Pharmacy-led smoking cessation services are “disjointed and confused” despite community pharmacies being “ideally placed” to support people in quitting, the Company Chemists’ Association (CCA) has said.
In a report published today, the CCA called for the “consistent commissioning” of community pharmacy stop smoking services to help the government achieve its “ambition of a smoke-free future”.
The report warned that the government’s target is currently “unlikely to be met” and recommended a “funded three-tier model” enabling community pharmacies to play a bigger role alongside existing smoking cessation services.
“Postcode lottery of access”
The CCA said that pharmacies’ positions at “the heart of communities”, as well as their “universal online access” and long opening hours, offer smokers “choices to access services in a way that fits their life”.
It added that pharmacies are “ideally placed to reach people who smoke in deprived areas”.
But it criticised local authorities for “creating a postcode lottery of access” through “variable commissioning of pharmacy-based stop smoking support”.
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“Despite the strong potential, the current service offer available to smokers from pharmacies is disjointed and confused,” it said.
The report highlighted that the nationally commissioned NHS Advanced Community Pharmacy Smoking Cessation Service “provides consistency for smokers and providers”, but only accepts referrals from hospitals.
It said this “narrow inclusion criteria” had led to “extremely low” referral rates, with just 2% of pharmacies conducting a consultation between January and June this year, despite 50% being signed up to deliver the service.
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According to the body, pharmacists who have completed the necessary training are not receiving enough referrals to “hone and maintain their skills and build confidence and competence”.
The CCA also said that stop smoking services “effectively compete against other services within the pharmacy business”, with behavioural support “usually provided across multiple appointments over 12 weeks”.
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It noted that while stop smoking services “take significantly longer to deliver than other clinical services”, funding often fails to reflect this.
“Pharmacies need more enabling commissioning frameworks to encourage participation,” it added, and “services must be standardised and economically viable”.
Three-tiered approach
In the report, the CCA called for a “coherent and nationally consistent approach”, recommending a three-tiered model supported by “appropriate funding” to better equip pharmacies to deliver smoking cessation services.
At tier one, it said, existing routes used to identify and refer smokers to help should be maximised “to ensure brief interventions can be delivered routinely and to a high quality in every pharmacy”.
Tier two would see the introduction of a national framework for a medicine supply service to “enable pharmacies to work with other smoking cessation providers more consistently”.
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The framework would include “equitable access to nicotine replacement therapy and prescription-only medication”, national training requirements and “nationally agreed payment terms”.
And under tier three, the government would develop a national framework for a Community Pharmacy Stop Smoking Service to support “local delivery and priorities while ensuring consistent standards, funding, referral pathways and patient access”.
“Universal front door”
The CCA’s report also set out several “core principles” that it said should underpin its recommendations.
The body said pharmacies should act as “a universal front door”, capable of identifying and advising smokers and connecting them with “appropriate support”.
It added that participating pharmacies should be able to deliver walk-in treatment without a referral where appropriate, and should have “equitable treatment choice”, with access determined by need and not by postcode or local supply arrangements.
And it called on the government to establish “sustainable funding” for the delivery of community pharmacy smoking cessation services, adding that payment should be based on “engagement, treatment initiation and follow-up” rather than on quit outcomes alone.
“Scandalously underutilised”
CCA chief executive Malcolm Harrison said the current system makes it “unnecessarily difficult” for pharmacies to support smokers, adding that it is “imperative that policymakers use all levers at their disposal – including community pharmacies – to support people to quit smoking once and for all”.
“It cannot be right that around half of pharmacies have signed up to the national NHS service, but less than 2% are receiving referrals for patient consultations,” he said.
“If the government is serious about achieving its smoke-free ambitions and tackling health inequalities, it must remove the barriers preventing community pharmacy from playing its full part.”
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National Pharmacy Association chief executive Henry Gregg said that pharmacies are being “scandalously underutilised” in smoking cessation services, despite smoking continuing to be “the single biggest preventable cause of death in the UK”.
He said pharmacy-led smoking services are “a low-cost but highly effective way of supporting patients to quit smoking and improve their health”.
“The government should remove barriers in place from allowing pharmacies to play their full part in this effort, simplifying commissioning arrangements and encouraging more patients to make greater use of support services available on their doorsteps,” he added.
Read more: CCA calls for national pharmacy smoking cessation service
It comes after the CCA called for the expansion of community pharmacy’s role in preventing cardiovascular disease after the publication of the Department of Health and Social Care (DH) and NHS England’s new modern service framework.
Chief executive Malcolm Harrison said the pharmacy blood pressure check service should be expanded as “a first step”, and that independent prescribing should be “harnessed by allowing pharmacists to initiate the supply of medicines to treat hypertension”.
