Solihull CT

Service Level Agreement forPharmacy Access Scheme to supply Nicotine Replacement

Therapy

SLA between:Service Provider:(Community Pharmacies in Solihull)

Commissioner:Solihull CT

Date of Development:August 2009Due for review:August 2010

Solihull LPC Endorsement:This Service Level Agreement was endorsed by Solihull Local PharmaceuticalCommittee on ……………………….

1. Purpose

1.1 This agreement enables Pharmacies to work in partnership with the Solihull Stop Smoking Service (SSSS) in order to: • Facilitate the accessibility and availability of Nicotine Replacement Therapy (NRT) within the community setting in accordance with Solihull Stop Smoking Service Protocol for the Supply of Nicotine Replacement Therapy (NRT)

1.2 The SSSS currently supports a number of pharmacies to deliver an enhanced Stop Smoking Service whereby pharmacists may offer a comprehensive stop smoking service.  This access scheme is in addition to the full stop smoking service currently offered by some of our pharmacies to support the Solihull Stop Smoking Service Protocol for the Supply of Nicotine Replacement Therapy (NRT) 1 The vouchers will be redeemable at local participating pharmacies across Solihull.

1.3 Pharmacies are ideally placed to advise people on how to stop smoking and/or to facilitate the supply of Nicotine Replacement Therapy (NRT).  The contribution pharmacists can make to improving the health of the population has been recognised in ‘A vision for pharmacy in the new NHS’  (DH, 2003)

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and is supported by ‘Choosing health through pharmacy:  a programme for pharmaceutical public health 2005-2015’  (DH 2005)

1.4 Tobacco use is the single biggest cause of premature death, killing over 84,000 people in the UK every year.  In Solihull, smoking is responsible for the deaths of around 305 people per year.

2. The contract price and payment method

2.1 NRT will be reimbursed at agreed drug tariff price + VAT at 5% (see enclosed invoice sheet) + supply fee of £2 for each 2 weeks worth of NRT product Appendix 1, NRT Supply Recommendation form). 2.1.1 Contributions made by the client (i.e. prescription charges) will be deducted from the final payment.

2.1.2 The drug tariff price has been agreed until April 2010 when it will be reviewed.

E.G. if drug tariff is £10 :-

2.1.3. Patient who is exempt from prescription charge will not pay, therefore invoice to SSSS will be £10 x 12 weeks + handling charge of £2.00 x 6 = £132.00

2.1.4. Patient who pays prescription charge: pays 6 x £7.20p to the pharmacy* 12 weeks of NRT = £120 6 x £2 handling charge = £12

Total £132.00 (-6 x 7.20p = £43.20) £43.20 Total to claim £82.80 (due to pharmacy retaining prescription charge).

* = assuming this is current prescription charge 2.1.5 Patient who is advised to use combination therapy will be required to pay two prescription charges. Pharmacists can claim for 2 x handling fee in these instances.

Per voucher with combination therapy patient will pay 2 x £7.20 to the pharmacy*2 weeks worth of NRT at £9.97 = £19.942 weeks worth of NRT at £8.89 = £17.78

Total = £37.722 x £2 handling charge = £4

£41.72(-2 x £7.20 = £14.40) -£14.40Total to claim £25.32 (due to pharmacy retaining prescription charge x 2).

* = assuming this is current prescription charge

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2.2 In order for payment to be facilitated as swiftly as possible, all paperwork (i.e. NRT Supply Request forms) collected, will need to be returned on a monthly basis in supplied envelopes from Solihull Stop Smoking Service. 2.4 Payments will be generated following an agreed process on the basis of information submitted by the Solihull Stop Smoking Service to the Care Trust. 2.5 If and when the CT introduce an IT based claim system and community pharmacies will be trained and expected to use once it is available.

2.6 The provider will be responsible for financing other operational aspects of the service from within the agreed payment value. This will include all telephone costs, stationary costs and miscellaneous costs associated with the delivery of the service. Postage costs will be supported from the Stop smoking service.

