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NICE now recommend that all primary healthcare staff should, at every opportunity, ask people if they smoke and advise them to stop smoking in a way that best suits their preferences5.

However, we know time is a barrier when encouraging smokers to quit.

Very brief advice (VBA) is a framework for patient conversations that aims to promote the most effective way to stop smoking and prompt quit attempts in 30 seconds. It can be used:

  • opportunistically in almost any conversation
  • without challenging or pressuring a patient
  • can be delivered without requiring detailed knowledge of the patient’s smoking habits
  • can be delivered in many consultations to reinforce the message of how to quit

There is no need to go into detail about what or how much they smoke or stating the harms of smoking as these can be discussed at a separate, specific smoking cessation appointment. Instead VBA is simply used for offering advice and sign posting, in a way that feels supportive to the patient.

According to a Cancer Research UK survey in 2017, of the 45% of GPs who have heard of VBA, 81% think its effective for smoking cessation6.

In addition, NICE now recommend that all frontline health professionals should be trained to offer VBA to their patients and that it is delivered according to the NCSCT training module. It has been identified that the systematic delivery of VBA and referral of smokers to effective and evidence-based stop smoking support is vital to ensure that individuals have the best chance of quitting.

If you want to learn more about prevention and very brief advice visit the RCGP/CRUK e-learning module on Behaviour Change and Cancer Prevention



‘3 A’s of VBA to frame your conversation

advice and e-cigarettes
‘Do you smoke?’ ‘Do you still smoke?’ ‘Are you a smoker?’ ‘I see from my notes you’ve stopped smoking, how’s that going?’ ‘Did you know the best way to stop smoking is with specialist support and medication which makes it far easier to stop/more likely to succeed?’

You could inform the patient about a local Stop Smoking Service and the free, personalised support that they can provide and explain that safe and effective stop smoking medications such as varenicline and NRT are available on prescription.
‘All you need to do is make an appointment with the free local Stop Smoking Service. I can make a referral for you now if you like?’

If there isn’t a local Stop Smoking Service available or the patient doesn’t want to attend, have a conversation about alternatives including asking them to come back for a dedicated consultation about medication.

If they’re not interested in stopping, then try to encourage future attempts.

‘That’s fine, there are options available, just let me know if you change your mind’ ‘There is help available when you are ready.’

As per NICE guidance, record the fact that they smoke and at every opportunity ask them about it again in a way that is sensitive to their preference and needs. Don’t forget to explore your local Stop Smoking Service offer and prepare for consultations by having referral information to hand.


VBA and e-cigarette examples

Example 1: Smoker who doesn’t want behavioural support and has tried medication
‘Do you still smoke?’

Yes
‘Did you know the best way to stop smoking is with specialist support and medication which makes it far easier to stop/more likely to succeed?’

Yes, but I don’t want to talk to a specialist and I have tried medication before.
‘Have you tried e-cigarettes as a stop smoking aide? Research so far shows they are far less harmful than smoking, and many people have found them helpful to stop smoking.’

Example 2: Smoker and vaper

‘I see from my notes you’ve stopped smoking, how’s that going?’
I have tried to stop smoking but I have also been using an e-cigarette


Coding e-cigarette users: If a patient uses an e-cigarette (vapes) but doesn’t smoke tobacco at all, then code as a non-smoker
If a patient uses an e-cigarette (vapes) but also smokes tobacco, then code as a smoker
‘Did you know the best way to stop smoking is with specialist support and medication which makes it far easier to stop/more likely to succeed?’

Ok that sounds interesting, as I really do want to stop smoking.
‘Great, all you need to do is make an appointment with the free local Stop Smoking Service- you can take your e-cigarette along with you. I can make a referral for you now if you like?’

Case study

Dr Ben Noble, a GP Partner from Loughborough, has been discussing e-cigarettes as part of VBA, particularly with working class men. He has focused on the financial benefits of using e-cigarettes such as offering smokers a lower cost quit aide to breaking their habit and other advantages such as maintaining their “smoke breaks”, whilst encouraging others to quit.

“This is a demographic who I find won’t make time for formal smoking cessation clinics and who seem to consider the use of NRT e.g. patches a more “feminine” option. Many of them would have tried e-cigarettes before were it not for the perception that they are just as, if not more, unhealthy than cigarettes. Hence, my VBA has seemed to hit home quite encouragingly.”

  1. National Institute for Health and Care Excellence (NICE). Clinical guideline 92: Stop smoking interventions and services, March 2018. www.nice.org.uk/ng92
  2. Cancer Research UK. Health Professionals Tracker survey. 2017
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