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GPs should prescribe NRT to help smokers cut down, says NICE

GPs should prescribe nicotine replacement therapy to patients who remain smokers, but intend to smoke less, recommends new NICE guidance.

The draft guidance - published yesterday - suggests GPs should offer NRT to smokers, even if they do not set a date for when they will quit smoking.

The new guidance comes after a study published by UK researchers last year that recommended GPs should offer treatment to all smokers regardless of whether they had expressed an interest in quitting or not.

The guidelines go further than previous recommendations that recommended GPs only provided NRT for patients who have set a date to quit.

They recommend GPs should broaden the patients in whom they consider prescribing NRT, including those who wish to:

1. Cut down prior to quitting, with a view to stopping smoking within the next few months, by smoking fewer cigarettes or inhaling or smoking less of the cigarette, with or without the help of one or more NRT

2. Smoke less, by smoking fewer cigarettes, inhaling less or smoking less of each cigarette, with or without the help of NRT, while remaining a smoker

3. Temporarily abstain with or without the help of one or more NRT, for example ‘during the working day’ or ‘while in the home’, while remaining a smoker.

Professor Mike Kelly, director of the NICE Public Health Centre, said: ‘Smoking less is an option for those who are not interested in quitting smoking, although the health benefits are not clear. However, for some people this can kick-start a gradual change in behaviour that eventually leads them to quit smoking.’

Dr Alex Bobak, a GP in south London and smoking cessation adviser at Wandsworth PCT said he was surprised by the guidance.

He said: ‘My understanding is that we should promote complete stopping. We know most smokers who want to reduce smoking want to do so to eventually stop. Having said that there is a small minority of people who would not consider stopping who could be offered NRT, but the aim would still be for them to completely stop at some point.’

However, Dr Bobak also criticised the guidance for only focusing around NRT and not the other types of smoking cessation therapies, varenicline and bupropion.

He said: ‘The primary goal has to be to get people to stop smoking. In order to achieve this we must offer all available therapies as well as support.’