PCT cost-cutting breaches NHS rules

PCTs are breaching the NHS constitution and may damage patients' health by blocking GP prescribing of smoking cessation drugs, a GP investigation reveals.

Smoking: restricting choice undermined patients' faith in treatment, making it harder to quit (Photograph: SPL)
Smoking: restricting choice undermined patients' faith in treatment, making it harder to quit (Photograph: SPL)

Figures obtained under the Freedom of Information Act also show 33 per cent of PCTs slashed funding for smoking cessation services by up to 90 per cent in 2010/11.

GPs criticised the measures as short-sighted and potentially harmful to patient health.

The investigation of 120 PCTs found 14 per cent contravene NICE advice by failing to back equal first-line access to smoking cessation drugs NRT, varenicline or bupropion in general practice.

NICE guidance says clinicians and patients can choose the drug that is most likely to succeed. But some PCTs have ruled that patients cannot access varenicline or bupropion until they have failed on NRT.

The NHS constitution makes clear that PCTs must provide NICE-approved treatments when appropriate for a patient.

South west London smoking cessation GPSI Dr Alex Bobak said restricting choice undermined patients' faith in treatment, making it harder to quit and a relapse more likely. 'Smoking cessation is a behavioural change. A key factor is to have the smoker buy into the treatment,' he said.

Birmingham smoking cessation expert and GP Professor Paul Aveyard said: 'Quit attempts are precious. Each that fails costs a patient quality and length of life.'

Martin Dockrell, director of research and policy at charity Action on Smoking and Health, said: 'With a cost of £1,000 to £2,000 per life-year saved, quitting aids far out-save most other medicines. These PCTs are opting to pay for costly care in the future rather than help smokers to quit today.'

Dr Bobak accused PCTs of 'ridiculous short-termism' by reducing budgets: 'PCTs which cut smoking cessation are cutting based on cost, not cost effectiveness,' he said.

West Midlands GPSI Dr Charles Broomhead, a member of the Smoking Cessation in Primary Care group, said he was 'very concerned' about the cuts. His PCT, NHS Birmingham North and East, slashed budgets by 20 per cent (£170,000) in two years. It said numbers of patients quitting had not fallen in this time.

Dr Broomhead, also chairman of Birmingham's Forward Health GP consortium, said it would 'oppose these decisions in our commissioning role'.

Dr Charles Broomhead: 'GP consortia can oppose these decisions in their commissioning role'

The findings also show just 4 per cent of PCTs follow NICE advice to record all forms of tobacco use in their area.

The Race Equality Foundation said mapping tobacco use among black and ethnic minority communities is vital to improving poor service access.

  • Smoking-related illness costs the NHS £5.2 billion a year.
  • It costs the NHS £249 on average to help one patient quit, excluding drug cost.
  • A successful quit attempt saves the NHS £1,000-£2,000 per life-year saved.
  • About 10 million UK adults smoke; 100,000 die each year of smoking-related causes.

Source: NHS Information Centre, Action on Smoking and Health

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