Editorial: PCTs must prioritise smoking-cessation bids

Does your primary care organisation incentivise your practice through a local enhanced service to record smokeless tobacco use among patients?

If not, it's not alone, because this week GP reveals exclusively that just five of 120 PCTs hold up-to-date information on all forms of tobacco use, despite NICE requiring it.

Smokeless tobacco use is highly addictive and linked to both oral cancer and cardiovascular disease.

PCTs paying practices to collate such information would enable managers to tailor their services appropriately. As our analysis reports, smokeless-tobacco use is common among ethnic-minorities in England yet data are rarely collected and access to smoking-cessation services remains poor among these communities.

But it's not just data collection that PCTs must improve. Our investigation also finds that one PCT in seven restricts GPs' choice between the three NICE-approved cessation drugs - NRT, varenicline and bupropion - as equal first-line treatments.

NICE advises that clinicians and patients must be allowed to choose the one that seems most likely to succeed.

Cost may be a factor with varenicline more expensive than NRT, although arguably more successful. Does restricting access to first-line treatments damage patient attempts to quit? West Midlands GP Dr Charles Broomhead, a member of Smoking Cessation in Primary Care, fears so.

Funding potential in the longer term is also disappointing, with our investigation finding that a third of PCTs have cut funding to smoking-cessation services in the past year, with further cuts likely in 2011/12.

Smoking cessation is one of the most cost-effective interventions medicine has. While PCTs are still with us, they should be encouraged to increase spending, better research population need and allow GPs to prescribe the treatments patients should have. It is better to invest now than pay for cancer care in the future.

The challenge to consortia will be to do better with more limited resources.

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