Q. Is every contractor expected to go live with the SCS from 10th March 2022?
No. The SCS is an Advanced service, so contractors are free to choose if they will provide the service and when they will start provision. At the time of launch, most contractors will be busy completing work for the Pharmacy Quality Scheme 2021/22 and subsequently winter-related workload is also likely to mean they may not immediately have time to implement the service. Contractors will also need to assess the likely number of referrals they might receive, which will include determining whether local hospitals have started to make referrals.

Q. Is provision of the SCS mandatory?
No. This is an Advanced service, so contractors are free to choose if they wish to provide the service.

Q. Can distance selling pharmacies provide the SCS?
Yes. A distance selling pharmacy (DSP) may provide Advanced services. The DSP must fully meet the requirements for the provision of the SCS, which includes the consultation room requirements.

Q. Do I need to update my pharmacy’s NHS website and Directory of Services (DoS) profile to say the pharmacy is now providing the SCS?
No. The pharmacy’s NHS website profile and the Directory of Services (DoS) profile do not need to be updated to indicate that the service is provided as this is not a service that patients or NHS 111 can refer themselves/patients into.

Q. Should we be advertising or promoting the SCS?
No. NHS trusts are responsible for recruiting patients when they are inpatients. The service should not be actively promoted to the public by contractors.

Q. Can I recruit patients for the SCS?
No, only patients referred from an NHS trust can be supported to quit smoking through this service.

Q. How do contractors sign up to provide the SCS?
Contractors can sign up to provide the service by completing a registration declaration on the NHS Business Services Authority’s (NHSBSA) Manage Your Service (MYS) portal.

Q. If there is not a local stop smoking service available in my area, who/what organisation should I signpost a patient to if they decline the referral, do not want to stop smoking now or are deemed not eligible to continue with the service as they have re-started smoking?
If a local stop smoking service is not available, patients should be signposted to the National Smokefree Helpline (0300 123 1044). Patients could also be advised about the Better Health quit smoking page, which includes information on getting daily email support, online communities and information on the National Smokefree Helpline.

Q. We are a DSP without a consultation room; can I provide the SCS to patients remotely via video conference/phone?
No. All contractors must have a consultation room that meets the requirements outlined in the service specification, even if they intend to offer remote consultations, when appropriate.

Q. If a pharmacy does not have a consultation room, but has access to an appropriate room during the week are they still ineligible for the service?
Yes. It is a requirement of the service specification for pharmacies to have a consultation room on the pharmacy premises which meets the requirements in the Terms of Service to provide the service.

 Q. My pharmacy has an exemption from NHS England and NHS Improvement on the requirement to have a consultation room. Can I therefore provide the service from a designated area in the pharmacy or outside my pharmacy?
No. It is a requirement of the service specification for pharmacies to have a consultation room which meets the requirements in the Terms of Service to provide the service.

Q. Why can only pharmacists provide the SCS?
Under current VAT rules, pharmaceutical services provided by other staff under the supervision of a pharmacist attract VAT, which will not be reimbursed as part of the service fee. Therefore, to start with, the service will only be provided by pharmacists as the associated fees are exempt from VAT. If changes to the VAT rules can be agreed between the Department of Health and Social Care, HM Revenue and Customs and HM Treasury, to ensure pharmaceutical services provided by other staff, but under pharmacist supervision are VAT exempt, the service will be modified to allow better use of skill mix.

Q. Can trainee pharmacists provide the SCS?
No, only pharmacists can provide the service.

Q. I am a qualified NCSCT stop smoking practitioner and I provide the locally commissioned stop smoking service from my pharmacy, but I am not a pharmacist. Can I provide the SCS?
No. Currently, only pharmacists who have completed the required training as stated in the service specification can provide the service.

Q. Will any equipment be provided to support the service?
The responsibility of purchasing equipment to provide the service sits with the contractor.

Q. What type of CO monitor should be used to provide the SCS?
Contractors must have a working carbon monoxide (CO) monitor, which is suitable for use with pregnant women, and meets the minimum technical specification for a CO monitor as listed in Appendix A of the service specification.

Q. How often does calibration of the equipment need to occur?
The calibration of the CO monitors used to provide the service should be conducted in line with the manufacturer’s instructions.

Q. Will NHS England and NHS Improvement cover the cost of procurement of an appropriate IT system to provide the service?
Procurement of IT systems to support the service is the responsibility of the contractor and the cost of this has been recognised in the funding for the service.

Q. Is there an IT system available to support the service?
Several IT system providers are understood to be developing IT systems to support the service and an application programming interface (API) to facilitate transfer of data into the NHSBSA’s MYS platform to support claims for payment. However, not all IT systems will be ready for when the service launches on 10th March 2022.

If a contractor’s preferred IT system is not ready when the service launches, contractors may need to provide the service and maintain their clinical records on paper, use alternative IT options available to them or consider not offering the service until the IT system is in place.

