Smoking cessation services have been among the worst affected by cuts to public health budgets, but pharmacy still has a vital role to play in supporting patients to quit. Rachel Carter reports.
Key learning points
‘Public health cuts’
Smoking cessation is one of the local services most frequently commissioned from community pharmacies, according to the Pharmaceutical Services Negotiating Committee (PSNC), but they are also under increasing threat.
Since 2015, public health budgets have been slashed by central government and councils have been forced to cut spending on services, with smoking cessation among the worst affected. An analysis of council spending, published by the King’s Fund last year, showed that stop smoking services faced a cut of £16m in 2017-18.
A spokesperson for PSNC’s services team tells The Pharmacist that the squeeze on budgets is having a ‘detrimental impact’ on public health provision, including that provided by pharmacy teams and the organisation has seen a rise in the number of smoking cessation services decommissioned in the past year.
However, community pharmacists remain an ‘established’ and ‘trusted’ provider of stop smoking services, the spokesperson adds, and pharmacies provide an accessible setting where staff are well-placed to provide interventions on quitting smoking and increase access to smoking cessation products for patients.
‘Beef up the business case’
So how can community pharmacists make this service work in the current climate?
Mike Holden, principal associate at training and consultancy firm Pharmacy Complete, says some commissioning of this type of service should remain, but there’s ‘no point pleading for it to be a national service’, because public health money is devolved. Instead, pharmacists need to ‘beef up’ the business case locally.
He adds that there is scope for smoking cessation to be a private service, similar to the way flu jabs are offered to patients who fall outside the eligible groups.
‘Flu is commissioned nationally, which is great, but the opportunity to provide a private service is there and a lot of people take that up,’ he says.
‘So if you put the competencies and service process in place, and the clinical governance that underpins that, then why not offer it [smoking cessation] on a private basis? Why wait for someone to be eligible under a commissioned service?’
‘Consider the local market’
Whether pharmacists go down the private route, or approach a commissioner to bid for a service, there needs to be a local market, Mr Holden says.
He says pharmacists can do their research by checking out their local area’s Joint Strategic Needs Assessment and by using Fingertips, a Public Health England (PHE) website, which provides a four-page health profile of the health needs locally.
Hazel Cheeseman, director of policy at the Action on Smoking and Health (ASH) charity, adds that the ‘contracting provision elsewhere in the system’ has made the provision of smoking cessation services through pharmacy ‘all the more important’.
‘Local authorities are less likely to be funding services that are available to everybody and for some reason, GPs seem to be following suit,’ she says.
‘So in the context of there being fewer options available for smokers in many communities, it is really vital that there continue to be pharmacy-based services.’
‘The role pharmacy can play’
One of the advantages of providing a smoking cessation service in a pharmacy, Ms Cheeseman adds, is the flexibility and immediacy this type of setting offers.
‘Pharmacies are on the high street, they are open at times convenient for people who work, so they are a really accessible location for lots of smokers,’ she says.
But she adds that it’s more difficult for pharmacies to offer ‘a real level of expertise’, because while they may be trained in smoking cessation, it’s not their primary job.
‘So there’s a balance to be struck between making sure we’ve got services that meet the needs of smokers who need something accessible and convenient, but also more specialist services for those who might need additional support.’
Undertaking adequate training and providing access to a range of nicotine replacement products are the most important factors for pharmacists to consider, Ms Cheeseman adds, but it also helps if they can actively engage with patients – ‘particularly those groups that might be quite amenable to quitting smoking’.
‘People with respiratory or heart conditions, new parents, pregnant women – these are all populations where this is a strong motivation to make a quit attempt,’ she says.
‘You can’t offer the support unless you know which of your patients are smokers, so thinking about those populations and being able to identify them is important.’
Free training is available for pharmacists through the National Centre for Smoking Cessation and Training (NCSCT), and is focused on providing the core knowledge and skills to deliver effective behavioural support to patients who want to quit.
Laura Reed, patient services manager at Numark, says this training can largely be completed online now, but she recommends undertaking a face-to-face training where possible, because it gives an opportunity to put those skills into practice.
The main thing about delivering this type of service, Ms Reed adds, is knowing how to have those conversations with the patient – because ‘you are trying to create a behavioural change in them, taking them away from the reliance on smoking’.
‘There will be times when they come and they’ve had relapses or they are feeling a bit down, so a lot of the work you do in the consultation will be around coaching and motivating them to get through the next couple of weeks,’ she says.
‘So for me there’s nothing like role-play and being able put that into practice before you see the patient – and doing face-to-face training gives the opportunity for that.’
‘Equipment and marketing’
Pharmacists will also need to consider the costs of setting up this service.
Ms Reed says the biggest expense is a carbon monoxide monitor, which is needed to assess ‘whether or not the person is still smoking’. The upfront cost is usually around £100 – although some commissioners may loan one to you. The monitor will also need recalibrating every year, which costs in the region of £30-£40, she says.
Pharmacists opting to run the service privately will also need to pay the cost for a patient group direction for Champix, a medicine used to help reduce cravings and withdrawal symptoms. This is again around £30-40, Ms Reed says.
The other cost is marketing materials. As Ms Reed points out, ‘whenever you launch a new service, you’re going to want to make sure everyone knows about it’.
‘You need to think about leaflets, posters and getting in touch with the local GP practice – because they may not be offering stop smoking clinics,’ she says.
“But if they are asking patients if they smoke as part of their Quality Outcomes Framework (QOF) points and you’re somewhere they can refer to locally, then it just closes that loop and helps the GP.’
Another option is to contact local businesses, Ms Reed says, and let them know that you are offering a smoking cessation service that could be suitable for employees.
‘Quite often businesses will want to be seen to be providing health advice for their employees, so if they’ve got somewhere where they can signpost people for support on quitting smoking, then it helps them as well,’ she adds.