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Community Pharmacy

Hartlepool Middlesbrough

Stockton on Tees Teaching Redcar and Cleveland

Service Level Agreement

Between

Tees Primary Care Trusts (Commissioners)

&

Named Community Pharmacy

(Provider) This is a Service Level Agreement (SLA) for the provision of stop smoking interventions by community pharmacies. The service is based on a ‘One – Stop’ model, which incorporates the use of a voucher scheme to facilitate optimum access to NHS Stop Smoking provision and includes the provision of nicotine replacement therapy.

Community Pharmacy Enhanced Service

For the provision of Stop Smoking Interventions

Community Pharmacy SLA for Stop Smoking Interventions Jan 2010 1

CONTENTS Contractual Agreement Page Parties 1.Interpretation

2.Services to be Provided 3.Contract Term 4.Price

2 2 2 2 2

5.Payment Terms 6.Workforce

3 3

7.Statutory Obligations 8.Insurance and Indemnity 9.Contract Governance

4 4 4

10.Variations 11.Breach of Contract 12.Termination

5 5 5

13.Waiver 14.Subcontracting and Assignment 15.Agency 16.Notices

6 6 6 6

17.Dispute Resolution 18.Complaints

7 7

19.Third Party Rights 20.Exclusivity 21.Mistakes in Information 22.Confidentiality 23.Human Rights Act

8 8 8 8

24.Freedom of Information Act 25.Data Protection

9 9

26.Improvement and Innovation 27.Diversity 28.Force Majeure

10 10 10

29.Whole Agreement - Authorised Signatories 11 Schedule 1 – Service Specification 1.Background and Rationale 2.Service Description 3.Aims and Intended Service Outcomes

12 13 13

4.Service Outline 14

5.Service Standards 5.1 Clinical Governance (General) 5.2 Premises 5.3 Equipment and Consumables 5.4 Workforce: Qualifications, Training Accreditation, Competency 5.5 Workforce: Staffing Requirements

18 18 19 19 20 22

6. Service Monitoring 23

7. Quality Indicators 24

8. PCT Responsibilities 25 Appendix 1 - Community Pharmacy Self Assessment Document 26

Appendix 2 - Client Pre-screening Tool 35

Appendix 3 - Client Register of Attendance 37

Appendix 4 - Exception Report Form 38

Appendix 5 - Service Documentation including Gold Standard Forms

Provided separately

Appendix 6 - Contact Details of participating community pharmacies by Tier Level

40

Schedule 2 – Financial Arrangements Payment Tariff Appendix 1a - Dispensing and Product Fees Appendix 1b - Monthly Summary of Bonus Payments and Assessment Fees

44 45 46


CONTRACTUAL AGREEMENT

This Contract is made on the 1st day of January 2010 BETWEEN THE PARTIES: 1. The Tees Primary Care Trusts hereafter called (PCT) which expression shall

include its employees agents and sub-contractors thereof

And 2. [Insert name and brief address] Community Pharmacy (hereinafter called the

Service Provider) which expression shall include its employees, agents and sub-contractors.

WHEREAS:

The PCT has requested the Service Provider to provide a Stop Smoking Service and the Service Provider has agreed to provide services on the terms herein contained.

NOW IT IS HEREBY AGREED AS FOLLOWS: 1. Interpretation

A reference to any statute, enactment, order, regulation or other similar instrument shall be construed as a reference to the statute, enactment, order, regulation or any subsequent re-enactment thereof. Headings are included for ease of reference only and shall not affect the interpretation or construction of this Contract.

2. Services to be Provided

The Service Provider shall provide to the PCT a Stop Smoking Service (hereinafter called ‘the Service’) as set out in Schedule 1 - the Service Specification.

3. Contract Term

The Contract shall commence on 1st January 2010 and will continue until March 2011 unless terminated in accordance with clause 12 herein.

4. Price 4.1 In consideration of the Service being provided by the Service Provider, the PCT

shall pay to the Service Provider the Price as set out Schedule 2 – the Financial Schedule of this Contract (hereinafter called ‘the Price’).

4.2 The price payable by the PCT to the Service Provider will with the exception of

any request by the Service Provider for a reduction to that price remain in force until any variation in the price is authorised by the PCT.


4.3 The PCT accept no responsibility for any additional costs incurred by the Service

Provider above the Price in the provision of the Service. 4.4 The Price is fully inclusive of VAT. 4.5 The Provider will indicate VAT (if applicable) on a fully detailed tax invoice so as

to facilitate recovery (Appendix 1A).

5. Payment Terms 5.1 Payment will normally be made by the PCT in arrears no later than two months

following submission of correct invoices or claims to NEFHSA at Poole House, who will arrange direct payment provided that the Service has been performed to the satisfaction of the PCT.

5.2 The Service Provider shall maintain separate financial information for the Service

which will be subject to scrutiny by the PCT and discussion at the Annual Review referred to in clause 9.3 herein, or earlier during the phased introduction period for the Service.

6. Workforce 6.1 The Service Provider shall during the Contract Term (as defined in the Service

Specification) provide persons with suitable experience, skills, abilities and qualifications to deliver the Service to the satisfaction of the PCT as described in the Service Specification and associated protocols.

6.2 Where the PCT agree to the use of sub-contractors, the Service Provider will

ensure that any subcontractor provides sufficient persons with suitable experience, skills, abilities and qualifications to deliver the Service to the satisfaction of the PCT and the Service Provider shall employ sufficient persons with suitable experience, skills, abilities and qualifications to properly supervise those subcontractors in order to ensure that they provide the Service to the satisfaction of the PCT.

6.3 The Service Provider shall at all times ensure that its workers are given sufficient

and specialist training, related to their job role in respect of the stop smoking service, to ensure their knowledge, skills and competence in the latest clinical, legal and technical developments needed in the performance of their duties under this Contract. This will include, for example, understanding of stop smoking interventions, assessment of readiness to change, behaviour change interventions, lifestyle referral pathways and the underlying principles and practice of clinical and information governance including infection prevention/control, data protection and Caldicott guidance.

6.4 The PCT expect all workers to be aware of and adhere to local Policies,

Procedures and Practice Guidance in relation to the delivery of stop smoking services and referral pathways. This also corresponds with NICE 10 Public Health Guidance (2008). It is also expected that Service Provider will have an internal policy and training that links into local Policies.


6.5 The Service Provider shall ensure that all workers and approved sub-contractors are aware of the terms and conditions of this Contract and their obligations under it.

6.6 The Service Provider has a duty to take reasonable steps to provide themselves with assurance related to previous criminal convictions of workers involved in the service, and the PCT may request evidence in relation to this.

6.7 The PCT reserve the right to carry out background enquiries on all persons

involved in this Contract. 6.8 The persons employed or used in connection with the provision of the Service

shall not be deemed to be the employees or agents of the PCT and the Service Provider shall be liable at all times for those persons and shall indemnify the PCT in respect thereof.

6.9 The Provider is responsible for ensuring a safe and secure working environment,

(see Service Specification). The Provider should be able to access premises the service is carried out from to carry out any assessments and checks it may consider necessary to ensure the health safety and wellbeing of their staff. The PCT should be informed of any findings of Health & Safety issues affecting the ability of the provider to undertake this contract.

7. Statutory Obligations The Service Provider shall comply with all statutes, regulations and Codes of

Practice relating directly or indirectly to the provision of the Service. 8. Insurance and Indemnity 8.1 The Service Provider agrees to indemnify the PCT from and against all actions,

claims, costs and proceedings whether on account of personal injury or death or loss of or damage to property or otherwise which arise from the provision of the Service and which are not attributable to the negligence of the PCT, their servants or agents.

8.2 The Service Provider shall maintain in force throughout the term of the Contract

adequate insurance to cover the following liabilities and shall provide a copy of any certificate of such insurance to the PCT upon request:-

i) Employer’s liability of at least £10,000,000. ii) Public liability up to £5,000,000 in respect of any one event. iii) Property and contents insurance.

9. Contract Governance

9.1 The Service Provider shall keep such records relating to the provision of the

Service and in such form as the PCT may from time to time specify including details of Service Users and such other matters as the PCT may specify from time to time and the Service Provider shall provide copies of such records when requested by the PCT.


9.2 The PCT and the Service Provider shall usually meet when required to monitor the performance of the Service Provider under this Contract at reasonable notice. The frequency of these meetings may be reduced or increased if deemed appropriate by the PCT.

9.3 The Specialist Stop Smoking Service will produce quarterly returns to the SHA

on behalf of the Service Provider. Any provider identified as under performing (see DH Guidance) may initiate a service review where appropriate.

9.4 At any time during the continuation of this Contract, the PCT may review the

provision of the Service by the Service Provider. 10. Variations Following the execution of this Contract no deletion from, addition to or variation

of these terms and conditions shall be valid or have any effect unless agreed in writing and signed by the PCT and the Service Provider at any time during the period of the Contract.

11. Breach of Contract 11.1 If the Service is not provided in accordance with the terms of this Contract and

associated Service Specification, the PCT may issue a remedial notice in writing to require the Service Provider to remedy the failure and provide the Service in accordance with the terms of this Contract within a 30 day period.

