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At the heart of general practice since 1960

GPs can help smokers quit

Smoking will be banned from virtually all enclosed public places and workplaces in England from 1 July 2007.

The experience from Scotland and Wales, which are already smoke-free, suggests that this will encourage more smokers to make quit attempts and lead to an upsurge in the number of patients asking GPs for help to stop smoking. This is good news, provided that practices are prepared for it.

Smoking is the UK's leading cause of premature death, primarily from cardiovascular disease, lung disease and cancer.

Approximately a quarter of the adult population smokes, with the highest rates among those on low incomes. As a result, each year in the UK more than 100,000 people die prematurely from smoking; many of these deaths are preceded by years of disabling illness.1

Stopping smoking has enormous health benefits, both in the long and the short term.2 Even in conditions such as COPD, where lung damage is irreversible, stopping smoking can prevent deterioration and significantly improve quality of life, by reducing infective exacerbations, for example. It is never too late to quit.

Smoking is driven by addiction to nicotine, so stopping smoking is not a simple matter. If it were, most smokers would have stopped a long time ago. Every year in the UK, between a third and a half of all smokers make an attempt to stop, but only a small proportion are successful.3 This reflects the pull of addiction, rather than a lack of desire to stop smoking.4

There are treatments that substantially improve a smoker's chances of stopping smoking and remaining stopped. The mainstay of these is behavioural support, using techniques borrowed from cognitive behaviour therapy, combined with medication. Drug therapies include nicotine replacement in various forms, bupropion, and a new medication varenicline which specifically targets the nicotine receptors in the brain that are involved in addiction.5

Treatment for smokers is best provided through the dedicated NHS smoking cessation services. It is not feasible for GPs themselves to provide the intensive support required. However, in many parts of the country, the local smoking cessation service will be able to fund nurse-led clinics within the GP surgery. In other areas, patients may have to be referred to an outside clinic. In either case, smokers trying to stop will benefit from an intensive and structured programme of support.

NICE, in its guidance on brief interventions published last year, described the important contribution that GPs can make, recommending that they raise the issue opportunistically with patients and assess their readiness to stop smoking.

Patients who are willing to stop should be referred to an intensive support service, while those who are not ready should be given information about the local NHS Stop Smoking Service and have their smoking status reviewed annually.6 This advice is in line with QOF2, which offers a total of 87 points for smoking-related indicators.

General practice has a key role to play in reducing the enormous toll of disease and premature deaths associated with smoking. It is not enough simply to advise smokers to quit; the emphasis must be on helping them to gain access to effective treatment.

The change coming into force on 1 July provides us with a unique opportunity to do that, and we should exploit it fully.

Author

Dr Kevin Lewis
MBChB
Former GP, Clinical Director of Smoking Cessation, Shropshire County Primary Care Trust

It is not enough simply to advise smokers to quit; the emphasis must be on helping them to gain access to effective treatment

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