2.7 Details of support materials available from the Solihull Stop Smoking service will be made available to pharmacy providers.

2.8 An initial £50 will be paid to each pharmacy when signing up to the scheme in June 2010.

3. Parties to the Contract

3.1 The Contract is between the Commissioners namely, Solihull CT and the providers who will be designated primary care providers located within theSolihull CT area.

3.2 Pharmacy Contractors must be compliant with all other Essential Services in the Pharmacy contract.

3.3 Please note that a copy of this SLA must be signed and returned toAlison Trout , Tobacco Control & Stop Smoking Services Manager, Solihull CT, 6th Floor, Mell House, 46, Drury Lane, Solihull, B91 3BU.Payments for services will not be made until this SLA has be signed &returned.

4. Quality Indicators

4.1 The pharmacy has appropriate Care Trust provided health promotion material available for the user group and promotes its uptake.4.2 The pharmacy contractor or a designated deputy must attend training provided by the Care Trust before the service is provided.

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4.2 The pharmacy contractor or a designated deputy has a duty to ensure that pharmacists and staff involved in the provision of the service are aware of and operate within the local protocols.4.3 The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken continuing professional development/training relevant to this service.4.4 The pharmacy should maintain appropriate records to ensure effective ongoing audit.4.5 The pharmacy participates in an annual Care Trust organised audit of service provision if requested to do so.4.6 The pharmacy co-operates with any locally agreed Care Trust-led assessment of service user experience

5. Term of the Contract

5.1 The Contract shall commence with effect from the date signed on behalf of the provider and will continue until further notice, or otherwise as provided for in Clause 7 (Termination)

6. Service to be Provided

6.1 The “voucher” is intended to maintain patient motivation to stop smoking by providing access to medication in a safe and timely manner from a qualified healthcare professional using the existing network of community pharmacies. 6.2 This scheme will enable participating pharmacies to supply NRT to those clients who are currently enrolled in the Solihull Stop Smoking Service, upon receipt of an NRT supply recommendation form (Appendix 1). 6.3 Following a consultation with the Specialist Stop Smoking Advisor, clients will be given a ‘Solihull Stop Smoking NRT Supply Recommendation Form’ voucher (Appendix 1) stating the type, dose and frequency of NRT, which will be signed by the Named Stop Smoking Advisor included in the SSSS Protocol 1. The pharmacist will be asked to supply NRT based on the recommendation. 6.4 Vouchers will be redeemable at any pharmacy across Solihull involved in the scheme. Clients will not have to attend the same pharmacy to redeem subsequent vouchers in the same course, although it may be recommended for consistency. 6.5 Solihull Stop Smoking Advisors will screen the clients at their appointment or group session to assess nicotine dependency, motivation and readiness to quit smoking. Each Stop Smoking Advisor will have discussed all available NRT products with the client. A risk assessment will have been carried out to ensure there

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are no contra-indications for use of NRT and the type, dose and quantity of NRT to be supplied will be written on the voucher.

6.6 If there is no preference for a particular brand of NRT this part will be left blank.

6.7 The use of the chosen NRT product will have been completed by the Stop Smoking Advisor and should be reinforced by staff on supply at the pharmacy. 6.8 In line with NICE guidance, NRT should be supplied on a 2 weekly basis. It will not be common practice to recommend more than 2 weeks supply of NRT, however exceptions may be applicable in some conditions for example to allow for holidays, the standard 2-week supply may be exceeded on a discretional basis if specialist advisors are confident that diversion or wastage will not occur. If a request is made for 2 types of NRT in combination for 2 weeks supply pharmacists will receive £2 for each 2 weeks of an NRT product so pharmacists will receive £4 for a 2 week voucher with 2 products to use in combination. If a request is made for 4 weeks of NRT pharmacists will receive £2 for every 2 weeks issued so will receive £4 for a 4 week voucher, Once the client has received 8 weeks worth of Nicotine replacement it may be appropriate to continue treatment to 12 weeks as recommended on product licence. In this instance a further 2 or 4 week supply request may be made. The maximum supply will be 12 weeks of NRT per client. 6.9 Vouchers will be valid for 14 days from the issue date.

