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Paying GPs a bonus if smokers give up 'cost-effective'

By Nigel Praities

GP targets for the proportion of patients who give up smoking have moved a step closer with new research finding paying by quit rate would be cost-effective.

The study found paying GPs over £100 for each patient who remained abstinent after one year was cheaper than prescribing pharmacological therapy alone.

The QOF currently only pays GPs for providing a brief intervention or referral to a stop smoking service, but NICE intends to give the framework a greater focus on outcomes from April.

Some experts believe the new study, published in the Archives of Internal Medicine, provides the institute with the evidence it needs to push smoking cessation targets.

German researchers studied 577 patients for 12 months, and found just prescribing NRT or bupropion hydrochloride cost 92.12 Euros per patient.

This compared with 82.82 Euros per patient if GPs were paid 130 Euros if the patient did not smoke at the end of the study and were free to prescribe NRT or bupropion hydrochloride if they wished.

The authors concluded both strategies were cost-effective and should be recommended. ‘Both strategies have a high potential to decrease the prevalence of nicotine abuse,' they said.

Dr Alex Bobak a smoking cessation GPSI in Battersea, south London, said practices required adequate resources to provide a full smoking cessation service.

‘There is a common perception we are already paid for this. But the QOF only pays us to deliver brief interventions to check smoking status, whereas what we need to be paid to do is to deliver proper smoking cessation.

‘We have two healthcare assistants here and they need to be paid for a lot of time, because it takes about two and a half to three hours per quit attempt and not all smokers succeed,' he said.

Dr Paul Aveyard, a GP in Solihull and a member of the smoking cessation guideline development group at NICE, disagreed with the QOF providing this type of incentive.

‘Stopping smoking is quite a rare event. GPs and others can work hard at it and even with the best the NHS can give only 15% of people who try to stop will stay abstinent for a whole year,' he said.

Smokers: could be cost effective to pay GPs for those who successfully quit

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