Workload and funding cuts leave GPs struggling to offer stop smoking services

Rising workload pressures and cuts to public health funding have left GPs struggling to provide basic smoking cessation services to patients, reports have warned.

Smoking (Photo: Mike Kemp/Getty Images)

Research by Cancer Research UK found that just 53% of GPs and nurse practitioners had time to offer patients 'very brief advice' about quitting smoking. The model encourages primary care staff to ‘ask, advise and act’ on patients’ smoking status - and should take ‘less than 30 seconds’.

Nearly three quarters of GPs surveyed (72%) said they did not have enough time within a consultation to conduct VBA on smoking cessation, while 40% felt patients would be ‘unreceptive’ to advice on how to quit smoking.

Additional barriers included concern over negative patient reactions (15%), the perception that other healthcare practitioners were responsible for this type of intervention (15%) and the lack of referral options (15%).

Meanwhile, 42% of primary care practitioners agreed that government budget cuts - the most significant of which saw the public health grant slashed by £200m in 2015 - had negatively impacted smoking cessation services locally. Further cuts have been announced for 2019.

Smoking cessation

These figures are broadly in line with a GPonline survey conducted last year, in which 40% of GP partners reported a reduction in funding for smoking cessation treatments - making them the worst-hit of all public health services.

BMA public health medicine committee chair, Dr Peter English, said that smoking cessation services ‘remain one of the most effective ways of quitting’, offering smokers a ‘vital source of support’ when it comes to reducing ‘one of the leading causes of preventable ill health’.

‘Budget reductions have unfortunately led to unacceptable variations in the quality and quantity of services available. This is particularly apparent in more deprived areas where demand is higher, and resources more thinly spread,’ he said.

Public health cuts

‘Government reductions in the public health grant has meant many local authorities are under a lot of pressure to make savings and are very often in the position of having to rob Peter to pay Paul with prevention services often at risk.’

He added: ‘Cuts to smoking and other healthcare prevention services are not cost-effective in the long run. They have a detrimental impact on population health which risks widening health inequalities and increases future NHS demand requiring further spending.’

In response to the report’s findings, Cancer Research UK has made several policy recommendations. These include…

  • Prioritise smoking cessation and tobacco control in regional plans.
  • In England, work with local authorities to ensure shared understanding of tobacco control responsibilities, seamless referrals to local SSS, and availability of pharmacotherapies to all smokers.
  • Signpost to and/or provide all primary care health practitioners with training in the delivery of VBA.
  • Ensure pharmacotherapy for smoking cessation is available on prescription and encourage primary care health practitioners to prescribe pharmacotherapy with brief advice for smoking cessation.
  • Support the use of e-cigarettes as an aid to stop smoking, recommending that they can also be used alongside behavioural support.

GP support

Smoking is still the single biggest cause of preventable illness, cancer, and avoidable death in the UK, and is estimated to cost the NHS around £2bn a year

Although evidence-based models that ‘routinely provide treatment to smokers admitted to hospital’ are being rolled out across secondary care - potentially achieving net savings of £30-60m a year - there are no such plans for primary care.

Kruti Shrotri, policy manager at Cancer Research UK, said: ‘Every visit to see a GP is an opportunity to help smokers to quit, but because GPs have so much to cover in a short space of time, this doesn’t always happen. Smoking substantially increases your risk of developing several long-term conditions, including cancer, so there’s no doubt that tackling smoking rates would improve patient health and reduce demand on the health system.

‘GPs need more support to help them make smoking cessation a priority. This means better training for GPs on how to help their patients quit smoking and better incentives in place to encourage them to do so.’

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