6.10 One week after ‘quit day’ the client will be issued with a voucher for a further 2 weeks. 4 weeks after ‘quit day’ the client will be assessed by the Specialist Stop Smoking Advisor for abstinence from smoking using a CO monitor. If there is evidence they are still smoking, no further vouchers will be issued. 6.11 If their abstinence is verified, vouchers to complete the course will be issued. 6.12 Thus a client will typically present four vouchers for an 8 week course or 6 for a complete 12 week course of treatment where the maximum duration of any voucher will be two weeks. If a client presents four vouchers for 8 weeks of NRT and the last 4 weeks is requested from one voucher this will mean they typically present with 5 vouchers and the final 4 week voucher will be redeemable at £4.00.

6.13 The advisor completes the first part of the voucher. At the pharmacy the remainder of the voucher is completed (including

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prescription exemption information, which will help evaluate the scheme), and voucher is retained. The third part of the voucher is returned to the service along with the monthly summary sheet for payment. The second part is retained by the pharmacist. 6.14 At the end of each month the pharmacy returns the summary sheet plus copies of the third part of the voucher to the Stop Smoking Service. 6.15 Clients receiving NRT under this ‘scheme’ will be asked to pay a £7.20 fee (unless exempt from normal prescription charges). If paid, the Pharmacist should retain this charge and it will be recorded on the ‘NRT Supply Recommendation Form’ voucher. Please note: • Supply of NRT under this agreement will not replace FP10 prescriptions • The supply of NRT through this project will supplement current prescribing through the GP route

6.16 LABELLING – All NRT products supplied must be recorded on thePharmacy’s patient medication record (PMR) system and have a PMR generated label affixed, including the date, patient’s name and directions for use.

7. Human Resources

7.1 All accredited staff who undertake the Service must have the full support of their employers or management where appropriate.

8. Termination

8.1 Either party may elect to terminate this Contract early by giving 14 days written notice to the other.

8.2 In the event that this agreement is terminated early in accordance with clause 7.1 the provider agrees to complete all Service obligations with existingclients.

8.3 Notwithstanding anything in the Contract, Solihull CT may terminate this contract or any part of it immediately upon written notice to the provider if:a. The provider commits an irremediable material breech of this Contractand/orb. The provider having committed a remedial material breach of this Contract,

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shall neglect or otherwise fail to remedy such breach within such areasonable time as shall be specified after being required in writing to doso by Solihull CT, or repeats such remedial breach within the timeallowed to remedy the original breach; and/orc. The provider commits persistent minor breaches of this Contract

9 Confidential Information and Data Protection

9.1 The provider or accredited staff shall not disclose or allow to be disclosed to any person (except on a confidential basis when seeking professional advice) any information of a confidential nature in the course of carrying out their duties under this agreement, except as may be required by law or as directed by the Solihull CT.

9.2 The provider must store and retain personal data in accordance with theprinciples and provisions of the Data Protection Act legislation and mustensure the reliability of staff and where appropriate, the accredited staff, whohave access to such data.

10 Arbitration and Notice

10.1 This Contract is binding to both provider and purchaser. In the event of noncompliance with the terms of this agreement on the part of either party, ameeting will be instigated within two weeks to attempt to resolve the matter.

10.2 Any notice to be served by either party on another pursuant to this agreement shall be sent in writing to the other party. Except in urgent cases, a minimum of 14 days notice will be given.

