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GPs buried under trusts' workload dump

NRT 'doubles quit rate on its own'

Nicotine replacement therapy on its own – with no behavioural support - doubles the long term quit rate, say the authors of a groundbreaking new study.

The data means GPs should initiate NRT then refer smokers onto cessation clinics, rather than try and develop stop smoking services themselves, say the authors.

Doubts have been raised about the effectiveness of NRT outside the additional behavioural support provided in clinical trials.

But the new study – looking at over 5,600 smokers in the UK, France, Spain and North America, making self-initiated quit attempts – found that NRT more than doubled their chances of quitting.

The study is the first to look prospectively at NRT with no support services and the outcomes were similar to those in clinical trials with behavioural modification programmes, counselling or help from a stop smoking clinic.

Lead author is Professor Robert West, director of tobacco studies at the Cancer Research UK Health Behaviour Unit and architect of NHS stop smoking services.

He said the data confirms that GPs should have confidence that NRT is effective in the ‘real world.'

He stressed that good-quality behavioural support was still valuable, but was difficult to achieve in primary care and advised GPs should refer patients onto specialists, rather than trying to develop stop smoking clinics themselves. ‘GPs should prescribe NRT first and then encourage a patient to go to a stop smoking clinic,' he said.

Gay Sutherland, who runs a stop smoking clinic in London and is a research psychologist at the Institute of Psychiatry, supported the approach. ‘We have many fully-funded specialist clinics in this country that are not reaching capacity and GPs should be encouraging patients to come to them,' she said. She said her clinic had quit rates of 70-75%.

But Dr Alex Bobak, a GPSI in smoking cessation in Wandsworth, south London, maintained that GPs could run a successful stop smoking clinic. ‘Primary care is the ideal place to deliver this sort of care,' he said. ‘In our practice we have quit rates above the specialist clinic for our PCT.'

The study was published online in Thorax.

Is additional smoking cessation support from GPs worth it?

Is additional smoking cessation support from GPs worth it?

• NICE guidelines say that all smokers who want to stop should be offered a referral to an intensive support service. If they are unwilling or unable to accept this referral they should be offered pharmacotherapy and additional support
• Intensive support in primary care has no benefit compared with basic support, according to a recent study in Thorax
• A Cochrane review found that smokers undergoing spe-cialist counselling were 56% more likely to quit, compared with those receiving minimal contact


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