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No smoke without fire



Interesting juxtaposition of stories. On the one hand we have NICE suggesting that we should ‘adopt a harm reduction approach’ by prescribing NRT to smokers who aren’t actually interested in stopping smoking. And on the other, we have Clare Gerada pointing out that we’re booked up to our eyeballs and regularly working 15 hour days.

As Private Eye would say, do you think they might be in any way related? I think maybe yes. Let’s look at that NICE guidance in a little more detail. What it requires of us is to

  • Identify people who smoke but aren’t willing/able to give up.
  • Ask these people if they would like to consider a harm-reduction approach.
  • If they agree, ‘Help them to identify why they smoke, their smoking triggers and their smoking behaviour. Use this information to work through the harm-reduction approaches.’
  • Discuss the pros and cons of these approaches.
  • Explain that NRT may help them reduce the amount they smoke.
  • Recommend and prescribe NRT.
  • About 16 other steps I can’t be arsed to describe.
  • Froth at the mouth.
  • Die.

Let’s put to one side the fact that there are times when evidence, facts and authoritative guidance just smell completely wrong, and this is one of them. And that, if there’s one thing more tedious than nagging people to stop things they’ve no intention of doing, it’s prolonging that conversation when they’ve already made that fact as crystal clear as it can be through the cloud of tobacco smoke. And that the nation’s repeat prescribing systems will, within a year or two, be clogged up with every form of NRT known to man as we end up subsidising the nicotine habit of around 20% of the population.

Instead, let’s focus on the key points, specifically that

a)     This will generate more consultations.

b)     This will generate longer consultations.

c)     Yesterday there was another thing we ought to be doing that will generate more and longer consultations, and tomorrow there will be something else.

Clare Gerada, in her GPs are overwhelmed story, commenting on the comments, comments that WE NEED MORE GPs. Maybe. But more, much more than this, WE NEED LESS WORK.