under this enhanced service, where such admission or death is or may be due to the Providers treatment of the relevant underlying medical condition covered by this specification. Notifications are to be sent to the Director of Nursing and Patient Safety with a copy to the Senior Primary Care Commissioning Manager for the specific locality. 9 REVIEW AND AUDIT 9.1 Service review meetings will be required if Quality Assurance criteria outlined above are not met. 9.2 There will be an annual meeting between Provider staff providing the service and the Primary Care Trust lead specialist for the area to review the service. 10 PRICING 10.1 Providers will receive 60 per successful quitter. 10.2 If the Provider supports successful quit attempts over and above the Provider target (detailed in Section 2.1 of the Enhanced Service Agreement) they will continue to receive the agreed payment. 11 PAYMENT 11.1 To enable service set up and ensure shared risk between Provider and Primary Care Trust 50% of the Provider quit target payment will be made in advance, split across quarters. 11.2 Payment balance will be made quarterly as long as the services are provided and quality markers delivered as outlined within this service specification. 11.3 If Providers do not provide the service to sufficient numbers to make up the quarterly payments, the balance will be reclaimed quarterly by the Primary Care Trust. 11.4 Outside of the defined service other four week quitters supported through primary care will attract a 10 rate of remuneration to cover the cost of provision of the client consent for further contact up to confirmation of 52 week quit. 12 PATIENT AND PUBLIC INVOLVEMENT 12.1 The service will conform to professional and legal requirements especially clinical guidelines and standards of good practice issued by the National Institute for Clinical Excellence (NICE) and professional regulatory bodies, and legislation prohibiting discrimination. It is anticipated that for the majority of enhanced services translated information will be available via the Department of Health. If a patient wishes to communicate via a language that is not covered via these leaflets please let the Primary Care Trust Equality and Diversity Lead know and use the commissioned interpretation and translation service (Applied Language Solutions) to facilitate the consultation and provision of information to the patient. Use of the interpretation/translation service should be recorded in the patients lifelong medical record including confirmation of the first language of the patient. 12.2 Practices should encourage, consider and report any patient feedback (positive and negative) on the service that they provide and use it to improve the care provided to patients, particularly if there are plans to alter the way a service is delivered or accessed. APPENDIX 1 PURPOSE AND CONTENT OF ADVISOR SESSIONS 1 In order to ensure the standards for providing quality treatments are met, all stop smoking interventions should include the following content: reinforcement of the motivation to quit and setting of a quit date informing of client expectations in relation to the structure and process of the intervention assessment of nicotine dependence and appropriate feedback to the client comprehensive advice about available/appropriate drug treatments and methods of access building of a repertoire of coping strategies information on the nature of tobacco withdrawal and advice on the management of withdrawal symptoms offer of regular carbon monoxide (CO) checks and feedback on progress ongoing monitoring of the use of pharmacotherapy troubleshooting for specific client problems or issues carbon monoxide (CO) verification of quit status at four weeks from the quit date onward planning (at the end of treatment) in relation to coping mechanisms, follow-up/support options and pharmacotherapy assessment of client satisfaction with the intervention provided APPENDIX 2 CLIENT INFORMATION REQUIRED 1 The minimum data set required in order to fulfil the Department of Health requirements for quarterly monitoring are: Gender: Male/Female Whether pregnant (at quit date): Yes/No Year of birth: Age Ethnic group: Entitled to free prescriptions: Yes/No Occupation Code* see Section 2 Setting for treatment* see Section 2 Intervention type* see Section 2 Client has received NRT? Yes/No/Not known Client has received bupropion (Zyban)/ Champix? Yes/No/Not known Quit date: Whether follow-up at 4 weeks was completed: Must be within 25 42 days of quit date; Yes/No Has client quit smoking at 4 week follow-up (based on self-report)?Yes/No/Not known (e.g. if follow-up unsuccessful) Carbon monoxide validation attempted at 4 week follow-up? Yes/No (e.g. if follow-up is done by telephone)/Not applicable (because client self reports as smoker at 4 weeks or lost to follow-up) If validation attempted, does carbon monoxide measurement at 4 week follow-up confirm non-smoking status? Yes/No/Not carried out (e.g. if client does not wish to undertake validation) Not applicable (because validation not attempted) Consent to follow-up. Yes/No 2 The following classifications will be used in coding client socio-economic status; occupation codes: full-time student never worked/ long term unemployed retired sick/disabled and unable to work home carer managerial/ professional intermediate routine and manual unable to code 3 Setting in which the intervention was delivered: stop smoking service venue pharmacy prison primary care hospital ward dental practice military base other and describe the setting involved using free text 4 Intervention type will be as follows: closed group (structured, multi-session group course with pre-arranged start and finish dates and a pre-booked client group) open group (sometimes called a rolling group, which has fluctuating membership and is ongoing) drop-in clinic (multi-session support) one-to-one support (structured, multi-session support) couple/family (structured, multi-session support for small family groups or couples) telephone support (structured, multi-session support via telephone) other (where an intervention does not fit with any of the above, it should be described using free text) APPENDIX 3 WEEKLY SEARCHES PROCESS Search 1 Number of clients joining the scheme in the last week: Read code 13p5 Smoking Cessation Program Start date with date range for week (Friday to Thursday) Search 2 Number of clients who had four week follow up in the last week. Read code 13p1 Smoking Status at four week with date range for week (Friday to Thursday) Search 3 Number of clients who had a four week follow up in the last week who quit smoking. Read code 13p1 Smoking Status at four week with date range for week (Friday to Thursday) and Read code 137L Current Non Smoker with date range for week (Friday to Thursday). For this search both the codes must be included and both must be within the date range. Only the total number of clients in each of the searches needs to be reported as follows: Week from: .. to : ... No of Clients joining scheme (from search 1) No of four week Follow Up (from search 2) No of four week Quitters (from search 3)  Orange book with regard to these services is available at  HYPERLINK "http://www.somersetpct.nhs.uk/how%20we%20do%20things" www.somersetpct.nhs.uk/how we do things PINs for accessing this service have been given to each provider.      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