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GPs have called for practices in high-smoking areas to be properly compensated for the extra workload after new figures revealed the gaping divide between different PCTs.

Trusts in London, Manchester and Liverpool topped the league table for high smoking-related mortality. In North Liverpool PCT 43 per cent of all deaths among the over-35s were attributable to smoking. On the other side of the divide, in rural East Devon PCT, only 23 per cent of deaths were related to smoking (see chart).

Dr Martin Breach, a GP in Haydock, Merseyside, and a former GPC member, suggested the Carr-Hill formula could be adjusted to normalise for smoking deaths.

And Dr John Pittard, a GP in Staines, Middlesex, and board member of the Primary Care Cardiovascular Society, said: 'If a PCT has a high prevalence you could argue it should be forced to commission enhanced services.'

The figures, based on averages for the years 1998-2002, were published in the Health Development Agency report The Smoking Epidemic in England.

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