Overview

The Royal Oldham Hospital (part of the Northern Care Alliance NHS Foundation Trust) started to refer patients who had quit smoking during their stay as an inpatient to community pharmacies across Oldham in December 2020 as part of the NHS England Pharmacy Integration Programme pilot NHS Smoking Cessation Service: Transfer of Care to Community Pharmacy from Secondary Care.

The pilot is based on the NICE guidelines on tobacco uptake, quitting and dependence, referenced in the NHS Long Term Plan, which establishes the smoking status of all admitted patients followed by brief advice, personalised bedside counselling, timely nicotine replacement therapy (NRT) or pharmacotherapy, and follow-up after discharge.

The aim of the referral pathway is to ensure patients’ quit attempts are assisted following discharge with behavioural support and NRT product supply, which we know means that smokers are three times as likely to quit.

The new service creates additional capacity for smoking cessation support and is not a replacement for locally commissioned services which may be initiated in primary care.

Key benefits and outcomes

• 187 patients were referred to 12 pharmacies in a 12-month period
• 45% of those patients referred to the community pharmacy stop smoking service engaged with a supported quit attempt. The community pharmacy service is achieving outcomes similar to that of the stop smoking services offered by local authorities
• Patient information is sent using NHS mail from the hospital smoking cessation team to the participating community pharmacy of the patient’s choice
• Patients are followed up by the pharmacy within five days of the referral being sent, with the first consultation in the pharmacy usually taking place within two weeks of discharge, to ensure there is no disruption in NRT supply
• 81 patients received 281 smoking cessation consultations over 12 weeks delivered in line with the National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme, in a 12-month period
• 57% quit rate for 4-week quits (in line with the national average of 59%)
• 37% of patients recording a 4-week quit also went on to record a 12-week quit

Background

The CURE model for smoking cessation is NHS England’s nearest adaptation of the Ottawa Model of Smoking Cessation (OMSC) which is a validated, evidence-based process to implement smoking cessation treatment and support as part of routine care in various healthcare settings, including hospital.

The Oldham borough of Greater Manchester was selected to pilot the referral pathway, as there was no commissioned community pharmacy stop smoking service in the borough, and so the pilot represented a real opportunity for patients and community pharmacies in Oldham. A project team was assembled including all key stakeholders – which was instrumental in securing support for and helping to set up the pilot, with, the training and implementation of the pilot commencing in August 2020 and the first referrals being sent in December 2020.

Results and outcomes

The Greater Manchester Tobacco Dependence Treatment Steering Group and Greater Manchester Making Smoking History team have both welcomed the pilot in Oldham, particularly recognising the % conversion and quit rates of referred patients, both of which compare well to other commissioned stop smoking services across the region. Following the success of the pilot, plans are underway to rollout the service across the other nine Greater Manchester boroughs when it becomes a nationally commissioned Advanced Service.

Pharmacists in 12 community pharmacies in Oldham undertook the National Centre for Smoking Cessation and Training (NCSCT) practitioner accreditation programme and were also provided with input and support from the locally commissioned smoking cessation service in Oldham. Project support, coordination and clinical input was commissioned by NHS England in Greater Manchester from the community pharmacy provider company CHL, who were integral in setting up the service, liaising with the project team and the community pharmacies and providing ongoing support and locally produced resources to support the pharmacies with service delivery.

Patients admitted to the Royal Oldham Hospital were identified as a smoker on admission and referred to the CURE specialist team for support. The CURE team visited patients on the ward and provided behavioural support and NRT products whilst in hospital. Prior to discharge, the CURE team discussed options with patients around continued support after leaving hospital.

27% of the patients who received a CURE intervention as an inpatient subsequently accepted support to continue their quit attempt post-discharge. For those patients accepting follow-up support in Oldham, 68.5% chose to accept support from a community pharmacy.