11.2 Where the Service Provider fails to provide the Service in accordance with the

terms of this Contract and the PCT suffers loss as a direct result, the PCT may make such deduction from the Price payable to the Service Provider as the PCT reasonably determines as compensation for the default and a breach of notice may be issued

11.3 The PCT is similarly required to undertake necessary action where breach of

contract is determined. 12. Termination 12.1 The PCT may terminate this Contract immediately if the Service Provider:

i) Fails to remedy the failure and provide the Service in accordance with the terms of this Contract within the period specified in clause 11.1.

ii) Commits a serious breach of the terms of this Contract which in the opinion of the PCT cannot be remedied by giving notice under clause 11.1.

iii) Persistently fails to provide the Service in accordance with the terms of this Contract.

iv) Has committed any offence under the Prevention of Corruption Acts 1889 to 1916.

v) Has offered or given any undisclosed or illicit fee or reward to any Member or Officer of the PCT.

vi) Becomes bankrupt, makes an arrangement with its creditors or other arrangement under the Insolvency Act 1986.


vii) Has an administrative receiver or liquidator or manager appointed or has a winding-up order made.

12.2 If the PCT breach a term of this Contract, the Service Provider may by written

notice require the PCT to remedy the breach within a specified period of not less than one month. If the PCT fail to remedy the breach within that period, the Service Provider may terminate the Contract immediately.

12.3 The PCT or the Service Provider may terminate this Contract by giving the other

parties 3 months written notice. 12.4 Upon termination of this Contract, the Service Provider will prepare and submit to

the PCT the final accounts for the Service and any other records and documents relating to it.

12.5 Any termination of this Contract is without prejudice to the rights of the PCT or

the Service Provider in respect of any antecedent breach by the other parties of any of the terms of this Contract.

13. Waiver 13.1 If either the PCT or the Service Provider waives a breach of any provision of this

Contract it shall not be treated as a waiver of any subsequent breach of the same or any other provision of this Contract.

13.2 If either the PCT or the Service Provider fails to exercise or delays in exercising

any right power or remedy under this Contract that shall not constitute a waiver by that party of that right power or remedy.

14. Subcontracting and Assignment 14.1 The Service Provider shall not assign, pledge, transfer or sub-contract the

provision of the Service or any part of it without the PCT’s prior written consent. 14.2 The PCT shall be entitled to assign or otherwise transfer or dispose of their rights

and obligations under this Contract without the consent of the Service Provider. In such circumstances the PCT shall forthwith upon request by the Service Provider execute and deliver to the Service Provider a novation agreement in terms to be agreed.

15. Agency The Service Provider shall not be the agent of the PCT for the purposes of the provision of the Service under this Contract. Nothing in this Contract shall create any agency joint venture or partnership between the PCT and the Service Provider, nor shall the PCT be liable for any losses, claims, demands, damages or liabilities arising out of the provision by the Service Provider of the Service.

16. Notices Any notice to the PCT or the Service Provider shall be deemed to be sufficiently

served if addressed and delivered personally to or sent by recorded delivery


post. Notices sent by post shall be deemed to have been received on the second working day after posting and notices delivered personally shall be deemed to have been received on the day on which they are served.

17. Dispute Resolution 17.1 In the event of a dispute or difference arising between the PCT and the Service

Provider relating to the Contract, both shall seek to resolve the dispute at the earliest and most informal opportunity, at the point nearest to Service delivery and without recourse to the formal disputes procedure in clause 17.2. First contacts in the event of dispute will be dealt with by the Assistant Director for Primary and Community Services for the commissioner and the Designated Pharmacist / Signatory to the SLA for the provider or nominated other.

17.2 If the PCT and the Service Provider are unable to resolve the dispute informally,

either may invoke the following disputes procedure:

(i) Request a meeting between representatives of all parties to discuss the issue with a view to resolving the dispute by mutual agreement. If the dispute remains unresolved, then further meetings may be requested involving senior representatives if appropriate.

(ii) If the dispute is still not resolved then the matter will, if the PCT and the

Service Provider agree, be referred to independent mediation as soon as reasonably practicable. The mediator shall be an individual agreed by all parties.

(iii) If the matter in dispute cannot be resolved through mediation it may be

referred by either party to a single arbitrator to be appointed by agreement between the PCT and the Service Provider or in default of such agreement within fourteen days to be appointed by the President of the Local Law Society pursuant to the provisions of the Arbitration Acts 1950 and 1979, and the decision of the arbitrator shall be final and binding on both parties.

17.3 Use of the disputes procedure will not delay, or take precedence over, any use

of the default or termination procedures. 18. Complaints 18.1 The Service Provider must comply with the NHS Complaints Procedure and have

a written procedure to enable individual Service Users or someone acting on their behalf to make comments or complaints relating to the Service provided to them. A copy of that procedure must be made available to the PCT for their approval, on request.

18.2 The existence of the Service Provider’s procedure does not remove the users of the Service right of access to the PCT’s Complaints Procedure. The Service Provider must ensure that any leaflets or documents relating to the Service Provider’s complaints procedure also makes the users of the Service aware of this right.


18.3 Any complaints received by the Service Provider relating to the provision of the Service together with a report of what action if any that the Service Provider has taken shall be provided to the PCT upon request for monitoring purposes.

19. Third Party Rights The PCT and the Service Provider agree that except where provided for in this

Contract, nothing else in this Contract is intended to confer or will confer by necessary implication any right or power on any person who is not a party to this Contract.

20. Exclusivity The Contract does not give the Service Provider an exclusive right to provide to

the PCT services similar to the Service. The PCT reserve the right to enter into any other contract for the same type of service that it considers necessary for the efficiency of its operation.

21. Mistakes in Information 21.1 The PCT and the Service Provider are bound by any mistakes in the information

given to the other and where it is not corrected and advised to the other parties before it has been acted upon or irrevocably committed to by the other parties, then the party giving the information will be liable for any claims for loss actually incurred by the other parties.

21.2 The PCT and the Service Provider will make every attempt to bring mistakes to

the attention of the other parties as soon as the mistake is discovered. 22. Confidentiality 22.1 The Service Provider must have a policy of confidentiality that complies with

Caldicott and current NHS Information Governance Standards in respect of personal information and ensure that it is put into practice.

22.2 Neither the PCT nor the Service Provider nor their respective workers, agents or

servants shall disclose any confidential information relating to or arising out of this Contract except to an authorised person who needs such information in the performance of this Contract.

22.3 The PCT will make available to the Service Provider the information needed to

ensure that the Service can be provided by the Service Provider (see Service Specification- Appendix 1)

22.4 If a breach of confidentiality occurs, the PCT may withhold further information until it is satisfied that the Service Provider has made suitable arrangements to prevent a recurrence.

23. Human Rights Act

The Service Provider recognises that the PCT are under a duty to act in a manner which is compatible with the convention rights as defined by Section 1(1)


of the Human Rights Act 1998 (hereinafter called ‘Convention Rights’). This duty includes a positive obligation on the PCT to ensure that service providers providing services on the PCT’s behalf act in a way which is compatible with the Convention Rights. The Service Provider therefore agrees to provide the Service and comply with its other obligations under this Contract in a manner which is compatible with the Convention Rights.

24. Freedom of Information Act For the purposes of this Condition:

a) “FOI Act” means the Freedom of Information Act 2000 and any subordinate legislation made under that Act or any code issued pursuant to sections 45 or 46 of that Act or any guidance issued by the Information Commissioner;

b) “Information” means all records and information or any sort obtained, created, collected or held by The PCT in relation to this Contract; and

c) “Information Request” means a request for Information within the meaning of section 8 of the FOI Act.

24.1 The Provider acknowledges that the PCT is subject to the FOI Act and agrees to assist and co-operate with the PCT to enable the PCT to comply with its obligations under the FOI Act.

24.2 The Provider acknowledges that the PCT may be obliged to comply with its obligations under the FOI Act without informing or consulting The Provider.

24.3 Without prejudice, The Provider shall provide the PCT with any Information necessary to enable The PCT to respond to an Information Request within 5 working days of a request from The PCT (or such other period as The PCT may reasonably specify).

24.4 The PCT shall be responsible for determining whether and to what extent any of the exemption provisions in Part II of the FOI Act apply in relation to an Information Request. The Provide shall comply with any such determination by The PCT.

24.5 If the Provider receives an Information Request which ought to have been addressed to The PCT it shall not attempt to process the request itself but shall pass it to the PCT within 2 working days of receiving the request.

24.6 The Provider shall ensure that any sub-contract it enters into in relation to this Contract contains a condition in similar terms to this Condition 18 whereby the sub-contractor acknowledges The PCT’s responsibilities under the FOI Act and agrees to co-operate with The PCT so that these responsibilities can be discharged.

24.7 The PCT acknowledges that The Provider is also subject to the FOI Act but it is agreed that all the enquiries for disclosure under this contract will be administered by and through The PCT and that The Provider will direct enquiries and requests to the PCT.