References:

1. Trout, A. (2009) Coventry Stop Smoking Service Protocol for the Supply of Nicotine Replacement Therapy (NRT). Solihull Stop Smoking Service. Solihull NHS Care Trust

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PHARMACIST PROTOCOL FOR REDEMPTION OF NRT VOUCHERSJune 2009

Only pharmacies registered with this Pharmacy Access Scheme to supply Nicotine Replacement Therapy can redeem NRT vouchers on behalf of Solihull Stop Smoking Service. Registered pharmacies will agree to:

Follow the protocol in redeeming NRT vouchers. Each voucher relates to two week’s supply of NRT

Ensure all counter staff have an overview of the NRT voucher scheme and how it operates

Stock all Nicotine Replacement Therapy products: patches (16 and 24 hour), gum, inhalator, nasal spray, lozenge and microtab

Role of Solihull Stop Smoking Advisor

Prior to a client presenting an NRT voucher to a pharmacist, they will have had at least one contact with a Solihull Stop Smoking Service Advisor or trained associate Advisor.

The client will have: Been assessed as motivated to stop smoking Been risk assessed to ensure there are no contra-indications to the use of

NRT Chosen to stop smoking with support Agreed to commit to a programme of stop smoking support Discussed their smoking habit with the stop smoking advisor and had NRT

identified as an appropriate treatment Received information relating to NRT and the types of product available Provided proof that they are aged 12 or above Received information outlining the names of participating community

pharmacies within which the voucher can be redeemed

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Given informed consent to provide information for monitoring purposes, which will be stored on a computer

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Guide to dealing with client

Always treat clients with respect and maintain their confidentiality at all times.

1. All clients requesting NRT will present a voucher to the pharmacy. The NRT voucher is a 3-part carbonated document (see Appendix 1); with 2 parts presented by the client to the pharmacist (the other part will be retained by the client’s advisor for client record).

2. The pharmacist should advise the client to use the NRT as directed by the Stop Smoking Advisor.

3. Check it is being presented within 14 days of issue. (If it is not then the client should be advised to return to the advisor, the voucher retained and marked invalid. It should then be submitted to Solihull Stop Smoking Service with the other vouchers).

4. Ask if the NRT is for the clientIf NO - do not redeem the voucher (except in extenuating circumstances)If YES - check the voucher has been signed by a Stop Smoking Advisor.

5. Check eligibility for free NRT by confirming prescription exemption or collect the current prescription charge in the usual way for those that pay (a single prescription charge should be collected for single therapy and an additional prescription charge should be collected for dual NRT therapy).

6. Ask the client to sign the voucher

7. Check if the client has any contraindications to NRT and is therefore excluded. If the client is contraindicated and is not suitable for NRT, retain the voucher, draw a line through it and write the word ‘INVALID’ across it. Submit the invalid voucher in the usual way

8. Check whether the client is taking any medication, including over the counter and herbal remedies, that may interact with the NRT product and advise as appropriate.

9. Select the product(s) . The voucher will indicate the product(s) to supply. The supply should be recorded on the patient medication record and a dispensing label affixed to the NRT with the directions on the NRT voucher. If there are no directions on the NRT voucher then the directions should state “Use as directed by the stop smoking adviser”

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10. The bar code should be marked with “NHS” with a pen to avoid un-authorised return.

11. Stamp and sign the voucher . Write the date NRT product(s) is issued on the voucher.

12. Ask if the client has any questions and advise as appropriate.

13. Thank the client for their custom and remind them that they will need to remain in contact with their Stop Smoking Advisor to receive subsequent vouchers.

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Voucher processing

1. The top copy of the voucher should be retained by the Pharmacist and all other copies submitted to Solihull Stop Smoking Service on a monthly basis

2. All copies of vouchers should be returned by the 8th day of the month following issue to Solihull Stop Smoking Service, 6th. Floor, Mell House, 46, Drury Lane, Solihull, B91 3BU together with a completed copy of the pharmacy claim form (Appendix 2).

