The Department of Health is rolling out a new systems-based approach to improve stop smoking interventions in primary care. This new approach has increased referrals to local NHS Stop Smoking services by up to 49% in pilot areas.
People who are referred to local NHS Stop Smoking Services are up to four times more likely to quit.
The new approach was developed to ensure stop smoking interventions by healthcare professionals are routine and systematic, providing a tailored and consistent approach to patient referral. It will be rolled out to practices over the next few months by trained local NHS Stop Smoking Service advisers who will support its implementation in local primary care settings.
The approach recognises smoking as a key clinical issue requiring treatment or referral to a specialist, joining standard issues such as hypertension or high cholesterol.
The system ensures that basic advice on stopping smoking is offered to all smokers, which doubles the likelihood of a quit attempt. Practices which have this systems-based approach in place are expected to see improved quit rates in their patients. There are also two stages within the system for practices to earn QOF points, increasing the potential revenue and funding for the practice.
The systems-based approach for delivering stop smoking in primary care comprises:
* a tiered approach to stop smoking support that establishes three different levels of interventions according to time available; a supportive delivery system of 10 components that ensures that quality stop smoking support becomes routine; and a supportive practice environment that demonstrates commitment to support all patients in stopping smoking.
This new approach, which was successfully pioneered by local NHS Stop Smoking Services in the Yorkshire and Humber region, has been put into practice by trained stop smoking service advisers in Rotherham from January 2007 to September 2008. Over this time, referrals to local NHS Stop Smoking Services increased on average by 49% (from 292 to 432) across nine GP practices in Rotherham, with one practice doubling its referrals.
Paul Aveyard, Senior Lecturer at the Department of Primary Care and General Practice at Birmingham University and senior consultant on the development of the primary care project, said:
“The approach works by offering patients three levels of intervention, from 30 second very brief advice to intensive support. The primary care programme establishes a supportive delivery system of 10 components that ensures quality stop smoking treatment becomes routine in the practice.
“What we are trying to do is to make the treatment of tobacco addiction routine, in a similar way to hypertension. Previously, the primary care system encouraged GPs to give their patients advice in terms of stop smoking. The difference here is that GPs will now be required to actively manage their patients – such as referring them to a specialist stop smoking service.”
The project was pioneered in Yorkshire and Humber from 2007 and data from the regional pilot in Rotherham shows how successful the approach has been in practices there.
Jacqueline Watson, local NHS Stop Smoking Adviser, Rotherham PCT, said:
“The rollout of Stop Smoking Interventions in Primary Care will help us improve the health of patients and save more lives, in addition to helping practices improve their performance by securing extra QOF points and therefore increasing their potential revenue. I have found that getting practice managers engaged and supportive is key, but in those practices I’ve been working with in Rotherham, it has already enabled managers to transform performance and boost QOF scores.”
The Dinnington Group practice in Rotherham worked alongside their local Stop Smoking Service to boost referrals to the local Stop Smoking Service by over 80%. Irene Botham, Clinical Nurse Manager of the practice said: “Our nurses received expert training from the local NHS Stop Smoking Service in smoking interventions. We worked hard to drive forward the initiative in my practice and saw great results – since we implemented the new systems based approach our referral rates have increased by 82%. There are clear clinical benefits to following this approach and health care professionals have a duty of care to help smokers to quit. In addition, our patients can benefit from the assistance of NHS support with which they are up to four times more likely to quit.”
National evaluation of the project’s rollout across England is due to take place in April 2010.
For more information, healthcare professionals should contact their local NHS Stop Smoking Service, which they can find by using the ‘Local Services Search’ at smokefree.nhs/resources
1. The majority of local NHS Stop Smoking Services in England have been trained to introduce primary care practitioners to the new system and its benefits and will be contacting GP practices imminently. A toolkit for local NHS Stop Smoking Services (LSSS) advisers and resources for practices have been developed to support the rollout. Evaluation is taking place in July & October 2009 and a final evaluation in April 2010.
2. Local NHS Stop Smoking Services
Local NHS Stop Smoking Services offer ongoing free support and advice close to people’s homes. There are over 150 throughout the country, offering a range of services including one-to-one or group support sessions with trained stop smoking advisers.
Advisers help smokers understand their addiction to tobacco and work together on a personalised plan to stop smoking. They can also provide information about nicotine replacement products and other stop smoking medicines. These are available on prescription from the NHS.
A total of 680,289 people in England set a quit date through the local NHS Stop Smoking Services in 2007/8 and over half (350,800 people) reported that they were still smokefree at their four-week follow-up.
3. The evidence is clear that local NHS stop smoking interventions are very successful:
* Offering brief advice to stop smoking is the single most cost-effective and clinically proven preventive action that a healthcare professional can undertake: Anczak J, Nogler R. Tobacco cessation in primary care: maximizing intervention strategies. Clinical Medicine & Research 2003; 1(3): 201-216.
* Smokers are up to four times more likely to quit smoking successfully with support from their local NHS Stop Smoking Services: Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction 2008; 100 (Suppl. 2): 59-69 and West R, McNeill A, Raw M. Smoking cessation guidelines for health professionals: an update. Thorax 2000; 55(12): 987-99.
* When stop smoking messages are received from trusted practitioners, motivation and the chances of action is likely to be increased. Fiore M, Bailey W, Cohen S et al. Treating Tobacco Use and Dependence. US Department of Health and Human Services, Public Health Service, 2000.
4. Supportive delivery system – the 10 components to success: The healthcare setting needs to establish a support system to ensure that successful smoking advice becomes routine. There are 10 components that work together and these are essential in making sure that the healthcare team can provide quality stop smoking support. In essence they demonstrate the team’s complete commitment to helping patients quit. Smokers are supported at every level, as is the team in the primary care setting. Managers give their team strong incentives to do well, backed up by the right resources, training and facilities. Each component is a link in the chain. If one link is missing, the whole system becomes weakened.
The 10 components are:
* Senior level commitment
* NHS Stop Smoking information
5. Smoking remains the main cause of preventable morbidity and premature death in England, leading to an estimated 82,900 deaths in 2007 (18 per cent of all deaths of adults aged 35 and over) estimated to be caused by smoking. (Statistics on Smoking, England 2008, Health Information Centre).
NICE (National Institute for Health and Clinical Excellence) recommends that all healthcare practitioners give brief stop smoking messages to all smokers (unless exceptional circumstances make it inappropriate to discuss smoking).
Department of Health, UK