25. Data Protection All parties warrant that in the performance of their respective obligations under

this Contract they will duly observe all their obligations under the Data Protection Act 1998 and any subordinate legislation relating thereto.

26. Improvement and Innovation The Service Provider agrees to work with the PCT in order to achieve continuous

improvement to and innovation in the Service provided. 27. Diversity

The Service Provider shall comply with the requirements of all equal

opportunities legislation, specifically the Race Relations Act 1976, Race Relations (Amendment) Act 2000, Sex Discrimination Act 1975 and 1986, and Disability Discrimination Act 1995, and the Service Provider will ensure that its policies and procedures reflect those Acts. The Service Provider must ensure that its workforce receives appropriate training in order to understand their roles and responsibilities in implementing those Acts, and to promote equality and to prevent discrimination.

28. Force Majeure

28.1 If either the PCT or the Service Provider fails to carry out their respective obligations under the Contract as a result of force majeure, then whichever agency is affected shall not be liable under this Contract for such failure.

28.2 If an event of force majeure occurs then the PCT shall meet with the Service Provider in order to discuss how best the Service Provider can provide the Service until the force majeure event ceases.

28.3 In this clause ‘force majeure’ is defined as:

i) acts of war

ii) acts of God

iii) decrees of Government

iv) riots

v) civil unrest;

28.4 For the avoidance of doubt, ‘force majeure’ shall not include any labour dispute between the Service Provider and its workforce or the failure to provide the Service by any of the sub-contractors or assignee.


29. Whole Agreement- Signatories This Service Level Agreement represents the complete agreement between the

PCT and the Service Provider and supersedes all other negotiations and agreements relating to the Service.

Signed by duly authorised signatories of the PCT and the Service Provider respectively: Signature on behalf of the Community Pharmacy:

State Pharmacy Name:………………………….………………… Signature Name Date (Pharmacist Clinical Lead only)

Additional Signature of Community Pharmacy Clinical Governance Lead (where required) Signature Name Date

Signature on behalf of the PCT: Signature Name Date

Peter Price Job Title: Acting Director of Public Health

23rd December 2009


SCHEDULE 1: CLINICAL INFORMATION

SERVICE SPECIFICATION Smoking is still the major preventable cause of death and disease and contributes to inequalities in health, killing over 100,000 people in the UK each year DH 1999; FRESH 2008/9

1 Background and Rationale for Commissioning the Community Pharmacy Stop Smoking Enhanced Service

1.1 In 2001 smoking caused 4.8m deaths equivalent to 1 in every 12 of all deaths globally. By 2025 it is estimated that smoking will cause approximately 10 million deaths each year (Royal College of Physicians, 2007). In the UK cigarette smoking is strongly linked with socio-economic disadvantage. People in disadvantaged socio-economic groups are more likely to smoke, to smoke heavily and to be heavily addicted (FRESH, 2008/9)

1.2 Over recent years, several government policies have dealt with the issue of

tobacco control. The Government’s first comprehensive tobacco control strategy, the smoking Kills White Paper (DH,1998) set out targets for reducing smoking prevalence in the overall population and within specific target groups including pregnant women and young people. It outlined proposals to develop a range of support service to help smokers to stop smoking and education programmes to prevent young people from taking up the habit. The NHS Cancer Plan (DH, 2000) set out an additional target to reduce smoking in manual groups.

1.3 More recent government publications including Choosing Health(DH, 2004), Our

Health, Our Care, Our Say(DH 2006) and NICE 1O Public Health Guidance(2008) have encompassed guidelines and considered measures to help prevent unnecessary deaths in the UK and tackle inequalities. They have recommended the establishment of cost effective, accessible community based services, which impact on the health of the target population.

1.4 Smoking currently directly causes around 5,500 deaths per year in the North

East region and on average smokers lose 16 years of life expectancy. The key target set in the Regional Health and Wellbeing Strategy(Better Health, Fairer Health) for the North East Strategic Health Authority region was – To reduce overall regional prevalence to no more than 23% by the end of 2010 dropping to 20% prevalence or below by 2015.

1.5 Since the establishment of the Specialist Stop Smoking Services (SSSS) in

2000/2001 increasingly ambitious quitters’ targets have been set locally. In order to meet the extremely challenging targets for 2008/9 onwards, it is has become vitally important to widen existing smoking service provision. Pharmacies are ideally placed in the heart of the community to provide stop smoking services to the general public. The NHS Stop Smoking Services: Service and Monitoring Guidance 2007/8 confirmed that partnership agreements with pharmacies should be established.


1.6 This Community Pharmacy Service Level Agreement (SLA) and Specification is therefore an integral part of the Tees-Wide Commissioning Strategy for Stop Smoking Interventions within a variety of healthcare, community and workplace settings. As a result of recent commissioning developments, a payment by results local tariff system will be introduced into this and other provider service specifications, its impact will be monitored by the Tees Stop Smoking and Tobacco Control Strategic Commissioning Partnership.

1.7 The Community Pharmacy Enhanced Service for Stop Smoking Interventions is

commissioned to contribute to:

• the delivery of the Public Service Agreement (PSA) targets included in the NHS Improvement Plan

• reducing smoking related illnesses and deaths by supporting people to give up smoking

• improving the health of the population by reducing exposure to second-hand smoke

in particular to

• improve access and choice of stop smoking services thereby contributing to the reduction of health inequalities.

2 Service Description

2.1 The Community Pharmacy Stop Smoking Enhanced Service will provide support, advice and treatment to people who are registered with a general practice in one of the four PCTs across Teesside and who want to give up smoking. The commissioned service will increase choice and improve access to NHS Stop Smoking Services, especially for routine and manual workers, pregnant mothers and young people.

2.2 The pharmacy will help facilitate access to, and where appropriate supply stop smoking pharmacological products either through the use of a Nicotine Replacement Therapy (NRT) voucher scheme or a ‘One-Stop’ service model.

2.3 The pharmacy will provide onward referral to general practice and Specialist Stop Smoking Services (SSSS) in accordance with local protocols and guidance.

2.4 Throughout the stop smoking programme, communication to the SSSS and the clients’ GP practice will be maintained as appropriate.

2.5 This Enhanced Service is to be provided in addition to, and complimentary to, the nationally contracted Community Pharmacy Essential Services including ‘Promotion of Healthy Lifestyles (Public Health)’ (ES4) and ‘Signposting’ (ES5).

3. Aims and Intended Service Outcomes

3.1 To provide a Tees-wide community pharmacy-based NHS Stop Smoking

Service, as an integral part of the wider Tees Stop Smoking & Tobacco Control


Strategic Plan and thereby ensure an equitable, high quality service is provided to all clients across the Tees PCTs, regardless of service provider.

3.2 To improve access to opportunities for stop smoking interventions by offering

increased convenience, choice of location and extended hours of availability (including times within the usually defined ‘out-of-hours’ period) from the community pharmacy settings.

3.3 Successful implementation of the SLA will

• increase clients’ to access stop smoking advice, baseline assessments and follow-up by trained Pharmacy Intermediate Assessors at community pharmacies.

• inform client choice of the most appropriate NRT product(s) to support their quit attempt and advise on their safe use, whilst taking into account behavioural dependence, co-morbidities and co-prescriptions.

• for those clients who are motivated to stop smoking, enable them to obtain supplies of NRT from community pharmacies without the need for a prescription

• provide on-going one-to-one motivational support and advice, normally for a 12/13 week period, with discretion, and in consultation with the Specialist Stop Smoking Service, to increase to a maximum of 16 weeks, to encourage a successful quit attempt. (Any clients requiring ongoing treatment beyond 16 weeks should be referred back to the SSSS for review and specialist intervention)

• provide NRT by use of vouchers (appropriate prescription–equivalent charges applied) to clients who have accessed NHS Stop Smoking Services and had an Intermediate Assessment via an alternative route e.g. workplace, secondary care or community setting. The provision of NRT will be supported with appropriate information, advice and monitoring to enable safe and effective use by clients.

• provide proactive follow up and support of clients, to promote long term quitters and the achievement of local and national targets as described in section 1.7.

4 Service Outline 4.1 All community pharmacies will be offered the opportunity to participate in the

Community Pharmacy Enhanced Service providing the service standards and PCT selection criteria based on a needs assessment are initially met and subsequently maintained.

4.2 The SSSS will coordinate the promotion of the service locally, including the

development of local publicity materials and the use of national campaign materials. Pharmacies should use these materials (and associated terminology) to promote the service to the public and should ensure they coordinate their own promotional activities with those of the SSSS.


4.3 As part of their national contracted Essential Service – ‘Promotion of healthy

lifestyles (Public Health)’, (ES4), all community pharmacies will promote public health messages related to smoking to general pharmacy visitors. Pharmacies may also signpost (in accordance with the national Essential Service for ‘Signposting’, ES5); to local stop smoking service providers.

