MASTERCLASS Should you set up a smoking cessation service in your pharmacy? Smoking cessation services have been among the worst affected by public health budget cuts, but pharmacies can still play a vital role in supporting patients to quit, says Rachel Carter moking cessation services are one of the most frequently commissioned local services from community pharmacies, according to the Pharmaceutical Services Negotiating Committee (PSNC), but they are also under increasing threat. Since 2015, public health budgets have been slashed by central government and councils have been forced to cut spending on services, with smoking cessation among the worst affected. An analysis of council spending, published by The King’s Fund last year, showed that stop smoking services faced a cut of £16m in 2017-18. A spokesperson for PSNC’s services team tells The Pharmacist that the squeeze on budgets is having a ‘detrimental impact’ on public health provision – including that provided by pharmacy teams – and it has seen a rise in smoking cessation services decommissioned in the past year. However, community pharmacists remain an ‘established’ and ‘trusted’ provider of stop smoking services, the spokesperson adds, and pharmacies provide an accessible setting where staff are well-placed to provide interventions on stopping smoking and increase access to smoking cessation products for patients. S ‘Beef up the business case’ So how can community pharmacists make this service work in the current climate? 34 | The Pharmacist | September/October 2018 Michael Holden, principal associate at training and consultancy firm Pharmacy Complete, says some commissioning of this type of service should remain, but there’s ‘no point pleading for it to be a national service’, because public health money is devolved. Instead, pharmacists need to ‘beef up’ the business case locally. Mr Holden adds that there is scope for smoking cessation to be a private service, similar to the way flu jabs are offered to patients who fall outside the eligible groups. ‘Flu is commissioned nationally, which is great, but the opportunity to provide a private service is there,’ he says. ‘So if you put the competencies and service process in place, and the clinical governance that underpins that, then why not offer it [smoking cessation] on a private basis? Why wait for someone to be eligible under a commissioned service?’ ‘Consider the local market’ Whether pharmacists go down the private route or approach a commissioner to bid for a service, there needs to be a local market, Mr Holden says. He argues pharmacists can do their research by checking out their local area’s Joint Strategic Needs Assessment and by using Fingertips, a Public Health England (PHE) website that provides a four-page health profile of the local health needs. Hazel Cheeseman, director of policy at the Action on Smoking and Health (ASH) charity, adds that the ‘contracting provision elsewhere in the system’ has made the provision of smoking cessation services through pharmacy ‘all the more important’. ‘Local authorities are less likely to be funding services that are available to everybody and for some reason, GPs seem to be following suit,’ Ms Cheeseman says. ‘So in the context of there being fewer options available for smokers in many communities, it is really vital that there continue to be pharmacy-based services.’ The role pharmacy can play One of the advantages of providing a smoking cessation service in a pharmacy, Ms Cheeseman adds, is the flexibility and immediacy this type of setting offers.