New primary care approach
boosts referrals to NHS stop smoking services by 49%
DEPARTMENT OF HEALTH
News Release issued by COI News Distribution Service on 2 June 2009
The Department of
Health is rolling out a new systems-based approach to improve stop
smoking interventions in primary care. This new approach has
increased referrals to local NHS Stop Smoking services by up to
49% in pilot areas.
People who are referred to local NHS Stop Smoking Services are up
to four times more likely to quit.
The new approach was developed to ensure stop smoking
interventions by healthcare professionals are routine and
systematic, providing a tailored and consistent approach to
patient referral. It will be rolled out to practices over the next
few months by trained local NHS Stop Smoking Service advisers who
will support its implementation in local primary care settings.
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 which have this systems-based approach in place
are expected to see improved quit rates in their patients. There
are also two stages within the system for practices to earn QOF
points, increasing the potential revenue and funding for the practice.
The systems-based approach for delivering stop smoking in primary
care comprises:
* a tiered approach to stop smoking support that establishes
three different
levels of interventions according to time
available;
* a supportive delivery system of 10 components
that ensures that quality stop
smoking support becomes
routine; and
* a supportive practice environment that
demonstrates commitment to support
all patients in stopping smoking.
This new approach, which was successfully pioneered by local NHS
Stop Smoking Services in the Yorkshire and Humber region, has been
put into practice by trained stop smoking service 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 project was pioneered in Yorkshire and Humber from 2007 and
data from the regional pilot in Rotherham shows how successful the
approach has been in practices there.
Jacqueline Watson, local NHS Stop Smoking Adviser, Rotherham PCT, said:
"The rollout of Stop Smoking Interventions in Primary Care
will help us improve the health of patients and save more lives,
in addition to helping practices improve their performance by
securing extra QOF points and therefore increasing their potential
revenue. I have found that getting practice managers engaged and
supportive is key, but in those practices I've been working
with in Rotherham, it has already enabled managers to transform
performance and boost QOF scores."
The Dinnington Group practice in Rotherham worked alongside their
local Stop Smoking Service to boost referrals to the 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
health care 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.
For more information, healthcare professionals should contact
their local NHS Stop Smoking Service, which they can find by using
the 'Local Services Search' at http://www.smokefree.nhs.uk/resources
Notes to Editors
1. The majority of local NHS Stop Smoking Services in England
have been trained to introduce primary care practitioners to the
new system and its benefits and will be contacting GP practices
imminently. A toolkit for local NHS Stop Smoking Services (LSSS)
advisers and resources for practices have been developed to
support the rollout. Evaluation is taking place in July &
October 2009 and a final evaluation in April 2010.
2. Local NHS Stop Smoking Services
Local NHS Stop Smoking
Services offer ongoing free support and advice close to
people's homes. There are over 150 throughout the country,
offering a range of services including one-to-one or group support
sessions with trained stop smoking advisers.
Advisers help smokers understand their addiction to tobacco and
work together on a personalised plan to stop smoking. They can
also provide information about nicotine replacement products and
other stop smoking medicines. These are available on prescription
from the NHS.
A total of 680,289 people in England set a quit date through the
local NHS Stop Smoking Services in 2007/8 and over half (350,800
people) reported that they were still smokefree at their four-week follow-up.
3. The evidence is clear that local NHS stop smoking
interventions are very successful:
* Offering brief advice to stop smoking is the single most
cost-effective and clinically proven preventive action that a
healthcare professional can undertake: Anczak J, Nogler R. Tobacco
cessation in primary care: maximizing intervention strategies.
Clinical Medicine & Research 2003; 1(3): 201-216.
* Smokers are up to four times more likely to quit smoking
successfully with support from their local NHS Stop Smoking
Services: Ferguson J, Bauld L, Chesterman J, Judge K. The English
smoking treatment services: one-year outcomes. Addiction 2008; 100
(Suppl. 2): 59-69 and West R, McNeill A, Raw M. Smoking cessation
guidelines for health professionals: an update. Thorax 2000;
55(12): 987-99.
* When stop smoking messages are received from trusted
practitioners, motivation and the chances of action is likely to
be increased. Fiore M, Bailey W, Cohen S et al. Treating Tobacco
Use and Dependence. US Department of Health and Human Services,
Public Health Service, 2000.
4. Supportive delivery system - the 10 components to success: The
healthcare setting needs to establish a support system to ensure
that successful smoking advice becomes routine. There are 10
components that work together and these are essential in making
sure that the healthcare team can provide quality stop smoking
support. In essence they demonstrate the team's complete
commitment to helping patients quit. Smokers are supported at
every level, as is the team in the primary care setting. Managers
give their team strong incentives to do well, backed up by the
right resources, training and facilities. Each component is a link
in the chain. If one link is missing, the whole system becomes weakened.
The 10 components are:
* Senior level commitment
* Incentives
* Protocol
*
Teamwork
* Training
* Environment
* Resources
*
Therapies
* NHS Stop Smoking information
* feedback
5. Smoking remains the main cause of preventable morbidity and
premature death in England, leading to an estimated 82,900 deaths
in 2007 (18 per cent of all deaths of adults aged 35 and over)
estimated to be caused by smoking. (Statistics on Smoking, England
2008, Health Information Centre).
http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/smoking/statistics-on-smoking-england-2008-[ns]
NICE (National Institute for Health and Clinical Excellence)
recommends that all healthcare practitioners give brief stop
smoking messages to all smokers (unless exceptional circumstances
make it inappropriate to discuss smoking).
Please contact Department of Health press office on 020 720 5221