4.4 In addition to the activity described in section 4.3 above, those pharmacies

participating in the Community Pharmacy Enhanced Service for Stop Smoking Interventions will respond to clients’ needs for stop smoking support depending on the accreditation status of that pharmacy. Pharmacies will confirm eligibility of the client to access the stop smoking service they are accredited to provide (Appendix 2). Smokers must be registered with a general practice from one of the four PCTs across Teesside to be considered for this Enhanced Service.

4.5 Table 1 shows the levels of pharmacy accreditation available. For details of

accreditation requirements – see Qualifications and Training Section 5.4.

TABLE 1 - Service Outline by Pharmacy Accreditation Level

Accreditation Level

Outline Description of Service

VOUCHER ONLY

(also excludes patients from ‘Cautionary Groups’)

Tier 1

Supply Only Voucher (Option 1)

Process vouchers to supply NRT for clients attending Level 2 Intermediate Assessment at non-community pharmacy settings.

Treatment voucher (includes follow up support) (Option 2)

Process vouchers to supply NRT for clients attending Level 2 Intermediate Assessment at non-community pharmacy settings and carry out

• CO monitoring

• Motivational support

• Data collection and reporting

• Audit of patient satisfaction of service

Tier 2

Tier 1 service plus Level 2 Intermediate Assessment for smokers EXCLUDING those from stated ‘cautionary groups’ e.g., pregnancy, young people.

Tier 3*

Tier 2 service plus Level 2 Intermediate Assessment for smokers INCLUDING those from stated ‘cautionary groups’ e.g., pregnancy, young people.

Tier 4*

Tier 3 service plus pharmacists additionally trained and competent to provide pharmacological support using Patient Group Direction(s).

ONE-STOP (INCLUDING VOUCHER)

Tier 5*

Tier 3 service plus pharmacists additionally trained and competent to prescribe pharmacological support.

* Accreditation Tier 3 Service is not currently available North of Tees. Tiers 4 and 5 are not available at

the point of development of this SLA. They have been included in anticipation of potential future service development.


4.6 The community pharmacy team will pre-screen the eligibility of potential clients in order to identify those people who meet criteria for inclusion in the community pharmacy stop smoking service in accordance with, local guidance; the accreditation level achieved by the pharmacy (see Table 1) and service availability (see 4.15).

4.7 Tier 1 pharmacies will be accredited to accept clients who have received an

assessment and a voucher from an alternative approved Tees Stop Smoking Service provider. Pharmacies may be required to either supply NRT only (Option 1 voucher) or to additionally provide follow up support as outlined in section 3.3 (Option 2 voucher). Clients from a ‘Cautionary Group’ (such as pregnant women and young people under 16 – as detailed in Appendix 2) should be signposted to a Tier 3 or above ‘One Stop’ pharmacy by the voucher issuer, or by the Tier 1 pharmacy if they present there inappropriately. Clients who present requiring an assessment should be signposted to a choice of appropriate Tier 2/3 or above ‘One Stop’ pharmacies or to alternative stop smoking service provision.

4.8 Tier 2 pharmacies will be additionally accredited to offer Intermediate

Assessments to smokers, excluding those belonging to a ‘Cautionary Group’ (such as pregnant women and young people under 16 – for other groups see Appendix 2).

4.9 Tier 3 pharmacies will be additionally accredited to offer assessments (and

process vouchers issued from non pharmacy settings) to all smokers (including young people of 12 years of age and over and pregnant women, providing a suitably accredited pharmacist is available to complete the assessment for clients belonging to a ‘Cautionary Group’. N.B. (Fraser Guidelines must be adhered to for under 16 years).

4.10 ‘One Stop’ clients must receive their entire programme of Stop Smoking

Intervention treatment at the pharmacy where their initial assessment is carried out. Voucher only clients must similarly attend the same pharmacy for the whole of their supply or treatment programme.

4.11 As part of their Community Pharmacy Enhanced Service, the community

pharmacy provider will develop capacity and capability to promote the stop smoking service at all opportunities; either pro-actively in the form of brief advice/brief Intervention or in response to a specific request for further information. Detailed information on the service (both written and verbal) should be available at all times when the pharmacy is open.

4.12 Pharmacies will usually operate a ‘drop-in’ facility for clients presenting with a

voucher following an intermediate assessment elsewhere. However pregnant women will be required to make an appointment with the Tier 3 pharmacy of their choice for their initial voucher presentation, as an Advanced Accredited Pharmacist must be available. Pregnant women should be offered an appointment within 1 working day of request. Where an appointment is unavailable within this timescale, clients must be given the choice of the nearest available alternative Tier 3 community pharmacy An exception report (Appendix 4) must also be completed and forwarded to the PCT.


4.13 The ‘One–Stop’ Stop Smoking Service will usually be operated on an appointment basis. Appointments will be available at a variety of times throughout the normal opening hours of the pharmacy, including evenings and weekends.

4.14 Suitable individuals will be offered an appointment for the Intermediate

Assessment at the soonest available opportunity, within one week of the first request. Clients will be advised in advance to allow approximately 30 minutes for the Intermediate Assessment process to be completed. Where the full service is unavailable in a pharmacy for any reason within the timescales above, clients should be signposted to the nearest available community pharmacy (Appendix 6) or alternative provider. An exception report must also be completed and forwarded to the PCT.

4.15 Service availability and client recruitment. Local agreement will be reached on

the minimum period during the week when accredited persons will usually be available at each pharmacy to offer the service. As a general rule, the pharmacy will normally have capacity* to support at least 20 clients (at various stages of the programme) at any one point in time. Contract monitoring will include tracking of clients attending pharmacies. *NB. The number of clients that may present at a Tier 1 pharmacy is entirely out of the control of the pharmacy; it is therefore not possible to set a minimum target number of clients within a given time frame. Voucher clients presenting at Tier 2 pharmacies are subject to the same limitation on target setting. These clients nevertheless take-up capacity in a pharmacy once they have presented.

4.16 Specific targets for recruitment of one-stop clients into Tier 2 services and above

are based on historical data; an aspirational target of 35 ‘4 week’ quitters annually has been set. Activity data will be monitored alongside exception reporting for ‘unavailability’ of any element of the service (see section 5) and action taken in response to client throughput considered to be consistently low. As a guide to maintaining staff competency to deliver smoking cessation interventions, it is expected that a pharmacy will treat a minimum of 100 clients annually.

4.17 Summary: Stop Smoking Interventions will be provided as follows:

Tier 1 pharmacies and above

Option 1 (Dispensing only) Voucher and Option 2 (plusTreatment Voucher)

• Tier 1 pharmacies cannot support clients from ‘Cautionary Groups’.

• Pharmacies will process o Option 1 vouchers issued by Intermediate Assesors within alternative

provider services who are commissioned to provide the ongoing Stop Smoking support in line with the PCT 12 week pathway. Pharmacies will supply NRT only; a pharmacist must be present when the supply is made, to authorise NRT issued in accordance with this Enhanced Service. A record of the supply will be recorded in the PMR.

o Option 2 vouchers - also issued by Intermediate Assesors within alternative provider services, but in this case the pharmacy will be directed to supply NRT as per Option1 and also to provide on-going motivational support (including CO monitoring or validation) in accordance with the Service Standards. It is expected that there will be a minimum of


one and a half hours support provided during the initial treatment voucher 5 week period.

Tier 2 pharmacies and above:

• Tier 2 pharmacies cannot support clients from ‘Cautionary Groups’.

• Pharmacies will process Option 1 and Option 2 vouchers as per Tier pharmacies.

• Clients presenting for the ‘One-Stop’ service will be provided with this service in accordance with the Service Standards (incorporating NRT supplies and on-going motivational support as per Option 2 voucher service).

Tier 3 pharmacies and above:

• Tier 3 pharmacies provide the full ‘One Stop’ and Voucher service including NRT supply and support for clients from ‘Cautionary Groups’.

4.18 Pharmacies delivering tier 2 and above services will be reimbursed in

accordance with the tariff payment aligned to the 12 week Stop Smoking Pathway (See Schedule 2). Pharmacies are encouraged to proactively follow up clients at the 4 & 12 week stages as payment is contingent on CO validation. Follow up status should be recorded on the Gold Standard Monitoring form and faxed to the SSSS within 48hrs, this will activate payment and de -activate SSSS follow up.

5 Additional Service Standards 5.1 Clinical Governance (General) 5.1.1 Community pharmacy providers will operate to appropriate standards of clinical

governance as detailed in Essential Services 8 of the Community Pharmacy Contractual Framework (2005)2. Pharmacies will have an identifiable Governance Lead and apply clinical governance principles to the delivery of all services. This will include use of standard operating procedures; recording, reporting and learning from adverse incidents; participation in continuing professional development and clinical audit; and assessing patient satisfaction.

5.1.2 In order to satisfactorily deliver this Enhanced Service as described in the

Specification, pharmacy contractors will have a particular duty to ensure that:

� premises are of a standard suitable for such consultations

� usual steps are taken to maximise quality improvement and minimise risks involved in providing the service -which includes ensuring that

� there are demonstrably effective general policies, procedures and practice in place in relation to:

• Health & Safety

• Complaints

• Confidentiality

• Data Protection

• Incident Reporting

• Infection Control (Including Hand Hygiene)


• Training, Development & Competence

and also that

• pharmacists and staff involved in the provision of the stop smoking service (a) have relevant knowledge and are appropriately trained in the operation of the service and (b) are aware of and operate within the specific local operating protocols or procedures related to it.

