Provision and background
The NHS Smoking Cessation Service (SCS) was launched as an Advanced service in England in spring 2022, following pilot schemes that ran in Oldham and South London. The service aims to reduce morbidity, mortality and health inequalities caused by smoking by bridging the gap between secondary and primary care. As such, only patients referred during discharge from an acute NHS trust are eligible, although the NHS Long Term Plan states that by March 2024, everyone admitted to hospital should be offered NHS-funded evidence-based smoking cessation support for 12 weeks, including follow-up after discharge. This is where the SCS fits in.
Patients should be referred to a pharmacy of their choice to receive continuing treatment, advice and support for their attempt to quit smoking. The SCS must be provided by an appropriately trained pharmacist/pharmacy technician who is able to provide medication and behavioural support.
According to data published by the Office for Health Improvement and Disparities, 12.7 per cent of adults in England were smokers in 2022, considerably higher than the 5 per cent rate needed to be regarded as “smoke-free”. Around 76,000 people in the UK die every year from smoking, with many more living with debilitating smoking-related illnesses.
The national dashboard for the SCS, provided by NHS Midlands and Lancashire Commissioning Support Unit, shows an uneven distribution across the country in terms of trusts that are ‘live’ with the referral service, those that are working towards going live and those of unknown status. The North West and South West regions appear to have the greatest proportion of trusts running the service.
Ten steps when setting up
Note that the service should not be actively promoted to the public by pharmacies, nor does the pharmacy need to update its NHS website profile — SCS referrals can only be made by NHS trusts.
An implementation checklist is available from Community Pharmacy England.
Follow established pathways to support quit attempt.
Check if referral has been receieved
If YES: provide SCS
If NO: Check patient has been discharged from an NHS trust, check which pharmacy they asked to be referred to, chase referral from NHS trust.
Offer date for initial consultation, ensuring the patient will not run out of NRT in the meantime.
Provide details of alternative stop smoking services for them to consider accessing in the future.
Notify NHS trust tobacco dependency team and close referral.
Funding and conditions of service
The following fees have been agreed for the service:
- Set-up fee of £1,000
- Initial consultation fee of £30
- Interim consultation fees of £10 each
- Final consultation fee of £40
- Reimbursement for products supplied.
Some conditions of service:
- The service must be provided from a consultation room that has IT equipment available to allow contemporaneous records to be made
- The service is intended to be provided face-to-face and while telephone or video consultations are allowed (for example, for a housebound patient), the service cannot be provided solely on a remote basis (i.e. by distance selling pharmacies)
- Patients must be 18 years or older and have started treatment for tobacco dependence in hospital. They must also have had a referral to continue their treatment in community pharmacy after discharge
- Pregnant women are not excluded (but there may be another relevant local service in place). Children and young people under the age of 18 years are not eligible
- Only products listed in the Drug Tariff determination are eligible for payment. Note that all are licensed nicotine replacement therapies and more than one can be supplied at a time (e.g. a patch plus gum). If patients wish to use vapes, these cannot be supplied as they are not licensed, but behavioural support can be provided
- The SCS is free of charge at the point of delivery, even to patients who would normally pay prescription charges
- SCS supplies of NRT should be entered on the patient medication record and labelled
- The final consultation can take place from and including the four-week review up until the 12-week review
- Patients can transfer to a different pharmacy, e.g. if they move house, as long as the patient’s referral details are sent via secure email
- If a pharmacy owner wishes to stop providing the SCS, they must give at least one month’s notice to NHS England and a reason for the decision. If this is within 30 days of registration, the set-up fee will be withheld or claimed back.
Case study: Rexall Pharmacy, Wolverhampton
Bal Dhariwal, pharmacist at Rexall Pharmacy in Wolverhampton, says the SCS has its challenges, including how the patients who are eligible for it are transferring from hospital to community. “Patients are expected to come to the pharmacy for supplies and CO testing, but for some that just isn’t practical – they might have limited mobility due to a stroke, for example. So be creative and think about how else you can provide the service. For instance, I might do a phone consultation with a patient then someone else collects their NRT or I send it out with our delivery driver.”
Everyone is different, so find out what will work best for them, says Bal. “Lots of people trying to give up smoking miss the hand- to-mouth action, but don’t necessarily like a nicotine inhalation device — so another form of NRT plus boiled sweets might work for them.”
That insight into your patients is invaluable, he says, pointing out that someone who has agreed to give up smoking when told to in hospital by a doctor is not necessarily going to feel the same way once they are back home.
“To make the Smoking Cessation Service work, you have to be a really positive communicator and good at motivating people. It’s about skills as well as knowledge. That said, you can tell when someone isn’t up for quitting, so have a frank conversation and don’t be scared to refuse the referral. Just explain to the customer that it is a waste of NHS money to provide NRT that they aren’t going to use.”