3. The NRT will be reimbursed at cost price plus VAT, together with a handling fee (currently £2.00).

4. If the vouchers are received after this date payment will not be processed until the following month. Payment will be made on a monthly basis in arrears by the third Monday of the month. Payment for vouchers cannot be made until they have been completed correctly. Reimbursement for incorrectly completed vouchers will not be made, with the vouchers returned for amendment. If you have any queries with regard to completing the forms, please contact the Solihull Stop Smoking Service on 0121 712 8333.

5. An audit of vouchers submitted for payment for each pharmacy will be made at least twice per year. The audit will be undertaken by Solihull Stop Smoking service staff.

If a pharmacy is found to have over claimed, the CT will adjust all previous claims since the previous audit by the same proportion

If a pharmacy has under claimed, the CT will pay an amended amount for this claim, but this will not be backdated to previous months

Any suspicions with respect to claims made will be referred by NHS Fraud Authority

6. Retain one copy of the voucher as proof of handling (for audit purposes) for at least 12 months. To maintain quality standards and comply with audit guidelines, vouchers will be verified against client use.

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Solihull Stop Smoking Service

Service Level Agreement for Solihull Stop Smoking Service, Pharmacy Access Scheme to Supply Nicotine Replacement

Therapy

PHARMACY REGISTRATION FORMI have read the Protocol and SLA on the Solihull Stop Smoking Service and understand how the NRT Access Scheme operates.

We undertake to meet the requirements laid out in the SLA.

Solihull CT will review the SLA annually or at any other time if required

I understand that Solihull CT and I have the right to withdraw this Service Level agreement if the requirements are not being met, giving 14 days written notice. I will be obligated to complete all contacts underway.

I undertake to ensure that the counter staff in my pharmacy, have an overview of the Solihull Stop Smoking Service, the NRT Scheme and how it operates.

I have read and have kept a copy of the NRT Scheme – Pharmacist Protocol dated June 2009.

We undertake to redeem NRT vouchers on behalf of the Solihull Stop Smoking Service in accordance with the above protocol.

We undertake to dispose of retained vouchers in an appropriate manner after 12 months

Pharmacist’s name (please print)

Pharmacy address (please print)

Authorised Signature

Position ________________________________

For and on behalf of: ________________________ (Pharmacy Company)

Date

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Appendix 1 - NRT Supply Recommendation Form

Solihull Stop Smoking ServiceThis voucher entitles the named patient or their representative to obtain 2 weeks / 4 weeks (delete as appropriate) supply of NRT at named pharmacies Voucher no: __________________Section 1: To be completed and signed by Stop Smoking Advisor Client Name: ___________________ GP practice: __________________________________Client Address: ____________________________________________________________Postcode: ____________________D.O.B : _______________ Pregnant: Yes / No

Nicotine Replacement Therapy Primary product Combination product (if appropriate)

Type of NRT:

Brand:Strength:Pack size & number of packs:

Signature of advisor:…………………………… Date: …………………………..Section 2: Client details: (to be completed by the client)

To obtain your NRT this voucher should be produced at a participating pharmacy within 14 days of issue.

I have paid prescription charge of: I have paid additional prescription charge for combination product of:

(Two prescription charges are required for two products used in combination). I do not have to pay a prescription charge for the current course of NRT because:

I am under 16 years of age I am 16, 17 or 18 in full-time education I am 60 years of age or over I have a valid maternity exemption certificate I have a medical exemption certificate I get income support I have a valid prescription pre-payment certificate I have a valid War Pension exemption certificate I get income based jobseekers allowance I am entitled to, or named on a current HC2 charges certificate I am entitled to, or named on, a valid NHS Tax Credit exemption certificate I have a partner who gets Pension Credit guarantee credit (PCGC)

Evidence of exemption seen: Yes No

Client Signature:…………………………………………. Date: ………………

Section three: To be completed and signed by your pharmacist

Pharmacist name: ……………….…………Date NRT supplied: …………….………….Pharmacist signature:………….…………..

