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GPs expected to chase all smokers

NICE urges GPs to give quitting advice at least yearly

GPs may be expected to chase up each one of their patients who smokes and offer yearly advice on quitting under forthcoming NICE guidance.

New draft guidance from the institute insists GPs should use registers of smoking status to target all their patients for cessation advice at least once a year.

The guidance, on brief smoking cessation interventions, makes clear GP advice must come on top of the efforts of other practice staff.

It states: 'GPs should, at least once a year, advise all patients who smoke to stop. If appropriate they should be offered a prescription for NRT and/or a referral to the NHS Stop Smoking Service.'

It adds: 'All smokers should be given advice ­ it should not be limited to individuals with smoking-related diseases.'

NICE said it welcomed comments from stakeholders on whether GPs should proactively seek out patients who smoke, although it admitted it had not found direct evidence to support the practice.

GP smoking cessation advisers welcomed the guidance, but other GPs warned targeting all smokers would be an 'enormous amount of work'.

Dr Alex Bobak, a smoking cessation adviser at Wandsworth PCT and a south London GP, said GPs could contact their patients over the telephone to give them advice.

'The majority of smokers see their GP two or three times a year anyway and there's nothing to stop practices phoning patients,' he said.

Dr Scott Wilkes, a researcher on smoking cessation and a GP in Morpeth, Northumberland, said more resources would be needed if advice was to be given proactively and as often as once a year.

'It would have to be opportunistic ­ but we don't see everybody every year.'

Dr Shaun O'Hanlon, a GP in Guildford, questioned whether the guidance was realistic: 'It would be very laudable but there's no point unless the patient wants to stop smoking.

'It would be an enormous amount of work and it's something that would have to be properly resourced. I certainly don't have the time or the resources to chase people up. You can give people all the advice but it's up to them to stop.'

Final NICE guidance is due in March.

GP smoking cessation advice

  • GPs should advise all smokers to quit at least once a year and prescribe NRT or refer where appropriate
  • Nurses in primary and community care should advise all smokers to stop whenever possible
  • Smoking status of those not ready to stop should be recorded and reviewed every year
  • Appropriate monitoring of smoking status and advice offered must be in place
  • Advice to stop smoking should be pragmatic and sensitive to individuals needs

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