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the Welsh Assembly Government’s 
 consultation on the 
Draft Tobacco Control Action Plan for Wales 
May 2011 
Contact Steve Simmonds MRPharmS, MBA NPA Representation Manager Wales National Pharmacy Association Bay Tree House Colwinston Cowbridge Vale of Glamorgan CF71 7NL 01656 668430 Email Part 1: Community Pharmacy and Public Health


The National Pharmacy Association (NPA) is the trade body which represents the full spectrum
and vast majority of community pharmacy owners in the UK, including across Wales. We count
amongst our members nationwide pharmacy multiples, regional chains and independent
pharmacies. This spread of large and small member companies, our UK-wide geographical
coverage, and our remit for NHS and non-NHS affairs means that we are uniquely fully
representative of the community pharmacy sector. In addition to being a representative voice,
we provide members with a range of commercial and professional services to help them
maintain and improve the health of the communities they serve.
The NPA is a member of Pharmacy Voice which is also fully supportive of the principles in this
response.
Pharmacy Voice (PV) represents community pharmacy owners. Its founder members are the
Association of Independent Multiple pharmacies (AIMp), the Company Chemists’ Association
(CCA) and the National Pharmacy Association (NPA). The principal aim of Pharmacy Voice is to
enable community pharmacy to fulfill its potential and play an expanded role as a healthcare
provider of choice in the new NHS, offering unrivalled accessibility, value and quality for patients
and driving forward the medicines optimisation, public health and long term conditions agendas.
The NPA welcomes the opportunity to contribute to the Draft Tobacco Control Action Plan for
Wales and to ensure that the unique role that community pharmacy can play in helping the
Welsh Assembly Government meet their smoking targets is fully considered.
A network of over 700 community pharmacies across Wales provides essential and much
valued services in the heart of the local community, including in rural communities, urban
deprived areas and the larger metropolitan centres. Community pharmacies have a range of
opening hours, often longer than any other health care professional, are usually available
without an appointment and are frequently the first point of call for those seeking advice about
health issues. These factors, together with their high footfall, makes the community pharmacy
network the most accessible part of NHS Wales and the obvious place to deliver high quality,
effective and accessible public health interventions.
Community pharmacists and their staff see a wide spread of the population; those who are collecting prescriptions, those buying over the counter remedies and those seeking support for self care. Community pharmacists and their staff generally see people more frequently than any other health care professional seeing them when they are in good health as well as when they are ill. Pharmacists and their staff are able to make opportunistic interventions with regard to smoking for example, when selling cough mixtures or mouth washes. In addition community pharmacies are regularly visited by those who are unregistered with GPs and people that live in hard to reach communities. Community pharmacies are located where people live, work and shop and buck the inverse care law, in that there are more pharmacies per head of population in areas of deprivation than in other areas. While the NHS provides stop smoking support it is important that it also recognises that around 25% of successful quitters will have given up on their own and they often purchase NRT over the counter, to support their efforts, from community pharmacies across Wales. A fact too often not recognised as evidenced by its absence from the Action Plan. Community pharmacists and their staff frequently add value to these sales by asking quitters how they are getting on and offering advice and support. In addition when selling NRT they will check that the product is appropriate for the quitter and there are no interactions with any other medication they may take. Part 2: Community Pharmacy and Stop Smoking Support
Community pharmacy has an important role in making smoking cessation and tobacco control services available for all patients in communities across Wales. It is imperative that the success of community pharmacy to date in engaging with smokers is recognised, and that this potential is incorporated in the proposed strategy under consultation. Amongst the most recently completed outcome data (2009/10) comes from Northern Ireland. Here community pharmacy was the most common service setting for all target groups (except pregnant women) and had the highest number of clients (58% of people who set a quit date)2. Additional evidence of success for smoking cessation services delivered in community pharmacy comes from The Healthy Living Pharmacies (HLP) model developed in NHS Portsmouth3. HLP encourage pharmacies to promote and support health and wellbeing with a framework based on public health need. To achieve HLP status, pharmacy teams have participated in training for Health Trainer Champions (HTC) and leadership training for pharmacists, a public communications plan, wider publicity campaign and a public awareness road show. Recent evidence from NHS Portsmouth demonstrates the positive effect HLP model has on quit rates. Quit rates were compared between two five month periods; January to May 2009 (139 “quits”) and January to May 2010 (333 “quits”), to investigate the impact of HLPs and HCTs on outcomes. There was over a 100 % increase in successful “quits” during the HLP initiative. Pharmacies with HLP status achieved more quits (average of 25.1) compared with HTC pharmacies (average 13.2) and non HTC pharmacies (average 3.7) Also, within HLPs the conversion rate from expression of interest and meeting an adviser to setting a quit date and achieving a four week “quit” was higher than for HTC pharmacies (49%), which itself was higher than for non HTC pharmacies (23%) This evidence clearly demonstrates the positive impact of increased focus on engaging with smokers by trained pharmacy staff has on quit rates. Despite a punitive tax regime and legislation to ban smoking in public places, smoking related diseases continue to claim thousands of lives each year. If Wales is serious about reducing the smoking levels from 24% of the population, to match places, like Sweden, with the lowest rates in the World (14%) then a national community pharmacy based stop smoking service is essential. Part 3: Improving outcomes through use of community pharmacy
The NPA congratulates the Welsh Assembly Government on its tobacco control achievements
to date and fully supports the Welsh Assembly Government’s ambitious targets to reduce adult
smoking prevalence to 16% by 2020. If this is to be achieved then this will require 22,000
adults to quit smoking each year. As even the very best stop smoking services will only achieve
a 40% quit rate then NHS Wales will need to provide stop smoking support to over 50,000
smokers each year.
To meet this target services will have to easily accessible to smokers at a
time to suit them. Commissioning stop smoking service from all community pharmacies would
increase the number of venues by 700.
While NHS Wales should feel justly proud of its Stop Smoking Wales (SSW) service it is clear
that, using the published intervention figures of 10,000 people per annum, the capacity of SSW
is clearly insufficient to meet the capacity requirements. In addition, the SSW service offers an
approach to smoking prevention that does not always meet the needs of the busy working
population. If however the SSW service was supported by a new National Community
Pharmacy Stop Smoking Service
then NHS Wales will not only offer its people a choice of
provider it will put in place a service that will have the capacity to reach over 50,000 potential
quitters each year.
To date, disappointingly, less than 10% of our members in Wales are commissioned to offer an NHS stop smoking service. This creates a situation where only the financially better off people can take advantage of the convenience and accessibility of the community pharmacy network for support in quitting. The NPA would propose that a fully integrated community service encompassing SSW,
community pharmacy and other primary care providers is established.