*Stop smoking advisor will retain top copy in client record * Pharmacist retain second copy for records * Send bottom copy to Solihull Stop smoking Service, 6th Floor, Mell House, 46 Drury Lane, Solihull, B91 3BUFor Stop Smoking Service use only: Amount payable to pharmacist from this voucher: £ _____________

Appendix 2

Pharmacy details (Stamp)

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SOLIHULL STOP SMOKING SERVICE NRT VOUCHER SCHEME

PHARMACY CLAIM FORM

Brand/Product Strength Quantity Number issued (A)

Unit Price (B) Total (AxB)

Nicorette InvisipatchPatches 10mg 7 £9.97 £

15mg 7 £9.97 £25mg 7 £9.97 £

Nicorette/NicassistPatches 5mg 7 £9.07 £

10mg 7 £9.07 £15mg 7 £9.07 £

Gum 2mg 15 £1.71 £2mg 30 £3.25 £2mg 105 £8.89 £4mg 15 £2.11 £4mg 30 £3.99 £4mg 105 £10.83 £

Microtab 2mg 30 £3.99 £2mg 105 £11.12 £

Inhalator 10mg 6 £12.82 £10mg 42 £3.99 £

Nasal Spray 10ml 1 £12.26 £NicotinellPatches 7mg 7 £9.12 £

14mg 2 £2.57 £14mg 7 £9.40 £21mg 2 £2.85 £21mg 7 £9.97 £

Lozenges 1mg 12 £1.71 £1mg 36 £4.27 £1mg 96 £9.12 £2mg 12 £1.99 £2mg 36 £4.95 £2mg 96 £10.60 £

Gum 2mg 12 £1.71 £2mg 24 £3.01 £2mg 96 £8.26 £

Gum 4mg 12 £1.70 £4mg 24 £3.30 £4mg 96 £10.26 £

Niquitin CQPatches 7mg 7 £9.97 £

Month claimed for:Jan Feb Mar Apr May June

July Aug Sept Oct Nov Dec

Pharmacy stamp:

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14mg 7 £9.97 £21mg 7 £9.97 £

Lozenges 2mg 36 £5.12 £2mg 72 £9.97 £4mg 36 £5.12 £4mg 72 £9.97 £

Gum 2mg 12 £1.71 £2mg 24 £2.85 £2mg 96 £8.55 £4mg 12 £1.71 £4mg 24 £2.85 £4mg 96 £8.55 £

NicoPassLozenges 1.5mg 12 £1.68 £

1.5mg 36 £4.18 £1.5mg 96 £8.94 £

NicoPatchPatches 7mg 7 £8.95 £

14mg 7 £8.95 £21mg 7 £8.95 £

Total NRT costs claimed excluding VAT(C) £Total NRT costs claimed including VAT (C x 1.05) (D) £

Total number of vouchers redeemed (E)Total handling fees claimed (E x £2.00) (F1) £

Number of clients exempt from prescription charge Number of clients from whom a prescription charge was collected (G)

Total cost of prescription charges collected (G x £7.10) (H) £

Total to be reimbursed (D + F1 +F2 – H) £

I claim payment for the NRT products that I have provided which are shown above. I confirm that the information given on this form is true and complete. I understand that if I provide false or misleading information I may be liable to prosecution or civil proceedings. I understand that the information on this form may be provided to the Counter Fraud and Security Management Service, a division of the NHS Business Services Authority for the purposes of verification of this claim and the preventing, detecting and investigation of fraud.

Name: Date:

Signature:

Please return with a copy of the vouchers to Solihull Stop Smoking Service, 6th

Floor, Mell House, 46, Drury Lane, Solihull B91 3BU to be received by 8th of month.

FOR SOLIHULL STOP SMOKING SERVICE OFFICE USE ONLY

Number of vouchers Products check Px charges check Total claimed check check

Please write on back of form all voucher numbers corresponding to this claim for finance to include on remittance advice.

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