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Tobacco Dependency Roadmap

The resources in this section have been put together to help you, as a clinical tobacco dependency lead, navigate the processes involved in delivering a successful tobacco dependency treatment service within your trust in 7 simple steps. 

 

These resources focus currently on the Long Term Plan for England but we hope sharing these key steps will also provide a useful framework for those of you working in the devolved nations. We are keen to hear from colleagues who are working across the UK to embed tobacco dependency programmes in their trust. If you would like to share your experience with us please email contact@respiratoryfutures.org.uk 

BTS has run a series of webinars to support this roadmap. Recordings are available here.

The 7 Steps

This step involves finding and securing the funding for your programme.

Tasks

Identify the Prevention and Health Inequalities Board Lead

This role would usually be based within an Integrated Care Board (ICB).

Join the ICB Prevention / Tobacco Steering Group

This group would usually be co-ordinated by the ICB.

It may have a wide remit and members will include representatives from Local Authority, Public Health and Regional Prevention Group Leads.

Submission & approval of a business case

You may be expected to assist in the completion of a business case to include a costing model.

This is to ensure you have sufficient funding as you may need to seek further funding to cover the costs of the programme.

 

Links and resources:

Organisation structure example

Business case template (CURE)

Service specification example (CURE)

Service cost-benefits analysis (CURE)

Integrated care - Who leads in your area

ASH - Tobacco Dependence Treatment Service ROI Calculator

ASH - ICB Ready Reckoner

ASH - Core20PLUS5 ICS briefings

This step outlines the key strategic leadership roles that are in place to help deliver the programme.

Tasks

Identify a strategic sponsor to endorse the programme. This person could be:

- Trust Chief Executive.

- Trust Chief Operating Officer.

- Trust Chief Finance Officer.

- Trust Head of Nursing.

- Senior Responsible Officer – based within the Trust.

- Chair of ICS Tobacco Steering group.

Identify a project manager

The project manager will implement all aspects of the programme and will work alongside the trust clinical lead.

The Trust Prevention Group responsibilities are:

- Development of a job description.

- Recruitment.

- Management of the project manager.

Identify regional and local key stakeholders. To include:

- Regional Tobacco Control Leads

- Regional Respiratory Clinical Network Leads.

- Regional Long Term Plan Prevention Working Group Lead.

- Local Authority Public Health Prevention Lead.

- Local Stop Smoking Service Lead.

- Local community pharmacy.

 

Links and resources:

Assistant Project Manager job description (CURE)

Project Manager job description (CURE)

Steering Group brief (CURE)

Case Study - James Paget University Hospital

NHS LTP Treating Tobacco Dependence Programme - Governance and Leadership

South Yorkshire & Bassetlaw ICS - QUIT Programme Steering Group Terms of Reference

Community Pharmacy advanced service specification: NHS Smoking Cessation Service (SCS)

This step is to ensure all aspects of the service delivery have been planned ready to launch the programme.

Tasks

Develop programme clinical pathways and protocols

This is to ensure the systematic opt-out treatment of all in-patients who smoke.

A useful checklist is:

- Patient referral pathway.

- Prescribing protocol.

- Discharge pathways.

- Peer level check and challenge.

- Patient resources.

Identify key members of the team and assign roles and responsibilities:

- Tobacco Dependence Advisors (TDAs )Recruit a sufficient number based on your trust size and budget.

- Communications Lead – Liaise and work alongside to develop communications strategy and resources.

- IT Lead – Liaise and work alongside to ensure all systems are in place.

Support project manager and provide appropriate clinical input where needed

Agree specific outcomes and associated data collection tools to evaluate your service and measure impact.

Agree key deliverables/milestones for each work stream.

 

Links and resources:

The CURE project - Pillars of Success

Initial assessment and treatment proforma & protocol (CURE)

Prompt Card - Prescribing (editable - CURE)

Prompt Card - Prescribing (CURE)

IT requirements for implementation (CURE)

Assessment and treatment plan (CURE)

Induction leaflet (CURE)

CURE Poster

CURE Pop-up banner

Pathway flowchart for inpatients 

Example varenicline PGD and NRT voucher protocol

Public Health England - CLeaR Tobacco Control Assessment

This step is to ensure that all staff are suitably trained to deliver the systematic treatment of tobacco dependency.

Tasks

Very Brief Advice Training (VBA)

Ensure all staff can access the most appropriate training available to gain the necessary skills to carry out VBA with every patient that smokes on admission.

This can be made available through on-line or face-to-face training.

IT systems

Ensure staff are trained to use the IT systems required to capture the patient’s details regarding their smoking status as the Long Term Plan Delivery model supports an opt-out tobacco dependency treatment pathway for all in-patients.

Prescribing

Ensure staff are aware of how to prescribe pharmacotherapy as a treatment method using the relevant prescribing protocols.

Referral

Ensure staff are aware of how to refer the patient to the Tobacco Dependency team based within the trust for on-going support and follow-up on discharge.

 

Links and resources

CURE Training manual

Training module on Very Brief Advice on Smoking (VBA+)

Competency Framework Overview (FutureNHS Login required)

Competency Framework for Acute Inpatients (FutureNHS Login required)

This step is to support the roll-out of a comprehensive programme within an acute trust.

Tasks

Measures needed to launch the programme  

Recruitment of an appropriately trained team to deliver the service.

Access to a data capture system that records activity.

Access to training, either on-line or in person sessions.

All necessary pathways and protocols are in place and accessible.

Provide on-going support to the project manager and appropriate clinical input

Attend steering/working group meetings as required.

Provide clinical expertise and liaise with key stakeholders as necessary.

 

Links and resources:

Band 2 Smoking Cessation Advisor job description

Band 3 Smoking Cessation Advisor Administrator job description

Band 5 Smoking Cessation nurse job description

This step is to highlight the role you play as a respiratory clinician in supporting the programme.

Tasks

Be an active role model

As the clinical lead, you can help to support the programme by becoming the trust champion for treating tobacco dependency.

Encourage your colleagues to sign up for the monthly Respiratory Futures Tobacco Dependency Newsletter. 

Drive Culture Change

Utilise your position as the visible lead for the programme and communicate with key decision makers to ensure this is firmly embedded into practice.

Help to shift attitudes and perceptions through promoting and endorsing the programme with your peers.

 

Links and resources:

NHSE LTP Tobacco Addiction Workshop for clinical & nurse leads

This step is to ensure the long term tobacco dependency programme is embedded and supports the Smoke Free 2030 target

Tasks

Maintain contact with the ICB

The long term implementation of the programme relies on this relationship to harness the longevity of the programme.

A key part of this will be to submit a business case to the ICB board in order to receive year on year funding and to secure extra funding if required.

Share results and impact to ICB Board

Continuation and longevity of the programme

In order to support continued service improvement you will need to ensure the following are carried out –

Maintain the relationship with the strategic sponsor

Provide continued clinical and leadership support to the Steering Group and other key work streams

Explore potential expansion into other areas and build on the success of the programme

Remain visible.

 

Links and resources:

Cost benefit analysis summary (CURE)

Tobacco Treatment Services: Gaining additional funding case study

ASH - Tobacco Dependence Treatment Service ROI Calculator