Tobacco use imposes a significant financial and emotional burden on the people of Wales. Almost half of all long-term smokers die in their middle age as a result of tobacco use and many others will suffer poor health and a reduced quality of life. The consultation recognises that ‘treating smoking related diseases costs NHS Wales an estimated £386 million per year’. In addition the consultation recognises that ‘research has demonstrated that evidence-based smoking cessation services are a highly cost effective way of helping smokers to stop smoking’.                                                              1 The Bow Group: Delivering Enhanced Pharmacy Services in a Modern NHS 2 DHSSPS, Annual and Quarterly Statistics on Smoking Cessation Services 3 NHS Portsmouth, September 2010: An interim report on the outcomes from the Portsmouth Health Living Pharmacy initiative The NPA would recommend that the Welsh Assembly Government work with the community
pharmacy representative bodies to design a community pharmacy stop smoking service that
complies with best practice guidelines and which, in line with NICE Guidelines, ensures that the
people of Wales are provided with the choice from a full range of stop smoking medication. This
way GP practices can be relieved of the workload associated with the provision of stop smoking
support, so that they can be better engaged in the Setting the Direction agenda, and will
confidently refer patients to the community pharmacy service in the knowledge that the service
is an effective, evidence based service.
Currently all NHS commissioned community pharmacy services in Wales are NRT based services and deny quitters the support of Varenicline and Buproprion. Evidence indicates that the costs are comparable (£795 per 1 year quitter for NRT and £728 per 1 year quitter for Varenicline) but quit rates are higher.    Part 4: Maximising the potential of community pharmacy stop smoking services
Quit rates increase with the use of NRT, Bupropion and Varenicline with a range of support.
Success rate increases with treatment options and In England pharmacists can be enabled to
supply bupropion and varenicline via Patient Group Direction (PGD) to ensure quitters can
choose the option which suits them best to support their quit attempt. In addition PGDs can be
used to enable community pharmacists to supply NRT to teenagers and those who are
pregnant, who wish to quit smoking.
As pharmacists are the experts in medicines there should be no barriers to opening up the full
range of stop smoking medicines to pharmacists to supply.
In addition we would encourage the Welsh Assembly Government to make more effective use
of the Public Health Campaign element of the Community Pharmacy Contractual Framework
by involving all community pharmacies across Wales in an annual and national public health
campaign in support of Stop Smoking Week.
Part 5: Conclusion and recommendations
NHS Wales has set very ambitious, but none the less achievable, smoking targets. That said, it will only succeed if it ensures that there is adequate capacity in the system and provides the leadership required to establish a national network of support, which meets the individual needs of potential quitters. The unique location and accessibility of community pharmacies must therefore be brought on stream as part of this network. It has the ability to offer effective, evidence based stop smoking support and has the capacity to handle the volume of stop smoking support that will need to be delivered if national targets are to be met. To maximise the potential of community pharmacy stop smoking services, they must be fully integrated into NHS stop smoking services. In addition they must be promoted through all possible avenues so those considering stop smoking know how and where to access the services they require. The National Pharmacy Association is content for this response to be made publicly available Steve Simmonds MRPharmS, MBA NPA Representation Manager Wales National Pharmacy Association Bay Tree House Colwinston Cowbridge Vale of Glamorgan CF71 7NL 01656 668430 Email

Source: http://www.npanet.co.uk/Documents/Docstore/Consultation-Responses/20110505_Tobacco_Control_Action_Plan_NPA_response.pdf

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