5.1.3 Before the SLA is signed, the community pharmacy provider will submit a self-

assessment document (using PCT provided template; Appendix 1) to the PCT which will provide evidence on which to judge the level of preparedness of the contractor to meet the required Service Standards. This will include an indication of capacity and potential client numbers (not targets) for planning purposes.

5.2 Premises 5.2.1 The community pharmacy contractor must ensure that appropriate standards of

facility/premises are in place to minimise risk to staff, clients and other service users. With regard to that part of the pharmacy used for the provision of the Intermediate Assessment part of service (hereinafter termed ‘consultation space’), this must

• provide a sufficient level of privacy (ideally at the level required for the provision of the Medicines Use Review service1) and safety and meet all other nationally and locally agreed criteria

• be easily accessible and sensitive to the needs of the target group 5.2.2 Where approved by the PCT another suitable space may be accredited whilst

not as substantial as a full consultation space, offers sufficient privacy and suitable conditions for the other activities provided to support the client.

5.2.3 The pharmacy provider will allocate a safe place to store equipment required for

the provision of the service. 5.2.3 Secure storage facilities will be required for confidential client records that must

be stored in line with NHS record retention policies.

5.2.4 Premises will require PCT accreditation before the Enhanced Service may commence.

5.3 Equipment and Consumables 5.3.1 Equipment required for the satisfactory delivery of this service, and NOT already

required by a community pharmacy to fulfil national Essential Services requirements (e.g., CO monitoring equipment) will be provided by the SSSS (and therefore remain the property of the PCT should the Enhanced Service SLA be terminated by either party). Should the pharmacy cease to provide the service then the equipment will be returned to the SSSS.

5.3.2 The provider will be responsible for the safe storage and maintenance of the

equipment and will be responsible for the supply of plastic T pieces and disposable mouthpieces and wipes. Calibration of CO monitors will be


undertaken by the SSSS and monitors should be made available for this purpose, on request.

5.3.3 The pharmacy will have access to a fax machine in order to fulfil interim

arrangements for record keeping and data transfer 5.3.4 With adequate notice pharmacies may be required to enable suitable secure

access to the IT solution provided by the PCT. This will facilitate client data capture and transfer in support of the stop smoking intervention. Internet access via a direct N3 connection and an nhs.net email account will be required in the near future.

5.4 Workforce: Qualifications, Training, Accreditation, Competency 5.4.1 All pharmacists involved in the Enhanced Service have a duty to ensure that

pharmacists (including locums) and staff involved in the provision of the Service have relevant knowledge and are appropriately trained in the operation of the Service. Ultimate responsibility for assuring competence for service delivery rests with the Pharmacist Clinical Lead. This will include an expectation that all pharmacy staff are competent in the provision of brief interventions and other relevant stop smoking initiatives.

5.4.2 Training requirements are shown in Tables 2a and 2b. Pharmacy staff and

pharmacies will be initially accredited by the SSSS when considered to be competent. On-going staff competency will be externally assessed via routine monitoring and on-going contact with the Specialist Adviser.

5.4.3 Note that the Pharmacy Clinical Lead, who takes day to day responsibility for the

operation of the Enhanced Service, is required to complete Level 2 Intermediate Training either through distance learning (CPPE) or through attendance at training offered by the SSSS. Evidence of completion will be required before approval.

5.4.4 In addition to the training outlined in tables 2a and 2b, pharmacies are required to

ensure that all staff who deliver pharmacy-based stop smoking interventions complete an Intermediate Level 2 update every two years to maintain their accreditation status.

5.4.5 For the purpose of sharing good practice and the continuing professional

development of staff, the SSSS will usually hold two briefing sessions annually. Pharmacies must ensure a minimum of one representative attends each session and cascades their learning to their colleagues.

5.4.6 Tier 1 pharmacies must provide at least two named staff members designated as Stop Smoking Pharmacy Support Staff. These staff must have completed Level 2 Intermediate training plus attend the required number of in-house training sessions to reach competency to undertake monitoring of clients.


TABLE 2a – Pharmacists - Training Requirements by Accreditation Level Accreditation

Level Training Requirements

VOUCHER ONLY

Tier 1

• CPPE or Intermediate Level 2*

• Service management training required for the Tier 1 service

(facilitated by the SSSS)

Tier 2

• CPPE or Intermediate Level 2*



• Mentoring (minimum 2 sessions**)

• Shadowing (minimum1 session**)

Tier 3*** (Advanced Accredited Pharmacist)

As Tier 2 plus

• Service management training required for the Tier 3 service.

• Mentoring (minimum 2 sessions) 1 with Specialist Pregnancy Advisor**)

• Cautionary Group Training to be completed i.e. Maternal Health/Pregnancy training, Fraser Competency


Tier 4***

As Tier 3 plus


• Training and accreditation required to using Patient Group Directive(s) (training provider to be confirmed)


Tier 5*** As Tier 3 service plus pharmacists additionally trained and competent to prescribe pharmacological support

* Accreditation will be confirmed by a certificate of attendance issued by the SSSS upon completion of relevant training.

** Minimum sessions as defined however further sessions may be required to ensure competency.

*** Accreditation Tier 3 is not currently available North of Tees. Tiers 4 and 5 are not available at the point of development of this SLA. They have been included in anticipation of potential future service development.

5.4.7 In addition Tier 2 pharmacies must ensure that there are two Accredited Pharmacy

Assessors identified and who undergo training as shown on Table 2c.


TABLE 2b - Pharmacy Intermediate Assessors and Support Staff Training Requirements by Accreditation Level

Accreditation Level

Training Requirements

Tier 1 Tier 2 One Stop

• CPPE or Intermediate Level 2

• Pharmacy Briefing

• Mentoring (minimum 2 sessions**)

• Shadowing (minimum 1 session**)


* Accreditation will be confirmed by a certificate of attendance issued by the SSSS upon completion of relevant training

** Minimum sessions as defined however further sessions may be required to ensure competency.

5.5 Workforce: Staffing Requirements 5.5.1 Participating community pharmacists must ensure that a Pharmacy Clinical Lead

has overall responsibility for the safe and smooth running of the stop smoking service provided in their pharmacy. A Pharmacist Clinical Lead will normally be regularly employed to work in that pharmacy for at least 20 hours per week (35 - 40 hours in a 100 hour pharmacy). They will sign the SLA and have clinical responsibility for the operation of the service in that community pharmacy.

5.5.2 In exceptional circumstances, the PCT may give approval for an accredited member

of non pharmacist staff, holding the position of Governance Lead for that pharmacy, to co-sign the SLA with an Accredited Pharmacist Clinical Lead who is an area manager or equivalent; providing suitable additional Accredited Pharmacists will be available to offer the assessments on an appointment basis.

5.5.3 If there is a change to the named Pharmacy Clinical Lead or the Accredited

Pharmacy Assessors then the SSSS must be informed at the earliest opportunity. The replacement pharmacist/Accredited Pharmacy Assessors will be allowed to take over but must complete the required training.

5.5.4 The community pharmacy provider must have a standard operating procedure in

place for this service. The Pharmacist Clinical Lead has a duty to ensure that pharmacists and staff involved in the provision of the service are aware of and operate within local protocols.

5.5.5 Normally pharmacies must have satisfactorily provided a Tier 2 service for a 6

month period in order to be considered for a Tier 3 status.


TABLE 3 - Minimum Staffing Provision according to Accreditation Level

Accreditation Level

Staffing Requirements

VOUCHER ONLY

Tier 1 • Pharmacist

• 1 Pharmacy Support Staff (2 recommended)

Tier 2 (Immediate Assessor)

• Pharmacist

• 1 Accredited Pharmacy Intermediate Assessors

(2 recommended)

• Optional Pharmacy Support Staff

Tier 3

• Advanced Accredited Pharmacist

• 1 Advanced Accredited Pharmacy Intermediate Assessors (2 recommended)

• Optional Pharmacy Support staff

Tier 4*** As Tier 3


Tier 5*** As Tier 3

* Accreditation will be confirmed by a certificate of competency issued by the SSSS upon completion of relevant training

** Accreditation Tiers 4 and 5 are not available at the point of development of this SLA. They have been included in anticipation of potential future service development.

6 Service Monitoring 6.1 The community pharmacy provider must collect the full gold standard data set in

a timely, consistent and complete manner in the required format. Data should be returned to the Specialist Stop Smoking Service within 2 working days of client contact at the following intervention stages:

• Initial assessment

• 4 week post quit date - follow up at four weeks must take place within the DH stated ‘window’ period of 25 to 42 days post quit date.

• 12 week post quit date (or end of treatment) - follow up at twelve weeks must take place between day 77 and before 98 days post quit date

• aspire to achieve a minimum of 35, 4 week quitters annually with a minimum quit rate of 35%.

