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New primary care approach to smoking cessation hailed

A new systems-based approach to smoking interventions in primary care has increased referrals to local NHS Stop Smoking services by up to 49% in pilot areas, says the Department of Health (DH).

The new approach, which will be rolled out to practices over the next few months, was developed to ensure stop smoking interventions by healthcare professionals are routine and systematic, providing a tailored and consistent approach to patient referral.

The approach recognises smoking as a key clinical issue requiring treatment or referral to a specialist, joining standard issues such as hypertension or high cholesterol.

The system ensures that basic advice on stopping smoking is offered to all smokers, which doubles the likelihood of a quit attempt. Practices that have this systems-based approach in place are expected to see improved quit rates in their patients.

The approach comprises: three different 
levels of interventions according to time available; a supportive delivery system that ensures quality stop smoking support becomes routine; and a supportive practice environment that demonstrates commitment to support all patients in stopping smoking.

This approach was successfully pioneered by trained advisers in Rotherham from January 2007 to September 2008. Over this time, referrals to local NHS Stop Smoking Services increased on average by 49% (from 292 to 432) across nine GP practices in Rotherham, with one practice doubling its referrals.

Paul Aveyard, Senior Lecturer at the Department of Primary Care and General Practice at Birmingham University and senior consultant on the development of the primary care project, said: "The approach works by offering patients three levels of intervention, from 30 second very brief advice to intensive support. The primary care programme establishes a supportive delivery system of 10 components that ensures quality stop smoking treatment becomes routine in the practice.

"What we are trying to do is to make the treatment of tobacco addiction routine, in a similar way to hypertension. Previously, the primary care system encouraged GPs to give their patients advice in terms of stop smoking. The difference here is that GPs will now be required to actively manage their patients – such as referring them to a specialist stop smoking service."

The Dinnington Group practice in Rotherham boosted referrals to their local Stop Smoking Service by over 80%. Irene Botham, Clinical Nurse Manager of the practice, said: "Our nurses received expert training from the local NHS Stop Smoking Service in smoking interventions. We worked hard to drive forward the initiative in my practice and saw great results – since we implemented the new systems-based approach our referral rates have increased by 82%.

"There are clear clinical benefits to following this approach and healthcare professionals have a duty of care to help smokers to quit. In addition, our patients can benefit from the assistance of NHS support with which they are up to four times more likely to quit.''

National evaluation of the project's rollout across England is due to take place in April 2010.

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Your comments (terms and conditions apply):

"You don't need to be a trained nurse to provide smoking cessation advice. My appointments are flooded, often 3 weeks' wait, and no time to see existing chronic disease sufferers on time. GPs state no funds to increase nursing team. Although I condone and appreciate the value of health promotion and disease prevention, if general practice is already overwhelmed, where are all these patients going along with the new over-40s screening?" - Lynne Hayward, Manchester

"This is what has been implemented in general practice for the past few years. We just need to keep at it so that more patients are helped to quit." - Cath Gleeson, W Yorkshire

"We are already implementing this process in stop smoking. Patients are coming forward BUT I think another way of repaying the nurses for their hard work is to pay the nurses to help to stop smoking. Patients feels they would like to repay their nurses in some ways. By paying the nurses it would success in both ways. Not that the nurses need more initiatives as they are doing their job but it helps the pts too to help them to think it also benefits someone else if they stop." - Sue Metcalfe, London

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