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Boosting Referrals To NHS Stop Smoking Services

Ruzanna Harutyunyan's picture

The Department of Health is rolling out a new systems-based approach to improve stop smoking interventions in primary care. This new approach has increased referrals to local NHS Stop Smoking services by up to 49% in pilot areas.

People who are referred to local NHS Stop Smoking Services are up to four times more likely to quit.

The new approach was developed to ensure stop smoking interventions by healthcare professionals are routine and systematic, providing a tailored and consistent approach to patient referral. It will be rolled out to practices over the next few months by trained local NHS Stop Smoking Service advisers who will support its implementation in local primary care settings.

The approach recognises smoking as a key clinical issue requiring treatment or referral to a specialist, joining standard issues such as hypertension or high cholesterol.

The system ensures that basic advice on stopping smoking is offered to all smokers, which doubles the likelihood of a quit attempt. Practices which have this systems-based approach in place are expected to see improved quit rates in their patients. There are also two stages within the system for practices to earn QOF points, increasing the potential revenue and funding for the practice.

The systems-based approach for delivering stop smoking in primary care comprises:

* a tiered approach to stop smoking support that establishes three different levels of interventions according to time available;

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* a supportive delivery system of 10 components that ensures that quality stop smoking support becomes routine; and

* a supportive practice environment that demonstrates commitment to support all patients in stopping smoking.

This new approach, which was successfully pioneered by local NHS Stop Smoking Services in the Yorkshire and Humber region, has been put into practice by trained stop smoking service advisers in Rotherham from January 2007 to September 2008. Over this time, referrals to local NHS Stop Smoking Services increased on average by 49% (from 292 to 432) across nine GP practices in Rotherham, with one practice doubling its referrals.

Paul Aveyard, Senior Lecturer at the Department of Primary Care and General Practice at Birmingham University and senior consultant on the development of the primary care project, said:

"The approach works by offering patients three levels of intervention, from 30 second very brief advice to intensive support. The primary care programme establishes a supportive delivery system of 10 components that ensures quality stop smoking treatment becomes routine in the practice.

"What we are trying to do is to make the treatment of tobacco addiction routine, in a similar way to hypertension. Previously, the primary care system encouraged GPs to give their patients advice in terms of stop smoking. The difference here is that GPs will now be required to actively manage their patients - such as referring them to a specialist stop smoking service."

The project was pioneered in Yorkshire and Humber from 2007 and data from the regional pilot in Rotherham shows how successful the approach has been in practices there.

Jacqueline Watson, local NHS Stop Smoking Adviser, Rotherham PCT, said: "The rollout of Stop Smoking Interventions in Primary Care will help us improve the health of patients and save more lives, in addition to helping practices improve their performance by securing extra QOF points and therefore increasing their potential revenue. I have found that getting practice managers engaged and supportive is key, but in those practices I've been working with in Rotherham, it has already enabled managers to transform performance and boost QOF scores."

The Dinnington Group practice in Rotherham worked alongside their local Stop Smoking Service to boost referrals to the local Stop Smoking Service by over 80%. Irene Botham, Clinical Nurse Manager of the practice said: "Our nurses received expert training from the local NHS Stop Smoking Service in smoking interventions. We worked hard to drive forward the initiative in my practice and saw great results - since we implemented the new systems based approach our referral rates have increased by 82%. There are clear clinical benefits to following this approach and health care professionals have a duty of care to help smokers to quit. In addition, our patients can benefit from the assistance of NHS support with which they are up to four times more likely to quit.''