• in line with the tariff payment 85% of 4 & 12 week quitters should be carbon monoxide validated.

Incomplete data sets will be returned to the provider for completion and return to the SSS with 48 hrs. NB: Incomplete data sets will be returned to the provider for completion and must be returned to the SSSS within the initial 2 working day period. *Failure to comply leads to non-payment*

All 4 & 12 week outcome data must be returned to the Stop Smoking Service whether quit, fail or lost to follow up.


Monitoring Guidance may be subject to change – if so Service Providers will be informed in writing of changes by the SSSS.

6.2 The pharmacy contractor will ensure that pharmacists and staff involved in the service maintain appropriate records to ensure effective ongoing service delivery and audit. Records will be confidential and must be stored securely and for a length of time in line with NHS record retention policies. Local documentation will be provided for the recording of relevant service information for the purposes of audit and the claiming of payment.

6.3 The pharmacy will inform the client’s GP within 2 working days of dispensing

NRT product using the documentation provided (see Appendix 5). GP practices will enter received results onto practice systems.

6.4 Monitoring information over and above that obtained during the delivery of the

Stop Smoking Service will include:

• information provided by the pharmacy with the self-assessment document prior to signing up for the SLA.

• client tracking including as appropriate o pre screening information. o numbers and times of appointments offered and taken up o DNA rates for appointments

• exception reporting for unavailability of services

• evidence required for audit and monitoring visits 6.5 The SSSS may also facilitate contributions from pharmacy staff and clients

towards evaluation and quality improvement of the pharmacy stop smoking services.

7. Quality Indicators Providers will be able to

• demonstrate that pharmacists and staff involved in the provision of the service hold the required monitoring accreditation and competency assessments, and have undertaken relevant on-going training or CPD. (This will include all appropriate staff attending, or otherwise completing, any Specialist Stop Smoking Service organised update training).

• demonstrate robust record keeping and quality assurance for any processes or equipment used.

• demonstrate the review of its own Standard Operating Procedures, and the referral pathways for the service, on an annual basis and whenever changes to the protocol are implemented.

• demonstrate the display the pharmacy premises’ accreditation certificate.

• participate in (PCT-led) audits of service provision and quality including regulation of financial claims

• co-operate with any locally agreed Specialist Stop Smoking Service assessment of service user experience.


• demonstrate low levels of exception reporting and satisfactory performance in all other PCT monitoring activities including quality assurance related to all service documentation.

• achieve a satisfactory 4 week quit rate – a minimum 4 week quit rate of 35% will normally be expected with 85% CO validation.

• promote the enhanced service for stop smoking interventions at all opportunities and participate in the development and use of local and national campaigns.

8. PCT Responsibilities

• To ensure clear processes for the procurement and contract management of the community pharmacy SLA

• To ensure a robust process is in place to make payments to community pharmacies.

• To ensure adequate provision for initial and on-going maintenance of training, accreditation and competency for all staff involved in the delivery of the community pharmacy service.

• To ensure clear processes for monitoring of the performance and quality of provision against the contract including processes for feedback to contractors.

• To provide clear communication to contractors on PCT lead contacts for all aspects of the provision of the contract.

• To co-ordinate publicity and promotional aspects of the community pharmacy service.


APPENDICES to SCHEDULE 1

Appendix 1 COMMUNITY PHARMACY SELF-ASSESSMENT DOCUMENT (EXAMPLE) Introduction The Community Pharmacy Stop Smoking Enhanced Service will provide one to one support and advice to people who are registered with a general practice in one of the four PCTs across Teesside and who want to give up smoking. The commissioned service will help to increase choice and improve access to NHS Stop Smoking Services, especially for routine and manual workers, pregnant mothers and young people.

The pharmacy will help facilitate access to, and where appropriate supply stop smoking pharmacological products either through the use of a Nicotine Replacement Therapy (NRT) voucher scheme or a ‘One-Stop’ service model.

The pharmacy will provide onward referral to general practice and Specialist Stop Smoking Services (SSSS) in accordance with local protocols and guidance. Throughout the stop smoking programme, communication to the SSSS and the clients’ GP practice will be maintained as appropriate.

This Enhanced Service is to be provided in addition to, and complimentary to, the nationally contracted Community Pharmacy Essential Services including ‘Promotion of Healthy Lifestyles (Public Health)’ (ES4) and ‘Signposting’ (ES5). Before the SLA is signed, the community pharmacy provider will complete and submit this self-assessment document to the PCT which will provide evidence on which to judge the level of preparedness of the contractor to meet the required Service Standards.


Service Standards: Self Assessment Criteria Community pharmacy contractors will use this self assessment to document the detail of their ability to fulfil the criteria required in the service standards section of the Service level agreement. Please complete the self assessment and submit a copy to Insert The named Commissioner/ reviewer of documents

This self assessment MUST BE approved and premises and relevant staff accredited by PCT before the service can commence.

Criteria One : Service Delivery

1.1 Governance Quality Indicator The pharmacy reviews its own Standard Operating Procedures, and the referral pathways for the service, on an annual basis and whenever changes to the protocol are implemented.

Community pharmacy providers will operate to appropriate standards of clinical governance as detailed in Essential Services 8 of the Community Pharmacy Contractual Framework (2005). In order to satisfactorily deliver this Enhanced Service as described in the Specification, pharmacy contractors will have a particular duty to ensure that:

� premises are of a standard suitable for such consultations

� usual steps are taken to maximise quality improvement and minimise risks involved in providing the service -which includes ensuring that

� there are demonstrably effective general policies, procedures and practice in place in relation to:

• Health & Safety

• Complaints

• Confidentiality

• Data Protection

• Incident Reporting

• Infection Control (Including Hand Hygiene)

• Training, Development & Competence

and also that

� pharmacists and staff involved in the provision of the stop smoking service (a) have relevant knowledge and are appropriately trained in the operation of the service and (b) are aware of and operate within the specific local operating protocols or procedures related to it.

The Pharmacist Clinical Lead has overall responsibility for the safe and

smooth running of the stop smoking service provided in their pharmacy. A Pharmacist Clinical Lead will normally be regularly employed to work in that pharmacy for at least 20 hours per week (35 - 40 hours in a 100 hour pharmacy). They will sign the SLA and have clinical responsibility for the operation of the service in that community pharmacy.

Self assessment

Describe how the governance criteria will be met and submit appropriate evidence

• Provide copy of Standard Operating procedure

• Infection control policies and associated SOPs Name of Pharmacist Clinical Lead


Hours worked in pharmacy

1.2 Premises Quality indicator The pharmacy premises accreditation is clearly displayed and easily accessible

With regard to that part of the pharmacy used for the provision of the service this must

• provide a sufficient level of privacy (at least at the level required for the provision of the Medicines Use Review service)

• be easily accessible and sensitive to the needs of the target group Where approved by the PCT another suitable space may be accredited whilst not as substantial as a full consultation space, offers sufficient privacy and suitable conditions for the other activities provided to support the client. The pharmacy provider will

• have access to a fax machine in order to fulfil interim arrangements for record keeping and data transfer

• allocate a safe place to store equipment required for the provision of the service

Self assessment

Does the consultation space and additional space meet the required criteria? Where will equipment be stored? Where will protective equipment be stored? Where will clinical waste be stored?

1.3 Equipment and consumables Quality Indicator The results of all quality assurance tests fall within the acceptable range

The provider will be responsible for

• Ensuring protocols, including audit, for quality assurance (internal and external) and calibration of testing equipment are in place and are followed.

• the safe storage and maintenance of the equipment and will be responsible for the supply of plastic T pieces and disposable mouthpieces and wipes. Calibration of CO monitors will be undertaken by the SSSS and monitors should be made available for this purpose, on request.

Self assessment How will you demonstrate that Equipment has been maintained and calibrated?

Quality assurance checks have been carried out?


Which member of staff will take responsibility for ensuring these records are maintained?

1.4 Access to service Quality indicator Evidence and records from Pre screening Tool Appointment diary DNA records

The community pharmacy provider will develop capacity and capability to promote the enhanced service for stop smoking interventions at all opportunities

• Clients may be referred by other services or self refer but must be screened for eligibility according to the service inclusion criteria (Pre-screening Tool)

• The assessment service will usually be operated on an appointment basis as accredited staff (including a pharmacist) must be available to complete it.

• The service will be available at a variety of times throughout the normal opening hours of the pharmacy; ideally over a minimum 6 day period.

• Clients will be advised in advance to allow approximately 30 minutes for the intermediate assessment process to be completed.

Self assessment

Describe how appointments will be managed Identify when appointments will be available during a typical week

1.5 Disruption of service Quality indicator Records from appendix 4

Where the service is unavailable in that pharmacy for any reason, clients should be signposted to the nearest available community pharmacy who provides the service and an exception report should be completed and forwarded to the PCT. If the pharmacy is unable to provide any pharmaceutical services then standard PCT procedure should be followed and recorded.

Self assessment

Describe how disruption of service will be managed.


