Robin Mitchell, superintendent pharmacist at Victoria Park Pharmacy in Dorchester, talks to Saša Janković about running community-based smoking cessation services.
Service type: Community-based smoking cessation services.
Name of pharmacy: Victoria Park Pharmacy, Dorchester.
Name of pharmacist: Robin Mitchell.
Why did you start offering this service?
We’ve been offering this service since at least 2013. There have been various changes to the scope since then, including the addition of ‘cut down to quit’ and ‘short-term abstinence’ services alongside the main ‘abrupt quit’ 12-week program.
We were looking to broaden our service offering in ways that would be of benefit to our patients and the community, ideally services that can be provided via a team approach. Plus of course smoking cessation services fit perfectly with Healthy Living Pharmacy objectives.
In a nutshell, what does the service involve?
Recruitment is mainly via word-of-mouth or referrals these days, and local public health teams provide radio promotions in support. We also run in-store promotions and identify patients – especially pregnant mums – for brief interventions. There’s plenty of scope for community outreach, though places like pubs and working men’s club require a tactful but forceful approach.
The main 12-week quit program involves an initial assessment, planning and counselling session, then follow-up appointments that tend to be more frequent in the first 4-6 weeks (weekly or 2-weekly), extending to 2-4 weeks apart depending on the chosen medication and client preferences. Exhaled carbon monoxide monitoring is an effective motivational tool that goes down well with many clients. Some will come in weekly for a ‘quick check’ (and some reinforcing encouragement).
Key (funded) milestones are recruitment, and recording a 4-week quit. Sadly, our commissioner has dropped the 12-week quit milestone as this is seen as a lessor priority for PHE nationally.
How much did it cost to set up the service?
The main effort in setting up the service was staff training, lots of online work and local training sessions (mostly online these days). Training should cover Safeguarding and a DBS check will be needed if not already done. We needed to purchase a CO monitor (and a backup is a good idea), calibration equipment, and consumables. We maintain a good stock of P and POM cessation products so that clients have a choice of options that will suit their preferences, and NRT medicines are stocked in the consultation room to facilitate advice and client choice.
What, if any, training did you or other team members have to undergo?
Staff providing the service must be trained practitioners, successfully completing the National Centre for Smoking Cessation Training’s Practitioner Training and Assessment Programme (available online at: http://elearning.ncsct.co.uk/england). Upon completion of the training, staff will be certified Stop Smoking Practitioners, and also attend local training as specified by the Commissioner – for us, local training is advertised on the Public Health Dorset website. Pharmacists also need to be able to operate under the PGD for varenicline (Champix) if that quit route is chosen.
Are there any opportunities to sell over the counter or prescription products during the consultation or after it?
Having smoking cessation expertise at hand certainly means we can advise on OTC purchases of NRT products, though our preference is to recruit into the service.
How have patients responded to the service?
Very positive. Clients love it when they are making progress, reach a significant milestone, or just start to feel healthier. Many clients report that their families are very happy too, which is a big motivator. Motivational coaching really works, and because we have four qualified practitioners, we can try to tailor to the client’s personality if needed. Patients appreciate candid feedback when needed, praise when appropriate, and an understanding approach if things go off the rails.
Roughly how often each month do you carry out the service?
Demand is seasonal and strongest in the new year. Normally, we might enrol 150 clients in the course of a year and see an average 6 to 12 appointments per week. Of course, we’ve had to adapt service provision to Covid conditions, but demand has been coming back to pre-Covid levels. We are now doing both face-to-face and telephone consultations, although no CO monitoring.
How much do you charge for the service?
The service is provided free to clients other than the standard NHS prescription charge for product if they are not exempt. Given the expensive price of some NRT products, clients have an incentive to enrol rather than purchase OTC.
Roughly how much a month do you make from offering the service?
This service is not a big money earner for us, but the income does significantly contribute to our wage bill, certainly covering the time required to run the service. The bigger value is as part of our portfolio of community services which enhances our reputation and encourages consultation and counter sales for minor ailments and other health needs.
Would you recommend offering this service to other contractors?
Working as a team has big benefits because maintaining access to the service at all times is important. The ability to discuss with colleagues, provide support, strategise service issues, and motivate the motivators really helps.
My advice would be to work with your local Public Health team to get the best outcomes for clients. Hopefully they will be supportive when opportunities arise that are not an exact fit to the service specification e.g., extending a course of varenicline beyond 12-weeks, or adapting to Covid conditions.
Also tap into the knowledge and resources of the pharma reps (while maintaining professional objectivity). They have up-to-date information; expert support for challenging clients with, for example, mental health issues, and can help with promotions.
Stay on top of NICE and NCST guidance for best practice. Generally, this encourages ‘can do’ ways rather than restricting options. And even if the service specification does not directly address all smoking cessation scenarios, it is important to be aware of developments in the field such as dealing with pregnancy, mental health, and e-cigarettes.
Encourage commissioners to adapt to client needs, budgets permitting; provide feedback to your LPC; and encourage referrals from GPs, social care orgs, and even your local hospital (discharge and pre-op needs).
Stay client-focused and ideally let them drive the key decisions. They often know what will work best for them if they are taken through the options, and if they are not committed to the program or their stated goals, step back to assess why and what adjustments are needed. Gathering feedback on the experience of using smoking cessation products can help you steer future clients.