One of the pharmacies taking part in the pilot is Lees Road Pharmacy, which has helped dozens of people to stop smoking, including Bilal Sarwar and Jacob Smith (names have been changed). Sixty year-old retiree, Mr Sarwar finally quit smoking after almost 50 years with the help and support of the pharmacy team.

A smoker since age 11, Mr Sarwar didn’t believe cigarettes were causing him harm, so carried on smoking even after suffering a heart attack. However, after discovering he needed an operation and following advice from his hospital cardiology team, Mr Sarwar was persuaded to give quitting a go and given a prescription of nicotine patches and spray to relieve his nicotine cravings. Mr Sarwar was referred to Lees Road Pharmacy in March 2021 and 12 weeks later he had successfully quit for good.

Bilal Sawar describes the support he received from the community pharmacy team and how the pilot has helped him finally stop smoking:

“All the people who supported me were wonderful and very helpful every step of the way. Nadia from the pharmacy built both my confidence and my purpose. She made me believe I could stop smoking and made me see that if I did quit, it would prolong my life and give me more time with my grandchildren.

“Giving up has helped me in lots of ways – my health is improved; my breathing is better, and people tell me I look healthier now”.

Nadia Hussain, Supervisor at Lees Road Pharmacy explains the difference stop smoking support from community pharmacy can make in helping people to successfully quit:

“As we get to know our customers and speak to them regularly, they trust us to help them continue their stop smoking journeys. It’s great to hear success stories like Mr Sarwar and Mr Smith, who have experienced such a difference to their lives since stopping smoking for good.

“I hope that we can continue to support patients who are referred to us after quitting smoking in hospital, as the benefits to the patient are tremendous and it is a great opportunity for community pharmacies to work with the hospital to support patients in this way”.

Sarah Wray, Team Leader of The CURE Project at the Royal Oldham Hospital says:

“This pharmacy pilot has proved to be a great success for some of our patients. I have seen the pharmacy teams quit rates grow as time has gone on and our confidence in their abilities has grown too.

“It is a wonderful service for our patients as they now have the choice of different places to access support once they leave hospital, including their local community pharmacy. It feels so good to know that together, our services are changing lives for the better”.

Alison Scowcroft, Director of Strategic Programmes at CHL and project lead for the pilot in Oldham said:

“It has been a privilege to work with the dedicated CURE team at the Royal Oldham Hospital who are so passionate about the stop smoking service they provide to inpatients and connecting this passion with the community pharmacy teams who are eager to demonstrate their place in the delivery of stop smoking services in Oldham, has been very rewarding.

“The results we have seen are also testament to the dedication, hard work and patient-centred consultations delivered by community pharmacy teams across Oldham”.

Take away tips

For community pharmacy teams:

1. NSCST resources, e-learning and practitioner certification. Consider completing the e-learning in preparation for the advanced service, if you have not done so already
2. Find out if there is a locally commissioned stop smoking service in your area, which could complement the new referral pathway – your LPC should be able to help
3. Get your team involved to support very brief advice (VBA) conversations around smoking with patients – there is e-learning on the NCSCT website and information on the PSNC website which includes links to information and guidance from NICE (National Institute for Health and Care Excellence)  and RSPH (Royal Society for Public Health)
4. Check with your LPC what plans are being developed to roll out the Stop Smoking Advanced Service in your area

For hospital teams:

5. Make as much effort as possible to ensure the patient is contactable after discharge: check the telephone number is correct, ask when is best to call, have an alternative number, gain consent to send text messaging, ask the patient to add the pharmacy telephone number to their phone if they do not answer unrecognised numbers
6. Provide the patient with the telephone number of the chosen pharmacy in case they do not hear from them
7. Ask which pharmacy they usually use and see if the advanced service is available there – patients often like to use the pharmacy they are familiar with

For more information about the NHS Smoking Cessation Service transfer of Care from hospital to community pharmacy pilot in Oldham, please contact Alison Scowcroft, Director of Strategic Programmes at CHL and project lead.