1.6 Promotion of service Quality indicator Availability of leaflets and information to support the service Evidence from Pre screening Tool - Appendix 2

The PCT will coordinate the promotion of the service locally, including the development of local publicity materials and the use of national campaign materials. PCT provided marketing materials will support all community pharmacies located in PCTs on Teesside to proactively promote the Stop Smoking Services Pharmacies should use these materials (and associated terminology) to promote the service to the public and should ensure they coordinate their promotional activities with those of the PCT. Information on the service (both written information and staff able to offer further verbal explanation) should be available at all times when the pharmacy is open.

Self assessment Describe how the service will be promoted in the pharmacy. How will you ensure display materials are always available?


Criteria Two: Data Collection 2.1 Records management Quality indicator The pharmacy can demonstrate robust record keeping and quality assurance for any processes or equipment used.

The community pharmacy provider will collect high quality data in a timely, consistent and complete manner in the required format for the Stop Smoking Services. Data should be returned to Specialist Stop Smoking Service within 48 hours of client contact at the following times:

• Initial assessment

• 4 week post quit date

• 12 week post quit date (or end of treatment) Monitoring information will include

• self-assessment document prior to signing up for the SLA

• client pre-screening information (numbers pre-screened, proportion eligible)

• numbers and times of appointments offered and taken up

• DNA rates for appointments

• numbers of assessments completed by each staff member (part of on-going competency assessment)

• numbers of referrals made

• Interventions offered.

• Incidents related to the service

Appropriate records will be maintained to ensure effective ongoing service delivery and audit. Records will be confidential and should be stored securely and for a length of time in line with local NHS record retention policies.

Self assessment

Describe how data and records will be maintained under the requirements of information governance Where will records be stored? How long will records be stored? Which member of staff will be responsible for overseeing the maintenance of records?


Criteria Three : Workforce 3.1 Qualifications, training accreditation and competency Quality indicator The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service hold the required PCT accreditation and competency assessments

The pharmacy contractor will ensure that pharmacists and staff involved in the provision of this service have relevant knowledge and are appropriately trained, and accredited by the PCT to operate the service(See Tables 2a-c, Table 3). The community pharmacy provider must have a standard operating procedure in place for this service. The Pharmacist Clinical Lead has a duty to ensure that pharmacists and staff involved in the provision of the service are aware of and operate within local protocols. Tier 1 pharmacies must provide named staff members designated as Stop Smoking Pharmacy Support Staff. These staff must have completed Level 2 Intermediate training plus attend the required number of in-house training sessions to reach competency to undertake monitoring of clients. In addition Tier 2 pharmacies must ensure that there are Accredited Pharmacy Assessors identified and who undergo training as shown on Table 2c. PCT will assess competence of staff members providing this service prior to accreditation NB: There will be no cascade accreditation outside of this process.

Self assessment

List all staff to be accredited to provide the service and give dates of training planned or undertaken together with means of ensuring skills are kept up to date. The Clinical Lead pharmacist has ultimate responsibility for ensuring that staff operating the service are trained and competent to do so. Pharmacists Support staff All staff in the pharmacy should have an understanding of the service and be able to offer brief advice or brief interventions and pre-screen for the service. Describe how this will be achieved List staff to be trained by the pharmacy to pre-screen for the service


Criteria Four: Review/Audit 4.1 Service monitoring Quality indicator The pharmacy participates in an annual (PCT-led) audit of service provision.

The pharmacy co-operates with any locally agreed (PCT-led) assessment of service user experience

For the purpose of sharing good practice and the continuing professional development of staff, the SSSS will usually hold two briefing sessions annually to

• promote service development, audit and clinical effectiveness;

• update pharmacy staff with new developments, knowledge and evidence. The pharmacy contractor will work collaboratively with the PCT to release staff to attend update training as is reasonably required. Pharmacies should ensure a minimum of one representative attends each session and cascades their learning to their colleagues.

The PCT should also facilitate contributions from pharmacy staff and clients towards evaluation and quality improvement of the vascular risk assessment programme. The pharmacy contractor will review any incidents related to the provision of this service.

Self assessment

Please supply the name and contact details of the member of staff designated to assist in any future service review.

Additional Supporting Information

Please provide any further information to support the self assessment and the provision of this service.


Declaration I declare that all information submitted in this self –assessment is true and accurate to the best of my knowledge. Pharmacist Clinical lead Signature Name & job title Date

Additional approved Clinical Governance Lead where permitted Signature Name & job title Date

Countersigned by area manger pharmacist / superintendent etc

Signature Name & job title Date

Pharmacy Name:

Pharmacy Address:

Pharmacy Telephone Number:

Pharmacy stamp:

Please complete & return to

For PCT use Approved by:

Name Designation

Signature Date


Appendix 2 - CLIENT PRE-SCREENING TOOL

This tool is to be used by pharmacy staff to select clients appropriate to the pharmacy’s accreditation status. Pharmacies that signpost clients to another service appropriate to the client’s need as a result of using this tool should record this activity in accordance with Essential Services 4 of the Pharmacy Contract.

Questions to ask the presenting potential client:- Tier 1 (voucher only) pharmacies

Eligible Not eligible Are you registerd with a GP from one of the 4 Tees PCTs?

Yes No- provide National Stop Smoking Helpline number

Do you have a voucher from a Tees-based smoking service?

Yes No- signpost to a Tier 2 or above pharmacy or the stop- smoking service for an intermediate level 2 assessment

Are you at least 16 years old?

Yes No - signpost to a Tier 3 or above pharmacy

For females ONLY: are you or could you be pregnant?

No Yes - signpost to a Tier 3 or above pharmacy

Have you been admitted to hospital with a heart attack or stroke or something like this in the last 6 weeks?

No Yes – Consult Specialist Service for further advice

Do you have any unstable medical conditions e.g. hypertension or diabetes?


If client is eligible then process the voucher in the usual way Tier 2 pharmacies



Do you have a voucher and assessment form from a Tees-based smoking service?

Yes No- proceed with check for eligibility for a level 2 assessment in this pharmacy


Yes No - signpost to a Tier 3 or above pharmacy


No Yes - signpost to a Tier 3 or above pharmacy

Have you been admitted to hospital with a heart attack or stroke or similar in the last 6 weeks?


Do you have any unstable medical conditions eg hypertension or diabetes?


If client is eligible then book them in process the voucher in the usual way


Tier 3 pharmacies and above



Do you have a voucher and assessment form from a Tees-based smoking service? GP?

Yes No- proceed with check for eligibility for a level 3 assessment in this pharmacy


Yes No – signpost to GP


Yes

Have you been admitted to hospital with a heart attack or stroke or similar in the last 6 weeks?


Do you have any unstable medical conditions e.g. hypertension or diabetes?


If client is eligible then book them in /process the voucher in the usual way


Appendix 3 – PHARMACY CLIENT REGISTER OF ATTENDANCE Stop Smoking Service Attendance Sheet

Pharmacy Name: Month: Address: Total new clients: Number of 4 week quitters claimed:

DATE NAME DOB POSTCODE NEW?

38

Appendix 4 - EXCEPTION REPORT FORM Exception report /Signposting record sheet

To be completed each time a Stop Smoking Intermediate Assessment, or other element of the recommended treatment programme cannot be delivered in accordance with the service specification of the SSSS community pharmacy SLA

Fax this form to …….within 24 hours of any failure to deliver a service element

Day Date Time Age

of client

Which service unavailable?

Pregnant?

Reason why service cannot be provided

Alternative date

offered

Signposted?

Staff Signature

example

mon 12/04/09

Assessment,

voucher dispensing Y/N No accredited pharmacist or

staff available

Y/N give date and indicate if accepted

Y/N give details

39

Appendix 5 SERVICE DOCUMENTATION

5a - Middlesbrough, Redcar and Cleveland

To be supplied separately as examples

5b Stockton and Hartlepool

To be supplied separately as examples


Appendix 6 - CONTACT DETAILS OF PARTICIPATING PHARMACIES

6a) Middlesbrough and Redcar and Cleveland

Middlesbrough - Tier 2 Pharmacies

Assura Pharmacy 9 Trinity Mews, North Ormesby Health Village,Middlesbrough TS3 6AL Tel : 01642 239050

Boots The Chemist Ltd The Cleveland Centre, 88/90 Linthorpe Road, MiddlesbroughTS1 2JZ Tel: 01642 249616

Boots Pharmacy 9a Lealholm Crescent, Ormesby Road, Middlesbrough,TS3 0NA Tel: 01642 314251

Crossfell Pharmacy The Berwick Hill Centre, Ormesby Road, Middlesbrough, TS3 7RP Tel: 01642 245859

David Jarvis Ltd 43 Eastbourne Road, Middlesbrough,TS5 6QN Tel: 01642 817361

Hunters Chemist Ltd 397 Linthorpe Road, Middlesbrough, TS5 6AE Tel: 01642 819533

Lloyds Pharmacy

9 High Street, Ormesby, Middlesbrough, Cleveland TS7 9PD Tel: 01642 314471

Lloyds Pharmacy 89 Acklam Road, Middlesbrough, TS5 5HR Tel: 01642 817570

Marton Pharmacy 12 Stokesley Road, Marton, Middlesbrough, TS7 8DX Tel: 01642 316072