Q. Will patients be supplied with NRT from the hospital when they are discharged?
Yes. Patients will be discharged from hospital with an initial supply of NRT.

Q. How is the pharmacy notified of a referral?
The referral will be made using an electronic system via a secure electronic system or NHSmail following discharge from hospital.

Q. What is the minimum information which should be included in the hospital referral (the minimum dataset)?
Appendix C of the service specification lists the information (dataset) which should be included in the hospital referral.

Q. Can general practices refer patients to community pharmacies for the SCS?
No.

Q. Who should I contact at the referring hospital if I have questions about the referral?
The referral message should include contact details for the referring Tobacco Dependency Team, which you can use where you have a query.

Q. Can I provide consultations remotely?
Yes. The service can be provided remotely (via telephone, another live audio link or live video link) if agreed to be suitable by the patient and pharmacist; however, consideration should be given to the fact that the patient will not be able to receive a CO test and self-reported smoking status will need to be used instead.

Further information on remote consultations can be found on the PSNC website.

Q. Can I provide the SCS to a child (is there a minimum age for provision of the SCS)?
No. Children and adolescents under the age of 18 years are excluded from the service. The minimum age for provision of the service is 18 years.

Q. What should I do if a patient that has been referred for the SCS informs me that they have smoked in between leaving hospital and having their first SCS appointment?
If the patient has restarted smoking in the period between discharge and their first SCS appointment, but they clearly demonstrate that they are motivated to quit smoking then they can continue with the service.

The traditional definition of a four-week quit used for stop smoking service returns to the Department of Health and Social Care is ‘continuous abstinence from smoking from day 14 to the four-week follow-up point’. This means that occasional smoking is permitted in the first two weeks of the quit attempt, but it should not be interpreted clinically that this is a strategy that is encouraged. Better long-term results are obtained from abrupt cessation and adoption of the ‘not-a-puff’ rule.

It would be down to the pharmacist’s discretion whether the quit attempt should be restarted at week one or continued at the stage that the patient had reached. Consideration should be given to the level of smoking that has taken place and for how long they have restarted smoking. Patients with a clear commitment to stopping smoking who have had a slight lapse should be supported to continue where possible.

See the NCSCT The ‘Not-a-Puff’ rule Briefing for further information.

Q. How long should I continue to see a patient for under the SCS?
The full treatment period is 12 weeks from the patient’s quit date (this date should be provided by the NHS trust on the referral). Pharmacists should check what the patient’s defined quite date is to allow them to calculate how many weeks support the patient has received in hospital and then deduct that from the 12 weeks in order to work out how many weeks support can be provided under the SCS. For example, if a patient was in hospital for one week after their quit date, they could then receive 11 weeks of support from a pharmacy under the SCS.

Q. How do I provide the service to a patient if they are housebound?
Where a patient cannot attend the pharmacy for a consultation, for example, if they are housebound or convalescing following surgery, the consultation can be provided remotely (via telephone, another live audio link or live video link) if the patient and the pharmacist agree to this. The patient should ask a representative to collect their NRT on their behalf; contractors are not expected to deliver to patients as part of the SCS but should follow their usual practice to support patients in gaining access to medicines.

Q. Do I need to obtain consent to provide the SCS?
Yes. At the initial consultation, the service should be explained to the patient and verbal consent must be sought and recorded in the pharmacy’s clinical record for the service. This consent should cover the full provision of the service.

Q. Does patient consent need to be recorded on a signed consent form?
No. Verbal consent must be sought and recorded in the pharmacy’s clinical record for the service.

Q. Can the SCS be provided to a patient in a care home?
The service could be provided remotely (via telephone, another live audio link or live video link) if a patient was in a care home, but the pharmacist could not provide the service in the care home as the Directions only allow the SCS to be provided in a consultation room in the pharmacy or remotely (if this is agreed with the patient).

Q. Can the SCS be provided in a patient’s home?
No. The Directions only allow the SCS to be provided in a consultation room in the pharmacy or remotely (via telephone, another live audio link or live video link) if this is agreed with the patient.

Q. Can the patient change pharmacies and continue to receive the SCS from a different pharmacy, for example, if they are moving to a different area?
Yes. The patient’s care and data can be transferred to another pharmacy providing the service, with the patient’s consent. Once the pharmacy accepts the referral, the patient’s referral details should be forwarded via a secure electronic message.

The duration of treatment should still be limited to 12 weeks from the patient’s quit date. For example, if the patient received one week of support from the hospital and four weeks of support from the pharmacy who provided the service initially, the new pharmacy providing SCS could only provide up to seven weeks of support under the SCS.

