Microsoft word - tp extra smoking cessation nrt formulary.doc

Tablet Press EXTRA
The prescribing newsletter for GPs, nurses and pharmacists in
Northamptonshire Primary Care Trust
Smoking Cessation and Northamptonshire NRT formulary
Between 2007-8 and 2010-11 the cost of NRT prescribed or supplied via pharmacies in Northamptonshire increased from £362K to £761K per year. In order to try to get the best outcome from this investment in NRT (and other smoking cessation pharmacotherapy) this bulletin advises healthcare professionals of the new Northamptonshire NRT formulary and emphasises the importance of using behavioural support in addition to pharmacotherapy. The table below (from Stead LF, et al. Cochrane Database of Systematic Reviews. 2008) depicts the comparative effectiveness of the six different types of NRT formulations. There is no evidence to suggest that one formulation of NRT is more effective than another (confidence intervals of the trials overlap). Form of NRT
Relative Risk
95% Confidence Intervals
No of trials
• Formulary
From 1st April 2012 a formulary for NRT products is being introduced across Northamptonshire. The formulary has been agreed by the Specialist Stop Smoking Service and the Northamptonshire Prescribing Management Group and is aligned with the NRT formularies at NGH and KGH. Nicorette Patches 
Pack Size 
Niquitin CQ Lozenge 
Pack Size 
Nicorette Gum 
Pack Size 
2mg (fresh mint, icy white, original)   Niquitin CQ Patches  
 Pack Size  
2mg (fresh fruit, fresh mint, mint, icy white, original)  4mg (fresh fruit, fresh mint, mint, icy white, original)  Nicorette Inhalator 
Pack Size 
Nicorette Spray 
Pack Size 
Stop Smoking Specialist recommendation only  Stop Smoking Specialist recommendation only  This edition is also available on HNN (Health Network Northants)
http://nww.northants.nhs.uk/Display/Dynamic.jsp?topid=14070&lhsid=514&oid=2854&currentid=2854
Disclaimer
Information in this newsletter is believed to be accurate and true. NHS Northamptonshire and its employees accept no liability for loss of any
nature, to persons, organisations or institutions that may arise as a result of any errors or omissions.
It is strongly recommended that prescriptions or supply via community pharmacy should be for a maximum
of 2 weeks’ supply of NRT at a time in order to avoid wastage.
Prompts on Scriptswitch will advise prescribers of the formulary choices; the formulary will also be loaded
onto the GP clinical systems as part of the overall formulary management.
Any non-formulary treatment courses initiated prior to 1st April can be continued and community
pharmacists will be able to claim these via Webstar until 1st July. After 1st April no new initiations of non-
formulary products should be made and after 1st July pharmacists will not be able to claim non-formulary
products via Webstar. The community pharmacy Local Enhanced Service (LES) and service specification
will be updated accordingly for 2012-13.
NICE guidance recommends that smoking cessation services should consider offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past. NRT remains the first-line choice of pharmacotherapy in Northamptonshire. The decision aid for prescribing of varenicline can be found on Pathfinder at Decision Aid for Prescribing Varenicline and on the intranet at Decision Aid for Prescribing Varenicline • Behavioural support
Evidence has shown the prescribing of NRT, together with behavioural support from a Stop Smoking
Advisor, can increase a smoker’s chances of stopping by up to four times (DH Local Stop Smoking
Services: Service delivery and monitoring guidance 2011/12).
Healthcare professionals are advised not to supply or prescribe NRT (or varenciline or bupropion)
without behavioural support as this is less likely to result in a successful quit.

The LES contract with community pharmacies and GP practices is aimed to encourage and promote the use of behavioural support for quitters. As part of the LES Contract 2011-12 for providing stop smoking support it is important to complete monitoring forms for all the smokers you are supporting; to comply with this contract these forms need to be returned within 42 days of ‘quit date set’ to initiate all payments promptly. Any forms you currently have in your possession with a quit date set between 1st September and 31st December 2011 must be received by the Stop Smoking Service by 1st March 2012 for DH Q3 return. Details of the Stop Smoking Service Intermediate Skills Day training dates and booking form are circulated with this bulletin. The Stop Smoking Service also facilitate their own one to one clinics and group meetings in a variety of locations across the county. Their Advisors offer weekly or fortnightly support as required throughout a 12 week programme; including a comprehensive initial assessment, lifestyle / behavioural support and recommend NRT, bupropion or varencline as appropriate. If you identify any smokers who would benefit from further specialist support please contact their helpline on 0845 6013116 to refer onto their service. This edition is also available on HNN (Health Network Northants)
http://nww.northants.nhs.uk/Display/Dynamic.jsp?topid=14070&lhsid=514&oid=2854&currentid=2854
Disclaimer
Information in this newsletter is believed to be accurate and true. NHS Northamptonshire and its employees accept no liability for loss of any
nature, to persons, organisations or institutions that may arise as a result of any errors or omissions.

Source: http://www.pharmacynorthamptonshire.co.uk/wp-content/uploads/TP%20Extra%20Smoking%20Cessation%20NRT%20formulary.pdf