Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
Schedule 2 Service Specification
Lot 3a Stop Smoking Service Provision &
Lot 3b Supply of Nicotine Replacement Therapy (NRT)
1.
Introduction
1.1.
This specification provides an agreement between Norfolk County Council and Any Qualified
Provider for the delivery of the service specified. It forms an extension to existing Pharmaceutical
and General Practice (GP) Services Contracts.
1.2.
Lot 3a: Stop Smoking Service Provision
The service to be provided is a level 2 stop smoking service which involves multi-session
interventions with a total potential client contact time being a minimum of 1.5 hours from pre
quit preparation to 4-weeks post quit. This will involve offering weekly support to individuals
committing to quit smoking from their quit date until they have been quit for 4-weeks or until
they relapse, if this is less than 4-weeks after the quit date. Support offered may be initially face
to face but can also include telephone support.
1.3.
Lot 3b: Supply of Nicotine Replacement Therapy (NRT)
The supply of NRT in accordance with the Protocol for direct supply of Nicotine Replacement
Therapy (NRT) by Competent non-Clinical Advisors of the Stop Smoking Service in Norfolk.
2. Service Structure/Levels/Definitions
2.1.
In this Specification the following expressions shall have the following meanings:
a) Level 1 = a clinicians responsibility to ask about smoking status, record the answer and
offer a referral for support to quit, if a desire to quit is expressed
b) Level 2 = 1:1 support sessions to help individuals quit smoking (offered by local clinicians
who have completed appropriate training)
c) Level 3 = group or 1:1 support sessions offered by the Specialist Stop Smoking Service
(clinics are held throughout the county. Contact the service for more local information)
d) Quit Date = the date that the client has committed to quit smoking
e) Monitoring Form = the form used to report activity on every person that sets a quit date
as part of this service (see sample in this schedule, Section 8)
f) A treated smoker = a smoker who has received at least 1 session of a structured, multisession intervention on or prior to the quit date with their advisor. Smokers who
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
participate in an assessment session but fail to attend for treatment shall not be counted
but those who have consented to a programme of treatment, attended their first session
and have set a quit date shall be included
g) A CO verified 4-week quitter = a self-reported quitter (who has set a quit date as above)
whose expired carbon monoxide (CO) reading is assessed 28 days from their quit date
(minus 3 days or plus 14 days) and whose CO is found to be less than 10ppm. The minus 3
or plus 14 day time range permitted for follow-up allows for cases where it is impossible
to carry out the follow-up at the normal 4-week time point, but in most cases it is
expected that follow-up will be carried out at 4 weeks from the quit date. This means that
follow-up must occur 25 to 42 days from the quit date. Clients whose follow-up dates all
fall outside this time range may not be counted.
h) CO reading attempted = an attempt to carry out CO verification should comprise a
minimum of 3 separate attempts to contact the client via telephone, text or e-mail in
order to arrange a face to face CO validation.
3.
Service Delivery
3.1.
Lot 3a: Stop Smoking Service Provision
3.1.1. The Provider shall conduct an initial assessment when a quit date will be set, treatment
options discussed (Nicotine Replacement Therapy (NRT), Bupropion (Zyban) or Varenicline
(Champix) if appropriate and the supply of treatment facilitated following Norfolk County
Council prescribing guidelines. It is mandatory for a Medical Assessment form (as supplied by
Stop Smoking Service) to be completed for each individual at the initial consultation.
3.1.2. There shall be a provision of a weekly contact preferably face to face (telephone contact will
suffice if face to face is impossible) when on-going behavioural support is given, carbon
monoxide levels are monitored and treatment effectiveness and compliance are discussed. A
face to face consultation should be the norm at the 4-week review which must take place 28
days from their quit date (minus 3 or plus 14 days).
3.1.3. The Provider shall conduct a review 4-weeks (28 days from quit date minus 3 or plus 14 days)
after the quit date when a carbon monoxide reading is taken, the monitoring form is
completed and the individual is congratulated if quit. Arrangements for the remaining course
of treatment shall also be made, but are dependent on the individual remaining quit. If the CO
reading is less than 10ppm this is a CO verified quitter.
3.1.4. Carbon monoxide validation of self-reported quits at 4 weeks shall be attempted in at least
85% of cases. Attempted means at least 3 separate attempts to contact the client via
telephone, text or e-mail in order to arrange a face to face CO validation. A written record
shall be made of these attempts.
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
3.1.5. The Provider shall complete (and if applicable return) a monitoring form for every person that
sets a quit date regardless of outcome. The monitoring form includes patient consent for the
transfer of data; the first page should be completed and signed by the individual who is
quitting smoking.
3.2.
Lot 3b: Supply of Nicotine Replacement Therapy (NRT)
3.2.1 The Provider shall supply the appropriate NRT product in accordance with the directions of the
level 3 advisor or appropriate senior clinical staff trained to issue NRT.
3.2.2 The Commissioner approved Prescribing Protocol shall be followed as detailed in this schedule,
Section 8.
3.3.
Delivery Model and Accessibility
3.3.1. Delivery Model:
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
3.3.2. Accessibility:
The service shall be aimed at smokers who are motivated to quit and for whom the Authority
is the responsible commissioner. Smokers who have medical conditions outlined in the
Prescribing Protocol will require a medical assessment prior to the commencement of giving
up smoking.
3.4.
Pathway diagram
3.4.1. Lot 3a Stop Smoking Service Provision:
Lot 3a Stop Smoking
Service Provision.docx
3.4.2. Lot 3b Supply of Nicotine Replacement Therapy (NRT)
Lot 3b Supply of
Nicotine Replacement Therapy Clinical Care Pathway.docx
3.5.
Accreditation, training and development specific to Lot 3a Stop Smoking Service Provision
3.5.1. Staff delivering Lot 3a (Stop Smoking Service Provision) must be appropriately qualified for
their level of responsibility. They must have completed an accredited level 2 stop smoking
service training that is approved by the Authority, and then logged with the Authority as a
level 2 advisor. Training is provided free of charge by the Authority.
3.5.2. All Qualified Providers delivering services for Lot 3a Stop Smoking Service Provision shall have
clinical senior staff who:

