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Quick QOF tips, 2013-4: Smoking (SMOK)

Dr Simon Clay offers advice for the new SMOK indicators

The area of recording smoking status, advising smokers and offering cessation treatment is pretty complex in the QOF this year. In this article I try to clarify who needs what doing, what codes are required and how often patients need their smoking status adding again.

Five indicators

There are five smoking indicators in the 2013-4 QOF. SMOKING 1 and 4 relate to all patients from 15 years old upwards, and record whether we have documented their smoking status in the 24 months before the reference date (that is, 1 April 2014). It also checks whether the practice has engaged with smokers in this group by offering advice and/or support or treatment.

SMOKING 2 and 5 are recorded in relation to a cut-down group of patients with one or more of the following nine diseases:

  • CHD
  • asthma (patients aged 20 and over on the reference date)
  • COPD
  • hypertension
  • diabetes (patients aged 17 and over on the reference date)
  • CKD (patients aged 18 and over on the reference date)
  • PAD  
  • MH (the QOF code covering schizophrenia, bipolar affective disorder or other psychoses)

Again, SMOKING 2 relates to whether the GP has recorded their smoking status, but in the last 12 months rather than in the 24 months to the reference date.

SMOKING 5 relates again, as per SMOKING 4, to whether we have engaged with smokers in this group by offering advice and/or support or treatment.

SMOKING 3 has moved from Information 7 for QOF 2013-14 and relates to whether we provide smoking support services and literature for people hoping to stop.

Offer referral or advice for SMOKING 5

Under Version 22.0 rulesets (April 2012), patients needed evidence of an offer of referral to a smoking cessation service (relevant read codes below) as well as evidence of pharmacological intervention or advice (again, relevant read codes below). Smoking patients with any of the nine diseases mentioned now needed to be offered ‘a record of an offer of support and treatment within the preceding 15 months’ (worth 25 points, 50-90%). However an addendum (Version 22.1) was released (May/June 2012) whereby one Read code from A or B would suffice (as opposed to both).

Evidence of an offer of referral to a smoking cessation service

  • 8CAL Smoking cessation advice (used previously, still counts)
  • 8HTK. Referral to stop-smoking clinic
  • 8HkQ. Referral to NHS stop smoking service
  • 8H7i. Referral to smoking cessation advisor
  • 8IAj. Smoking cessation advice declined
  • 8IEK. Smoking cessation program declined
  • 9N2k. Seen by smoking cessation advisor
  • 13p50 Practice based smoking cessation programme start date
  • 9Ndf. Consent given for follow-up by smoking cessation team
  • 9Ndg. Declined consent for follow-up by smoking cessation team

Evidence of pharmacological intervention or advice

  • 745H.% Smoking cessation therapy
  • 8B3f. Nicotine replacement therapy provided free
  • 8B2B. Nicotine replacement therapy
  • 8B3Y. Over-the-counter nicotine replacement therapy
  • du3..% Nicotine prescribed products (lozenges, gum and patches)
  • du6..% Bupropion (Zyban)
  • du7..% More nicotine products
  • du8..% Varenicline (Champix)
  • 8IEM.  Smoking cessation drug therapy declined

Record everyone’s smoking status every two years

  • You don’t have to collect smoking status for anyone under the age 15 on 1 April 2014.
  • If the patient is a current smoker, you only need to record that within 24 months of next April.
  • If the patient is 26 or over and you have recorded ‘never smoker’ as their last smoking code (after they reached 26), you do not need to record it again.
  • If the patient is aged 15-25 and a ‘never-smoker’ then you need to re-record smoking status every 24 months.
  • If the patient is an ex-smoker then you need to either have the ex-smoking status recorded within the last 24 months, or have a record of ex-smoker status in three consecutive years in their history.

Stop producing evidence of cessation drugs for Smoking 4 and 5

For SMOKING 4 and SMOKING 5, patients now do not need evidence of pharmacotherapy as well as advice as they did under Version 22.0). They need:

  • a code from the ‘offer of referral’ list (for example, advice to stop) or,
  • referral to a clinic, or
  • a code from the ‘evidence of pharmacological intervention or advice’ list (for example, evidence of pharmacotherapy) or,
  • the read code that documents them declining pharmacotherapy (8IEM).

Any one of these four will score SMOKING 5 (if added in last 12 months) and SMOK 4 (if added in last 24/12 months).

Search for ex-smokers

For the smoking ruleset, there are two ‘tricks’ I would commend to you. Firstly, say you ask a patient if they smoke and they say, ‘oh yes, I gave up in 1980’ as some patients do. There’s therefore nothing to stop you adding three ‘ex-smoker’ codes consecutively. The second trick for the smoking ruleset is to run a search on any ‘secret’ or ‘hidden’ ex-smokers on your list. At my practice we ran a report looking for patients aged 15 and over, coded an ex-smoker before 1 April 2012, whose records had free text added to the entry which might indicate a quit date some time before.  To run this search, the key codes to search for are

  • 1377 to 137B
  • 137F
  • 137K
  • 137N
  • 137O
  • 137S and 137T
  • 137j. and 137l

For the more organised or obsessive practices, this may be an idea worth looking at.

Dr Simon Clay is a GP in Birmingham. For information on Dr Clay’s QOF Resource Disc go to

Readers' comments (3)

  • So this is war.
    We need as a profession to realise that we are in a long and drawn out war with governments. We need to understand this is all part of an orchestrated campaign to destroy general practice and not just another isolated skirmish.
    Recent financial settlements especially the last have all been aimed at cutting off the life blood to the front line.
    CQC, revalidation, CCGs and structural changes have been imposed to weaken morale and professional cohesion and demote professionalism to an anachronism.
    The abusive and biased press reporting of the profession has been orchestrated to reduce the value placed on general practice by patients who in repeated surveys have been shown to be very happy and satisfied in general with the primary care services the receive.
    We now have a plan to reduce and finally cut of the supply of the very professionals who man the service.
    It is time for our professions leaders to take stock and point out to the public exactly what is going on and exposes them to the unstated but obvious final outcome of farming out all medical care to the cheapest provider and then to face multiple NHS 111 fiascos but eventually, having lost traditional providers in the war, the only option will be throw more and more money at the private sector who will bt then be in control, yet experience worse and worse care.

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  • Peter Swinyard

    Welcome to Planet Zog, all those who think this is a good idea.
    The cost of training a GP in a practice is already more than the training grant if you add in the extra 5 days study leave needed by a trainer (locum cost £3500), the loss of trainer and other GP clinical time in supervision of the trainee, the preparation time for tutorials and the protected time for tutorials etc etc.
    Yes, a good trainee can give back some clinical service in the later part of their training but a challenging trainee can take an inordinate amount of partner and trainer time for support and supervision.
    This is another barking idea from those who would destroy general practice.
    Most financially astute practices (would you want to be trained in a financially incontinent practice?) will withdraw from training.
    An idea to be left on the hillside of Delphi.

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  • Great ideas especially with so many qof points awarded to this indicator. Thank you

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