Stop smoking service

What: An enhanced smoking cessation service

Who: Wendy Preston – Consultant Nurse, George Eliot Hospital, Warwickshire

Background: Since qualifying in 1992 as an RGN Wendy has worked in a variety of medical nursing and education roles, specialising in Respiratory and Acute Medicine. Her studies have been varied with an MSc in Respiratory Care (2011) with post graduate certificates in prescribing and higher education.

Current teams are Nursing Times ‘Team of the Year’ 2014 which incorporates an acute medical unit and an ambulatory care unit with a range of respiratory pathways. Other roles include; non-medical prescribing lead, BTS stop smoking champion and also lecturing at Coventry University.

Wendy is passionate about respiratory care and smoking cessation, current Vice-Chair of the Association of Respiratory Nurses (ARNS). She participates in national and international groups including at parliament and the European Respiratory Nurses Association representing ARNS and the RCN. Also representing ARNS on national guideline groups and is BTS co-lead for Stop smoking champions. Her work was acknowledged in 2014 by being recognised as an HSJ Rising Star.

Approach: Prevention

Location: George Eliot Hospital NHS Trust, Nuneaton, Warwickshire

Speciality: Acute medicine and ambulatory care

What initiative or project are you involved in?

The aim of the project was to deliver an enhanced, integrated smoking cessation service. Smoking cessation services were provided in both a hospital and community setting. The outreach service focused on hard-to-reach groups and was delivered in schools, colleges and in the workplace.

The work was based on recommendations made by the National Institute for Health and Care Excellence (NICE, 2010) and Action on Smoking and Health (ASH, 2014), which include:

  • routine identification of patients who smoke
  • advice and support offered within the hospital setting
  • referral to a local NHS Stop Smoking Service.

What prompted the work?

A gap was identified in the provision of smoking cessation services for respiratory patients in secondary care.

A three-year contract was secured with the NHS West Midlands, to deliver a tariff-based NHS smoking cessation service. Under this pilot scheme, payment could be claimed at a standard rate, for every service user that the gives up smoking with an increased rate for a target population.

How did you initiate the work?

The team developed a project plan and worked through all of the challenges. This included the development of a Patient Group Directive (PGD), allowing medicines to be supplied directly to patients.

The project team partnered with the local Warwickshire Stop Smoking Service, which enabled access to staff training and equipment. A contract was also secured to deliver smoking cessation services to Warwickshire patients, which generated another income stream.

In April 2013, as part of a national reform, the Warwickshire Stop Smoking Service was transferred to George Eliot Hospital. This led to the creation of a new Community Division, as well as the development of a Public Health Strategy.

What difference has the project or initiative made?

The project has been praised by patients, family members, staff and carers. The service has proved both popular and accessible – members of the public often walk in and ask for help.

For many patients, a health scare provided the encouragement needed to give up smoking; therefore, it was important for the support to continue, once the patient was back at home, and motivation can be lost.

The project had many enablers; several schools, colleges and factories allowed clinics to be set up on-site. One of the highest rates of success was amongst workers in a local crisp factory, where staff motivated each other to give up smoking together.

Here is one patient success story:

When Jane arrived at the respiratory clinic, she could not walk more than a hundred yards, before becoming short of breath. The diagnosis was chronic obstructive pulmonary disease (COPD).

The consultant accompanied Jane to the Stop Smoking clinic. Jane was nervous at first and required intensive support, including weekly appointments at the clinic. It took two weeks to set a quit date.

With the help of nicotine replacement therapy (NRT) and behavioural support, Jane successfully gave up smoking and has not relapsed for the last three years. Six weeks after the quit date, Jane arrived at the clinic with her shopping bags; proud that she was now able to walk around town, without feeling short of breath.

What are the long term aims for the work?

When the contract with the NHS West Midlands came to an end in 2013, our challenge was to sustain the Stop Smoking Service, which had become fully integrated into secondary care.
We made use of the Commissioning for Quality and Innovation (CQUINs) payments framework, as well as the Public Health Strategy for George Eliot Hospital Trust, to ensure that the value of the work was recognised.
Recently, the Stop Smoking project was integrated into the work of the ambulatory care team. All members have received training to become Stop Smoking advisors. The team is able to provide a smoking cessation service, seven days a week, including evenings. The service is cost effective and provides a flexible model – we aim to train all new recruits. This is helping support a recent introduction of a Smoke Free Policy within the Trust.

Soon to be launched is an e-Referral Service and a split tariff agreement. Under the new agreement, the tariff sum for a patient’s spell of care will be divided between The Trust and a community service provider such as a local chemist or GP.