Viewpoint: How GPs can help smokers quit for good

By Martin Dockrell on the 27 November 2018

GPs play a crucial role in identifying smokers and signposting expert support. Martin Dockrell, Public Health England's tobacco control lead, outlines what GPs can do to support patients to quit.

Smoking rates are falling yet it is still too prevalent, with over 6m adults still smoking tobacco across the country. GPs will be well aware that helping more people quit tobacco is one of the single biggest things we can do to improve the nation’s health and this has been echoed by the secretary of state in his prevention vision.

As a likely first point of contact for patients who smoke, GPs play a crucial role in identifying smokers and signposting expert support. The RCGP has guidance to help doctors feel confident in discussing smoking and this has recently been updated to include the very latest information on different types of quitting aids including e-cigarettes.

Currently, around half of smokers trying to quit do so using willpower alone but this is by far the least effective method. Getting support can greatly increase a person’s chances of quitting successfully – 16 in 100 people remain non-smokers after a year when they choose to quit with support from a trained stop smoking advisor and use a stop smoking aid, compared to only three to four in 100 who go ‘cold turkey’.

The GP role

GP and primary care triggered quit attempts have been falling in recent years but evidence shows that prompts from healthcare professionals are the second most common reason for someone to make a quit attempt. With smokers seeing their GP 35% more than non-smokers, there are frequent opportunities to offer interventions.

With limited consultation time, there can be concerns about raising the issue of smoking. Using the Very Brief Advice model as part of consultations can help GPs make every contact count and there is guidance to support conversations with people who want to quit smoking on what method to choose.

An important part of delivering effective interventions is to communicate the evidence-based benefits of different quitting aids so that smokers can make an informed choice about their preferred way to quit.

Evidence shows that many smokers are still unclear about the benefits of different quitting aids, especially around e-cigarettes. It’s important to challenge these misconceptions, particularly in deprived communities where smoking rates are still high. One vital message is that despite being addictive, nicotine is relatively harmless.

Main types of support

A person’s chances of quitting are doubled if using stop smoking aid, including medicines available on prescription. Here’s a quick summary about three main types of support that smokers should know about.

Prescription tablets: Varenicline reduces cravings for nicotine while bupropion reduces urges to smoke and helps with withdrawal symptoms. Both can increase a smoker’s likelihood of becoming smokefree, in combination with behavioural support, and should be included in the local drug formularies in line with NICE guidance. However, neither are suitable for pregnant women.

Nicotine replacement therapy (NRT): Patients may already be aware of NRT in the form of patches and gum, but may not know that they are also available as inhalers, oral strips, lozenges, microtabs, nasal and mouth sprays. Products are available in different strengths so that nicotine intake can be gradually reduced when the person feels ready. NRT increases chances of stopping smoking for 6 months or more by over half and there is good evidence to show that combination NRT is more effective than single product use.

E-cigarettes or vapes: E-cigarettes are not risk free but evidence suggests that they are around 95% less harmful than tobacco. Yet many smokers incorrectly believe that vaping is as harmful as smoking. E-cigarettes are helping many thousands of smokers in England to quit and they are particularly effective when combined with expert help from a local stop smoking service.

You can read PHE’s response to some of the more commonly reported inaccuracies and misconceptions when it comes to e-cigarettes here. There are a number of free, online resources to support GPs in feeling confident discussing e-cigarettes: PHE’s latest Health Matters on stopping smoking and the BMA’s advice on what doctors should say when faced with questions.

The National Centre for Smoking Cessation and Training also offers a number of training resources, including a module on e-cigarettes and a short video explaining the facts around their safety.