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GPs sceptical of offering counselling to smokers

Most GPs are reluctant to

offer smoking cessation counselling and treatments recommended in NHS guidelines because of time pressure and doubts about effectiveness, an international study has shown.

The findings suggest GPs may struggle to meet demands in the new contract for them to offer smoking cessation advice to patients with cardiovascular disease, diabetes, asthma and COPD.

A research team at Guys, Kings and St Thomas's Medical School in London compiled data from 15 international studies, including five conducted in the UK, which focused on barriers to helping smokers in general practice.

The study, presented at a British Psychological Society conference last month, found 63 per cent of GPs did not have time to offer counselling or treatments such as nicotine replacement therapy or bupropion (Zyban). A similar proportion ­ 61 per cent ­ were concerned their efforts would be ineffective.

Lack of skills was cited as a barrier by 40 per cent of GPs and 23 per cent did not think it was their job to do so.

Fewer GPs had concerns about offering brief advice ­a five-minute opportunistic discussion with patients about smoking. Lack of time was a concern for 37 per cent, 26 per cent were unsure of the effectiveness of brief advice, and 20 per cent felt they lacked the necessary skills.

One of the researchers, Florian Vogt, said GPs' negative attitude to smoking cessation could be because they feel their chances of success with individual patients are slim. 'Brief advice increases the quit rate by 2 per cent and that is quite small. But on a nationwide level that is a huge number of people,' he said.

Dr Alex Bobak, a GP in Wandsworth, south London, with a special interest in smoking cessation, said: 'It is symptomatic of the strains of general practice ­ people do feel overburdened.

'But if you analyse it, this is a tremendously worthwhile use of our time. For every 10 people you treat you will prevent a death. No other intervention can provide this benefit. GPs are unbelievably well-placed to do it.'

NICE guidance says nicotine replacement therapy or bupropion should be prescribed for patients who want to quit smoking.

The institute estimates GPs would see one new patient requesting smoking cessation help every two weeks.

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