Q. The patient has presented for an SCS consultation, but I do not have the NRT product that they have been receiving in stock. The patient would like to stay on the same product, can I refer the patient to another pharmacy providing SCS?
Yes. The patient’s care and data can be transferred to another pharmacy providing the service with the patient’s consent, if they confirm that they have the NRT product in stock. Once the pharmacy accepts the referral, the patient’s referral details should be forwarded via a secure electronic message.

The duration of treatment should still be limited to 12 weeks from the defined quit date. For example, if the patient received one week of support from the hospital and four weeks of support from the pharmacy who provided the service initially, the new pharmacy providing SCS could only provide up to seven weeks of support under the SCS.

Q. How frequently can I deliver consultations with patients?
Appointments should be offered at least fortnightly – NRT can only be supplied for a maximum of a 2-week period, therefore patients using NRT to support their quit attempt will usually have a consultation every two weeks. However, it is at the pharmacist’s discretion to increase this to weekly if they feel the patient requires additional support. This may be more appropriate at the beginning of service provision.

Q. How should we dispose of the CO monitor mouthpieces?
The patient should be asked to remove the mouthpiece and to place it in the clinical waste disposal bag (if there is no clinical waste facility, then it should be wrapped in a disposable carrier) before placing in the waste bin.

Q. Can the patient be supplied with more than one NRT product (combination NRT)?
Yes. The service allows for patients to be supplied with combination NRT, for example, combining a patch with a faster acting product). A maximum of two different products can be supplied per patient as combination NRT.

There is strong evidence that combination NRT (combining a patch with a faster acting product) is more effective in helping smokers quit than using just one form of NRT. Further information on combination NRT can be found in the NCSCT’s Briefing on combination NRT.

Q. Can the pharmacist change the product supplied by the NHS trust?
Yes. The pharmacist should discuss at the initial appointment if the treatment initiated in hospital is suitable and acceptable to the patient. If not, the pharmacist can provide any NRT products included in the list of NRT products as published in the Drug Tariff Determination for the SCS.

As part of the SCS, the suitability of NRT products should be reviewed at each subsequent appointment.

Q. A patient is discharged on a different brand of NRT patches to what I have in stock in my pharmacy. Can I change the patient onto a different brand with their agreement?
Yes, if the patient is in agreement, the pharmacist can change the brand of NRT supplied to the patient.

Q. If a patient is unsuccessful at their quit attempt while participating in the SCS and is discharged from the service, can we ask them if they would like to participate in the locally commissioned stop smoking service that we provide at our pharmacy?
If the patient meets the inclusion criteria for the locally commissioned stop smoking service, then yes the patient could be offered that service.

Q. What is the recommended retention period for the consultation records in this service?
A retention period has not been specified for the consultation records, so it would be for the contractor to decide on retention periods. Two years meets the requirements for post payment verification; however, a longer period may be required for clinical data records. This retention period is for the contractor to determine and should be in line with Records Management Code of Practice for Health and Social Care.

Q. Do I need to notify the patient’s GP if the patient is not contactable or advises that they no longer wish to access the service?
No. The patient’s GP only needs to be contacted about the outcome (if the patient has been successful or unsuccessful in their quit attempt) if the patient participates in the service.

Q. Do I need to notify the patient’s GP if the patient is unsuccessful at quitting through the SCS?
Yes. If the patient participates in the SCS then the patient’s GP should be notified of the outcome if the patient is successful or unsuccessful in their quit attempt.

Q. How does a pharmacy confirm the NHSmail address for a GP practice they do not usually communicate with?
Pharmacies can use the NHS Service Finder to look-up non-public email and non-public telephone numbers (where available) for general practices. Pharmacies should then confirm with the practice that the identified email address is a suitable as a secure email that they can be used to send notifications or referrals to.

Q. How often should claims be made for the service?
Claims must be made monthly and by the 5th of the month following completion of the service.

Q. In Appendix B of the service specification, which details the patient flow for the service, there is an optional week 16 appointment for CO monitoring to positively reinforce continued quit. Is there a payment associated with this appointment as I have already claimed my fee for the last consultation?
No. There is no payment associated with the optional week 16 appointment; however, the pharmacist and patient may decide this would be beneficial to support the patient’s quit attempt.

Q. If a pharmacist decides it is not appropriate to make a supply of NRT to the patient, can they still claim the consultation fee?
Yes. It is also important to remember where no items are supplied to the patient, that the reason for not making a supply is captured within the clinical record for the service.

Q. Where is the funding for the SCS coming from?
The set-up fee and consultation fees are being paid out of the community pharmacy global sum.

The NRT costs have been included as part of the Long Term Plan tobacco dependency financial commitments to each ICS. An element of this funding is intended to cover NRT costs once patients leave hospital and will therefore need to be made available for the SCS. NRT costs for the SCS will therefore be re-charged to each ICS (or lead CCG).

Q. How do I withdraw from provision of the service?
Contractors can withdraw from the service by providing one month’s notice and completing the Stop Smoking Advanced Service withdrawn from service form on the MYS application.