you to the most appropriate places for your learning and to other key resources. ... There is good evidence for the effe
CENTRE FOR PHARMACY POSTGRADUATE EDUCATION
Learning about stop smoking support
A CPPE guide
October 2016
Learning about stop smoking support – October 2016 edition
About this guide on stop smoking support The purpose of this guide is to support pharmacy professionals who want to learn how to provide high-quality support for people who want to stop smoking. The guide will signpost you to the most appropriate places for your learning and to other key resources. First you need to decide why you want to learn about stop smoking and what you want the outcome of your learning to be.
Do you want to be able to provide a high-quality service when selling stop smoking products in your pharmacy? Do you want to set up your own stop smoking service? Do you want to provide (or continue to provide) services as part of the NHS network of stop smoking services?
This is the October 2016 edition of this guide and supersedes all previous editions.
Why should you learn about stop smoking services? Smoking claims over 80,000 lives per year and the NHS spends over £2.7 billion a year treating smoking-related illnesses. The National Institute for Health and Care Excellence (NICE) has said that empowering people to stop smoking is the single most clinically and cost- effective preventative intervention that a healthcare professional can make to improve a patient’s quality of life and life expectancy.1 NICE quality standards set out markers of high-quality, cost-effective patient care for different diseases and conditions and support the government’s vision for an NHS focused on delivering the best outcomes for patients. The quality standard for chronic obstructive pulmonary disease (COPD) recommends that patients with COPD who smoke are regularly encouraged to stop and are offered the full range of evidence-based stop smoking support.2 There is good evidence for the effectiveness of pharmacy-based stop smoking services.3 In 2004, the government recognised the valuable role pharmacy teams can play in helping people to stop smoking by including a requirement in the community pharmacy contractual framework to provide opportunistic healthy lifestyle advice to people presenting prescriptions who smoke.4 In the 2010 public health White Paper, Healthy lives, healthy people: our strategy for public health in England, the government stated its intention to strengthen partnerships with community pharmacies to secure their support in campaigns to promote effective routes to quit smoking.5 The government’s five-year tobacco control plan, published in 2011, recognises the ongoing need to increase access to evidence-based support for people who are prepared to stop smoking.6 More recently the NHS five year forward view October 2014 states smoking is still the number one killer and there is an increase in the focus on pregnant women and those with mental health conditions.⁷
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Learning about stop smoking support – October 2016 edition
What learning do you need to undertake to provide commissioned stop smoking services? The National Centre for Smoking Cessation and Training (NCSCT) was established to help local stop smoking services in England to deliver effective evidence-based tobacco control programmes, and to provide training and assessment programmes to stop smoking practitioners and other healthcare professionals. For more information, see: www.ncsct.co.uk The NCSCT training and assessment programme has been developed for experienced professionals providing stop smoking services who want to update or improve their knowledge and skills, as well as those who wish to start providing the service. It is likely that in the future all providers of commissioned stop smoking services will need to gain NCSCT certification in order to be commissioned.
NCSCT practitioners' training and assessment programme The NCSCT practitioners' training and assessment programme must be accessed from the CPPE website and not directly via the NCSCT website. You can find them at: www.cppe.ac.uk/programmes/l/smoking-e-01/ When you register with the NCSCT you will be asked for the following information: name and contact details age and gender name of employer role and length of time in it profession
when training and update training was provided for your role in stop smoking services whether or not you take the lead on providing services to specific groups of smokers.
Once registered you need to work through the Stop smoking practitioner training and certification section and then when ready attempt the assessment of core knowledge and key practice skills (formerly known as the stage 1 & 2 assessment programme). The multiple choice assessment is 25 questions long, includes some skills-based videos and is timed at 90 minutes. If you have previously passed the stage 1 assessment then you'll be a u t o m a t i c a l l y offered a shorter multiple choice version (15 questions) of the old stage 2 assessment. The programme is estimated to take between six and eight hours to complete in total and can be undertaken in as many sittings as required. It covers the following areas:
smoking patterns in the population and in different socio-demographic groups effects of smoking and stopping smoking why people smoke and find it hard to stop effective and ineffective methods of stopping smoking and, most importantly how to deliver effective behavioural support for stopping smoking including how best to keep smokers motivated to stay off cigarettes, how to help them avoid and deal with urges to smoke, and how to help them choose and make best use of medications to aid the quit attempts. Page 3
Learning about stop smoking support – October 2016 edition
There is a pass mark of 70 percent. You can have multiple attempts at the assessment, but a period of three days needs to elapse between each attempt to give you time to extend your learning from the programme. The NCSCT Assessment of Core Knowledge and Practice Skills certification is available to all those who pass the online assessment.