Shall have completed the NCSCT Very Brief Advice Online Training and attended the
specialist level 2 training meetings run by the Specialist Stop Smoking Service
OR

Shall have completed the NCSCT Level 2 and 3 Assessment Training
OR

Shall have completed the distance learning CPPE module and attended the specialist level
2 training meetings run by the Specialist Stop Smoking Service
OR
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b

Shall have attended the Specialist Stop Smoking Service 2 day Level 2 multidisciplinary
training or another Level 2 smoking cessation training recognised by the Authority.
3.5.3. All Healthcare Assistants counter staff or equivalent involved in the delivery of a Level 2 Stop
Smoking Service shall:

Attend the Specialist Stop Smoking Service 2 day Level 2 multidisciplinary training or
another Level 2 smoking cessation training recognised by the Authority.
AND

Have professional supervision from appropriate clinical senior staff (who will have
completed the NCSCT Very Brief Advice Online Training as a minimum requirement).
3.5.4. All Providers shall arrange include an assurance visit from the Stop Smoking Service on
completion of training.
3.5.5. Each trained member of staff will take responsibility for providing the service and the supply
of nicotine replacement therapy. If the Provider is supplying a Pharmacy Only NRT product the
appropriate clinical senior staff (in charge must supervise the supply.
3.5.6. The advisor shall be trained to use the Stop Smoking Service database.
3.5.7. Within 6 months of training, advisors must complete the NCSCT online accreditation.
3.5.8. Once trained, attendance at an update session must take place once a year whilst the advisor
is active.
3.5.9.
Where it is determined that pharmacotherapy is appropriate to support a service users
quit attempt, supply of, or facilitation of access to, this will form part of the service
provided.
3.5.10.
The Provider shall adhere to the prescribing protocols approved by the commissioner.
3.5.11.
It is mandatory for a Medical Assessment form (as supplied by Stop Smoking Service) to
be completed for each individual at the initial consultation.
3.5.12.
The Provider will ensure that CO monitors are used and regularly maintained and
calibrated to ensure accuracy of readings. The Specialist Service will provide calibration
support.
3.5.13.
The Authority will identify and work with Providers who fail to achieve the minimum
accepted quit success and/or CO validation rates (see this schedule, Section 5). Support
will be offered to Providers with the aim to improve their rates to an acceptable level, but
in exceptional circumstances the Authority reserves the right to withhold payment to
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
Providers who repeatedly fail to achieve the required standard and may terminate this
Contract as set out in Schedule 1, Clause 21.
3.6.
Accreditation, training and development specific to Lot 3b Supply of Nicotine Replacement
Therapy (NRT)
3.6.1 All Qualified Providers delivering services for Lot 3b Supply of Nicotine Replacement Therapy
(NRT):