PJ Wilkinson Chemist 273a Acklam Road, Acklam, Middlesbrough, TS5 7BP Tel: 01642 817164

Rowlands Pharmacy

169a Borough Road, Middlesbrough, Cleveland TS1 3RZ Tel: 01642 247382(off till Sept 09)

Tesco Pharmacy Parkway Centre, Coulby Newham, Middlesbrough TS8 0TJ Tel: 0845 6779878

Whitworths Pharmacy 17 Beresford Buildings, Thorntree, Middlesbrough, TS3 9NB Tel: 01642 243079


Redcar & Cleveland - Tier 2 Pharmacies

Boots The Chemist LTD

Rectory Lane, Guisborough TS14 7DL Tel: 01287 632120 (commencing 6

th August 09)

Boots 9 -11 Station Street, Saltburn TS12 1AE Tel: 01287 622820

Boots The Chemist LTD

High Street, Redcar TS10 3BZ Tel: 01642 482172

Cleve Chem

Redcar Health Centre, Coatham Road, Redcar TS10 1SR Tel: 01642 471316

Co-op Chemist 16 Westgate, Guisborough TS14 6BA Tel: 01287 632934

Coopers Chemist 6 Coatham Road, Redcar TS10 1RJ Tel : 01642 483861

Cooper and Kime 1 South Bank Terrace, South Bank TS6 6HW Tel: 01642 452968

Coopers Chemist Marske ltd 112 High Street, Marske By The Sea TS11 7BA Tel: 01642 485651

CR Kime 78 Bolckow Road, Grangetown TS6 7EG Tel: 01642 466256

Harrops Chemist 1 Zetland Road, Loftus TS13 4PP Tel: 01287 640557

Lloyds Pharmacy

High Street, Loftus Saltburn By The Sea TS13 4HA Tel: 01287 640301

Lloyds Pharmacy South Grange Medical Centre, Trunk Road, Eston TS6 9QH Tel: 01642 455792

Lloyds Pharmacy

Ennis Square, Dormanstown TS10 5JZ Tel: 01642 490964

Park Avenue

Park Avenue, Redcar TS10 3JZ Tel: 01642 484363

Scott Chem 15 Roseberry Square, Redcar TS10 4NY Tel: 01642 486186

Whale Hill Pharmacy 256 Birchington Avenue, Eston TS6 8BL Tel: 01642 454078


Stockton ASDA In Store Pharmacy 01642 623300

Portrack Lane, Stockton on Tees, TS18 2PB

Tier 2

ASDA In Store Pharmacy 01642 768400

Thornaby New Town Centre, Stockton on Tees, TS17 9EN

Tier 2

Alliance Pharmacy 01642 769600

12 Wrightson House, Mitchell Ave, Thornaby, Stockton on Tees, TS17 9EP

Tier 2

Boots Pharmacy 01642 605956

Unit 21b Goodwood Square Teesside Park Stockton on Tees TS17 7BU

Tier 2


12-14 High St, Norton, Stockton on Tees, TS20 1DN

Tier 2


58/63 High St, Stockton, TS18 1BE

Tier 2


Thornaby Medical Centre Development, Thornaby TS17 0DD

Tier 2

Davidsons Pharmacy 01642 360145

3 Station Road, Billingham, Stockton on Tees, TS23 1AG

Tier 2

Eaglescliffe Pharmacy 01642 782676

12 Durham Road, Orchard Est, Eaglescliffe, Stockton on Tees, TS16 0EH

Tier 2

Kelly Chemist 01642 751110

Myton Park Neighbourhood Centre, Myton Road, Ingleby Barwick, TS17 0WG

Tier 2

Lloyds Pharmacy 01642 780797

55 High Street, Yarm, TS15 9BH Tier 2

Newham Pharmacy 01642 608838

9/10 High Newham Court, Hardwick, Stockton on Tees, TSTS19 8PD

Tier 2

Pharmacy World Ltd, 01642 607217

59 Redhill Road, Roseworth, Stockton on Tees, TS19 9BX

Tier 2

Peter Milburn Pharmacy 01642 676842

113 Lane House Road, Thornaby, Stockton on Tees, TS17 8AB

Rowlands Pharmacy 01642 613533

The Health Centre, Lawson St, Stockton on Tees, TS18 1HU

Tier 2,


39 Queensway, Billingham, TS23 2ND

Tier 2


64-66 Norton Road, Stockton on Tees, TS18 2DE

Tier 2

Sainsbury Instore Pharmacy01642 01642 678614

White House Farm, Bishopton Road West, Stockton on Tees, TS19 0QB

Tier 2

Tesco Instore Pharmacy 01642 399447

Durham Road, Stockton on Tees, TS21 3LU

Tier 2

Whitworth Pharmacy 01642 676127

4 Varo Trce, Stockton on Tees, TS18 1JY

Tier 2


Hartlepool Tier 2 Pharmacies

ASDA Late Opening Pharmacy Marina Way Hartlepool TS24 0XR Tel: 01429 239010 M & J Pharmacy Ltd 62 Elizabeth Way Seaton Carew Hartlepool TS25 2AX Tel: 01429 268540 Boots the Chemist 89 The Shopping Centre Middleton Grange Hartlepool TS24 7RW Tel: 01429 272718 Clayfields Pharmacy 76 - 78 Oxford Road Hartlepool TS25 5SA Tel: 01429 274279


SCHEDULE 2: FINANCIAL ARRANGEMENTS

1.1 Provider remuneration for this service will be divided into three elements as shown in Table 1 below, plus Voucher fees and Drug costs. Enhanced outcome payments (EOPS) are for smokers from the most ‘disadvantaged’ communities (wards in the 20% most deprived in the country) and for pregnant women.

Activity/Outcome Requirements Standard

Fee EOP Pregnancy

EOP Deprivation

Level 2 Intermediate Assessment

Delivered by suitably accredited Adviser, completion of full data set and submission to SSSS within 48 hrs

£ 10

4 week quitter

CO validated and paperwork completed in line with protocol requirements (i.e. quitters must be eligible for inclusion in DH return to authorise payment)

£ 65

£5

£5

12 week quitter

CO validated and paperwork completed and submitted as above

£ 20

£5

£5

1.2 Voucher Fees In addition to the above fees for NRT supplies dispensed by pharmacies on submission of a voucher, an additional payment will be made in recognition of dispensing activity as follows:

5 week voucher £10 This is inclusive of all dispensing throughout the 5 week period, recommended 1 week, 2 week and 2 week. 8 week voucher £5 inclusive of all dispensing throughout the remainder of the 12/13 week pathway. 1.3 Drug Costs

For drugs supplied by voucher PCT reimburses pharmacies for cost of drugs supplied and for VAT at 5%.

1.4 The payment for assessments and CO validated quitters will be authorised by the SSSS in response documentation completed to a satisfactory standard. Payment will be authorised by SSSS on a monthly basis to NEFHSA who will notify NHSBA to make a payment to the contractor Payment claims for Voucher fees and Drug costs (using Invoice shown at Appendix 1A) will be submitted directly to NEFHSA on a monthly basis and will be validated by the SSSS in line with audit requirements at a post-payment authorisation stage. The PCT will pay all claims within one month of receipt.

1.5 Agreed remuneration will require review following any major change

1.6 The NHS inflationary uplift will be applied to fees annually on 1st April (from 2010).


Appendix 1a

M & RC S & H

Please tick

Dispensing and Product Fees for Smoking Cessation

Name of Pharmacy

Pharmacy Code

PLEASE USE ONE FORM PER CALENDAR MONTH Month and Year

Number Sub Total cost

Total no. initial dispensing fees claimed (A) @ £10

Total no. subsequent dispensing fees claimed (B) @£5 +

Total product cost (including VAT @ 5%) (C) +

Total cost (A + B + C) =

Prescription Equivalent Charges (minus VAT) (D) (Deduct from total cost)

-

Total Claimed [[[[ (A + B+ C) – D ]]]] =

I the pharmacist certify this claim is accurate and claim the total of £

Signed:

Print Name: Date of submission

Please complete and return to: Contractor Claims Section, Poole House, Stokesley Road, Nunthorpe, TS7 0NJ before the 7

th of the following month.

Pharmacy Stamp


Appendix 1b

M & RC S & H

Please tick

FOR INFORMATION ONLY

Monthly Summary of

Bonus Payments and Assessment Fees

Name of Pharmacy

Pharmacy Code

ONE FORM PER CALENDAR MONTH

Month and Year

Record of Intermediate Assessments 4 week quitters, 12 week quitters

No.

Standard

Payment

No. Pregnant

Additional

Tariff

No.

Deprivation

Additional

Tariff

Total payments including

additional tariffs

Intermediate Assessments

4 week quitters CO validated

12 week quitters CO validated

This information has been compiled by the Stop Smoking Service based on the receipt of your correctly completed assessment and monitoring forms.

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