ࡱ>  Zbjbj 4K*A K 8j"!"!"!LjNjNjNjNjNjNjSlnNj! @"!!!NjWW'cj & & &!*WRLj &!Lj & &@b " hp+2"^Ld:8jyj0jdo1#ot h ho4h"!6! &D! P!Y"!"!"!NjNj &"!"!"!j!!!!o"!"!"!"!"!"!"!"!"! :  PRIMARY CARE DEVELOPMENT 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 evidence base is that smokers are up to four times more likely to quit with pharmacotherapy coupled with behavioural support from an NHS Stop Smoking Advisor, compared to quitting without support. 1.3 This document specifies the enhanced service for the level 2 service in primary care. The level 2 service comprises the provision of behavioural support by registered Stop Smoking Advisors in GP surgeries and other primary care settings together with pharmacotherapy where indicated. 1.4 The Level 1 service comprises Brief Intervention (opportunistic advice) delivered by health care professionals in a wide variety of settings, including primary care. It consists of: offering brief, or very brief, advice to all smokers referring those who are ready to quit to a Stop Smoking Advisor referring more challenging clients who meet referral criteria to the Level 3 (Specialist) service. 1.5 The Level 3 (Specialist) service is provided directly by NHS Somerset and works with more challenging clients referred by Level 1 and 2 services provides one to one clinics and group sessions provides training and support for advisors in level 2 settings facilitates interim support for practices experiencing difficulties with service provision provides intensive support to difficult client groups and settings such as prisons and mental health institutions. can provide additional support to practices serving deprived populations, in order to reduce health inequalities. For example, direct marketing to smokers to increase recruitment of patients for the Stop Smoking Advisor. provides relapse prevention support to quitters from all settings, with consent, for one year after quitting. 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). 2.5 The NHS Somerset Stop Smoking Service will: focus support on high priority groups routine and 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 2.6 Service providers need to take responsibility for delivering treatment services stipulated by this contract. They need to ensure that all necessary data is collected and that data verification procedures are followed for each client. They are responsible for maintaining the quality of treatment delivered (in line with the quality principles set out in DH guidance) and for ensuring that client data confidentiality is protected in line with agreed protocols. Service providers need to ensure that staff receive the support they need to carry out their roles and remain up to date with national guidance and research developments. Service providers should be prepared for possible audits of their operations at any time and should maintain detailed records of their activities for inspection. 3 SERVICE REQUIREMENTS 3.1 This enhanced service requires Providers to: 3.1.1 Commit to attempting to achieve the target number of 4 week quitters specified for the practice in Appendix 3. As a guide roughly twice the target number of quitters need to be referred to a stop smoking advisor in the practice to achieve the target. 3.1.2 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. 3.1.3 Access training provided by the NHS Somerset Stop Smoking Service for staff not yet trained to provide the Support to Stop Advisor service. In addition at least one trained advisor from each Provider should attend the regular annual top up training sessions (Providers will be kept informed of available training). 3.1.4 Ensure that all appropriate Provider staff regularly record smoking status of all patients and refer smokers who are ready to quit to the Providers Support to Stop Advisor or to the Specialist Service - whichever is more suitable for the client. 3.1.5 Ensure appropriate smoking cessation guidelines are included in written Provider protocols. In particular the current NHS Stop Smoking Services Service and Monitoring Guidance. 3.1.6 Inform clients about all first line treatments, namely nicotine replacement therapy, varenicline (Champix) and buproprion (Zyban), and prescribe as appropriate, to clients being supported by the Support to Stop Advisor. Providers should note that currently the most effective and cost-effective medications are varenicline (Champix) and combination NRT (eg patch + gum/inhaler). 3.1.7 Prescription medications should continue to be prescribed for the duration recommended by the product specification. 3.1.8 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). 3.1.9 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, with weekly telephone contact between these dates. 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. 3.1.10 Ensure four-week follow-up occurs between 25 and 42 days from quit date being set. 3.1.11 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. 3.1.12 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. 3.1.13 Ensure that smokers motivated to quit do not have to wait more than two weeks for an appointment. 3.1.14 Prominently advertise the availability of the Support to Stop service within the Provider and the specialist Somerset Stop Smoking Service. In particular, the provider shall display a stop smoking service roundel in a prominent position at the entrance to the premises, and/or at reception. 3.1.15 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 Data collection will be on a weekly basis. Once practices are consistently achieving a satisfactory numbers of quitters, practices may change to monthly reporting by agreement. 4.2 The Primary Care Trust requires monthly Miquest reports that include full client information, including consent. This data will be 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 quarterly. 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. Tye evidence base shows that this is the 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, of which 85% should be CO verified, measured as a rolling total throughout the year. 5.2 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. Providers should contact the stop smoking service manager promptly if unforeseen circumstances lead to a loss, or significant reduction, in availability of the service to patients, in order to seek interim support. 5.3 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. 5.4 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. 5.5 A schedule of key dates for data returns and validation returns will be issued to providers. 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 relate only to those supported by Provider staff who are trained as Support to Stop Advisors. Advisors must have dedicated time to carry out one to one 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 Carbon monoxide (CO) readings should be taken and recorded at each patient contact. 6.4 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 Learning and Reporting 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 a base payment of 20 per target quitter, the target being based on practice population smoking prevalence, paid in advance. 10.2 Providers will receive an additional 60 per successful carbon monoxide (CO) verified quitter, paid quarterly in arrears. (This payment comprises of 20 for the initial consultation with a practice stop smoking advisor, and 40 for the four week post-quit advisor consultation with CO verification). 10.3 If the Provider supports successful quit attempts over and above the Provider target they will receive 80 per successful CO verified quitter. 11 PAYMENT 11.1 Payment balance will be made quarterly as long as the services are provided and quality markers delivered as outlined within this service specification. 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 classifications below Setting for treatment* see classifications below Intervention type* see classifications below 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 PROVIDER TARGET To be completed by Public Health for each practice.  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.      PAGE \* MERGEFORMAT 2 Key Points Box There are several important changes to the 2010/11 service specification There is a new base payment of 20 per target 4 week quitter, paid in advance. There is no longer a clawback provision on the base payment. While all 4 week quitters count towards the target, payment is made ONLY for carbon monoxide (CO) verified quitters. The payment for CO verified quitters is 60, on top of the base payment, paid quarterly in arrears. (This payment comprises 20 for the initial consultation with a stop smoking advisor, and 40 for the 4 week post-quit consultation with CO verification.) For clarity, there is no payment for self reported quitters or for patients who do not complete the course of treatment. Practices are expected to achieve at least a 45% quit rate, and aim to verify by CO monitoring at least 85% of 4 week quitters. Practices achieving a CO verified quit rate of 70% of 4 week quitters at the target level will achieve similar income to 2009/10, assuming target numbers were achieved in 2009/10 and target number remains the same. Practices achieving a CO verified quit rate of 85% will achieve proportionately higher income. 4 week quitter targets are based on practice population smoking prevalence, rather than just population. Practices achieving higher CO verification rates and/or exceeding target will be paid at the same rates as outlined above. There is no longer a separate 10 payment for data provision only, as this is now part of the base payment.  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