Shall have completed the NCSCT Very Brief Advice Online Training
OR

Shall have completed the distance learning CPPE module.
3.6.2. All training shall include an assurance visit from the Stop Smoking Service.
4.
Key Service Outcomes (including patient experience)
4.1.
At the beginning of the monitoring year (1st April) each Provider will be assigned a quit target
based on client/patient list size or if not possible a locally determined target. The target will
cover that monitoring year. Payment will only be given for a successful 4-week quit identified by
the entry of the outcome onto the Service Database.
5.
Quality Standards
5.1.
Quality standards will be applied to the service provided and monitored to assure the Authority
of the standard of service provision. The Provider may be requested to demonstrate its
processes to assure such governance practices at any time.
5.2.
Providers shall comply with the relevant guidance from The National Institute of Health and
Clinical Excellence (NICE), Department of Health, National Centre for Smoking Cessation and
Training (NCSCT) and any guidance/protocol issued by the Commissioner.
5.3.
Quality of service provision will be monitored using nationally recognised key performance
indicators:
5.3.1. Success rate: The proportion of those setting a quit date and successfully quit at 4 weeks will fall
between 35% and 70% (taking into account challenging client groups). The expected average
success rate is 50%. Providers falling below the 50% average will be contacted and offered
support and guidance by the Specialist Stop Smoking Service.
5.3.2. CO verification: At least 85% of quits shall be verified by Carbon Monoxide monitor.
5.3.3. Lost to Follow Up: An outcome of a quit attempt will be recorded in at least 85% of all cases.
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
5.3.4. Occupation “Unable to Code”: The number of clients setting a quit date with an occupation
recorded as “unable to code” shall not exceed 10%.
5.4.
Records made in relation to the delivery of this service shall be kept for a period of 2 years to
allow for possible audit.
6. Links to other Services and Agencies
6.1.
The Provider will be particularly interdependent on Specialist Stop Smoking Services, operating
within the Integrated Service Framework Model as detailed in this schedule, Section 3.3.1.
Specialist Services are commissioned by the Authority to offer training, mentorship, guidance,
service co-ordination and data entry (where appropriate).
6.2.
Patients who require elective surgery should be routinely asked to quit (Stop before your Op) as
this reduces surgical complications. The expected date of surgery must be made note of on the
monitoring form. Those patients with complex needs ie tried to quit many times before without
success should be referred on to the Level 3 service.
6.3.
The Provider shall develop an awareness and network of associated Health, local Voluntary and
Community Sector Providers.
6.4.
Service Promotion: The Provider shall link into and make use of “Norfolk’s Living Well”, the
Authority’s Public Health Engagement Initiative. As NLW is public facing, the Provider shall
ensure that all details relating to their service are up to date. The Provider shall also support
national regional and local campaigns as required by the Authority.
7.
Activity Monitoring
7.1.
All quit attempts regardless of outcome shall either be entered onto the Commissioner approved
Service database or returned on a monitor form to the stop smoking service as soon as the 4
week review is completed and following the schedule of dates (see this schedule, Section 8).
7.2.
There will be monitoring meetings between the Service Provider and the Commissioner as
required. If considered appropriate by both the Provider and the Authority, telephone
conversations may suffice.
8.
Service Documents
8.1.
Service Monitoring Form:
[TO BE INSERTED]
8.2.
Service Monitoring Guidance:
[TO BE INSERTED]
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Schedule 2
Public Health Primary Care Contracts
Service Specification Lot 3a & Lot 3b
8.3.
Protocol for direct supply of Nicotine Replacement Therapy (NRT) by Competent non-Clinical
Advisors of the Stop Smoking Service in Norfolk:
[TO BE INSERTED]
8.4.
Medical Assessment Form:
[TO BE INSERTED]
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