Funding cuts leave GPs unable to prescribe stop smoking products

Cuts to public health funding have led to a dramatic fall in prescriptions for stop smoking products and left many GPs unable to provide patients with support to quit, a health charity has warned.

(Photo: iStock.com/Mac99)
(Photo: iStock.com/Mac99)

The number of prescriptions issued in primary care in England for nicotine replacement therapy (NRT) fell by 75% between 2005/6 and 2016/17 and dispensing rates for varenicline fell by more than 50% between 2010/11 and 2016/17, according to new analysis by the British Lung Foundation.

The research also found that the number of stop smoking products dispensed in Wales in 2016/17 was two-thirds less than in 2007/8 and there was a 40% fall in the number of products dispensed in Scotland between 2012/13 and 2014/15.

The British Lung Foundation said the results were the ‘very real effects of sustained cuts to funding.’

The charity's report Less help to quit said the decline in prescriptions of stop smoking products over the past five years had not been matched by a similar decrease in smokers. Between 2010/11 and 2016/17 smoking prevalence in England fell by 22%, while prescription rates fell by 60%.

According to figures from NHS Digital, GP practices are the most common place for smokers in England to first seek help to quit, with 38% choosing this route. However, the British Lung Foundation said that people were increasingly unable to get help to stop smoking from their GP surgery because of funding restrictions. 

A survey by GPonline earlier this year found that 40% of GP partners had experienced cuts in funding for smoking cessation services provided by their practice in the previous 12 months

Regional variation

This latest research found significant regional variation in the availability of stop smoking products on prescription and specialist services. Stop smoking services had been cut, or decommissioned entirely, in areas of England and some CCGs had issued guidance asking GPs not to prescribe smoking cessation products.

In Worcestershire the local authority decommissioned its stop smoking services in April 2016 and CCGs advised GPs not to prescribe NRT, bupropion or varenicline for any new patients because the local authority would no longer reimburse the costs.

Across the area just 98 people were supported to stop smoking in 2016/17 compared with 2,208 in the previous year, and there were no recorded quit attempts made through general practice.

The report also found that some areas with higher than average smoking prevalence had 'incredibly low' prescribing rates. On average one prescription for stop smoking products is dispensed for every seven smokers in England. However, the research found that this figure drops to 1 in every 176 smokers in Bracknell and Ascot CCG in Berkshire and 1 in 55 smokers in Hackney CCG in east London.

Items prescribed per 1,000 population are also much lower in England than in Scotland, and this gap is widening, the report added.

The British Lung Foundation warned that the use of e-cigarettes, which are not available on the NHS, could not be guaranteed to fill the gap created by the drop in prescriptions. E-cigarette use had plateaued among smokers since early 2013 and their use among recent ex-smokers had declined from a peak in 2016.

Public health cuts

Professor Stephen Spiro, honorary medical adviser to the British Lung Foundation said: ‘Many smokers cannot get the medication they need to quit because of the decisions made by their local health services.

‘These decisions are of course not taken lightly or, in some cases, willingly. They are a result of the erosion of government funding for stop smoking support. In England, the national cuts in public health funding will total over £600m by 2021. This report shows that we’re reaping the very real effects of sustained cuts to funding. Yet again we must call for these damaging reductions to local public health funding to be reversed.

‘This report also shows how – to cut costs - decisions are being taken by a growing number of CCGs to stop GPs from prescribing clinically-effective and appropriate medication for smokers. This is a travesty.‘

The British Lung Foundation said all smokers should be able to expect their GP to provide access to stop smoking medication, either by issuing a prescription or referral to a specialist service.

It called on commissioners to remove any unfair restrictions on which types and how many approved stop smoking products could be prescribed.

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