CPPE offers a workshop called A CPPE workshop to support local public health services, which aims to help pharmacy professionals work towards full NCSCT certification by acquiring the knowledge, developing the skills and demonstrating the behaviours necessary to provide effective support for stop smoking services. NCSCT can also offer a two-day face-to-face training course on behavioural support. You are not required to attend a training course before taking the online assessment but it may help you develop and practise the skills you need. The NCSCT national training needs to be complemented by local training and for practitioners to be effective they must also, in addition to being NCSCT certified, observe an experienced practitioner before seeing clients, be observed themselves and receive regular support and supervision. They should also engage in continuing professional development activities and ensure that a minimum number of clients are seen a year to maintain their knowledge and skills.8 The NCSCT assessment of core knowledge and practice skills must be accessed from the CPPE website and not directly via the NCSCT website. You can access it at: www.cppe.ac.uk/programmes/l/smoking-e-01/ Once you have passed the assessment you can undertake additional specialist modules on smoking cessation in mental health, smoking cessation in pregnancy and the post-partum. The medication module was released in the spring of 2015 and includes video sessions of how to explain treatments. There is also advice on the use of e-cigarettes.
Is there a standard approach to stop smoking in England? Local stop smoking services need to provide a consistent, high-quality service. Performance across different services and between individual practitioners can be variable. Although interventions should be tailored to match the smoker, there is some benefit in having an evidence-based framework that forms the basis of all interventions. The NCSCT has evidence for the effectiveness of a range of behavioural change techniques (BCTs). These BCTs have been incorporated into an NCSCT Standard Treatment Programme that consists of six sessions: pre-quit, quit date and four post-quit sessions. Page 4
Learning about stop smoking support – October 2016 edition
The Standard Treatment Programme also acts as a guide to help practitioners structure the content of weekly, individual face-to-face interactions with smokers and gives examples of questions and phrases to use when undertaking interventions. You can learn more about the Standard Treatment Programme in this NCSCT document: www.ncsct.co.uk/shopdisp_a-standard-treatment-programme-for-smokingcessation.php (this document does carry a charge of £10 to access).
What else do you need to know if you are providing commissioned stop smoking services in England? You should be aware of the Public Health England/NCSCT 2014 guidance which provides an overview of the latest evidence relating to the commissioning, delivery and monitoring of stop smoking service to support effective local planning and delivery.9 It is essential that you read this document thoroughly if you are delivering stop smoking services as it sets out fundamental quality principles and includes evidence-based recommendations for interventions, the use of carbon monoxide monitoring and the provision of pharmacotherapy. This guidance recommends that all NICE-recommended treatments should be considered equally as first line, including varenicline and bupropion where appropriate. The guidance also supports the routine use of combination nicotine replacement therapy (NRT) products (more than one NRT product at a time). The guidance also details the priority target groups for smoking cessation, though you will need to check local target groups with your service commissioner. The priority groups include: routine and manual workers black and minority ethnic groups pregnant women smokers with a mental disorder children and young people those who have made previous attempts to quit. In January 2012 the government published a Public Health Outcomes Framework for England10 that describes the outcomes it wants to achieve and the indicators that will help it assess how well local providers of public health services are performing. There are three specific indicators for smoking within the ‘health improvement’ domain: smoking prevalence in 15 year olds, smoking prevalence in adults and smoking status at the time of delivery. In April 2013, local authorities became responsible for commissioning a range of interventions, including smoking cessation services. Local authorities use the Public Health Outcomes Framework, the local joint strategic needs assessment and the joint health and wellbeing strategy to inform commissioning decisions. You need to be aware of NICE public health guidance on smoking cessation, particularly the section on prescribing and advising on pharmacotherapies.11 You also need to be aware of guidance on stopping smoking in pregnancy and after childbirth. NICE guidance12 states that there is mixed evidence on the effectiveness of NRT in helping women to stop smoking during pregnancy and that it should be used only if smoking cessation without NRT fails. It also recommends that pregnant women using NRT patches should remove them before going to bed and that liquorice-flavoured products should be avoided. Page 5
Learning about stop smoking support – October 2016 edition
The Commission on Human Medicines13 states that while it is important to be clear that pregnant smokers should, where possible, try to stop smoking without the use of NRT, it is also recognised that NRT can increase the chances of a successful quit attempt. Evidence shows that that a combination of behavioural support from a stop smoking adviser and pharmacotherapy can increase a smoker’s chances of stopping by up to four times.14 Recent findings from the Smoking Toolkit Study show that purchasing NRT over the counter without behavioural support has no greater effect on success rates than stopping without the assistance of medicines or support.15
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