Fall in Support for Smokers to Quit Is 'Concerning': Report

Peter Russell

July 16, 2018

British smokers are increasingly being left without support from GPs and pharmacists to help them quit, a new report found.

An analysis carried out by the British Lung Foundation (BLF) suggested that funding cutbacks were responsible for a "deeply concerning" decline in prescriptions for stop smoking aids.

The report, Less help to quit: what's happening to stop smoking prescriptions across Britain , found that the number of primary care prescriptions for nicotine replacement therapy (NRT), varenicline and bupropion had fallen in England, Wales and Scotland at rates which were much steeper than the fall in smoking. The main findings were:

  • A 75% decline in the number of stop smoking aids dispensed in England in 2016- 17 compared with 2005-6

  • A 40% drop in stop smoking aids prescribed in Scotland between 2012-13 and 2014-15

  • The number of all stop smoking products dispensed in 2016-17 in Wales fell to a third of what was dispensed in 2007-08

Central Government Funding Cuts

Alison Cook, director of policy at the BLF, said: "It's obvious cost pressures in local authorities are due to cuts from central government and the main reason these vital services are vanishing. NICE guidance is clear that all smokers should have access to specialist services where they can receive clinically-effective support based on their own needs and preferences.

"The new BLF analysis shows this simply isn't happening. Smokers are discriminated against depending on where they live due to the commissioning choices made by local NHS bosses."

The report identified regional variations in support levels for smoking cessation by Clinical Commissioning Groups.  Also, alternative routes to help people quit have been in decline, including specialist clinics.

Postcode Lottery for Smoking Services

Smokers in Worcestershire saw their local authority decommission its stop smoking services in April 2016. Three CCGs also advised that funding constraints meant that no prescriptions for NRT, bupropion or varenicline should be written for new patients.

As a result, prescriptions in Wyre Forest in the county fell by 85% from 2,034 to 302, and in South Worcestershire by more than 80%.

It said this led to a situation across Worcestershire – where smoking rates are close to the UK average of 15.8% – in which just 98 people were supported to quit smoking last year, compared with 2,208 in the previous year.

Elsewhere, in the city of York, stop smoking prescriptions were only available to those in priority groups.

In contrast, Bradford City CCG, which has a high smoking rate of 22.2%, offered an 'open to all' stop smoking service using pharmacies, GPs and stop smoking advisors working within the community. As a result, people wanting to stop smoking were "motivated and ready to quit", the report said.

It recommended:

  • The UK government reversed the cuts to public health funding for local authorities

  • Commissioners of stop smoking services removed from contracts any unfair restrictions on which, and how many, approved stop smoking products can be prescribed

  • The Scottish government maintained its commitment to sustainable funding of stop smoking services in its new Tobacco Control Strategy

Short-Term Savings 'Are Foolhardy'

The BLF report said cuts to stop smoking services would end up costing the NHS more.

"People who smoke are likely to be high users of NHS services," said Alison Cook. "Decommissioning the prescribing of stop smoking aids will only achieve short-term savings. Worryingly, it will shore up a greater burden on the NHS in the long run in terms of hospital admissions and the impact on already stretched A&E services. The decisions are foolhardy and must be reversed."

Responding to the report, Deborah Arnott, chief executive of the campaign group ASH - Action on Smoking and Health, said: "While it is true that smokers can buy nicotine patches and gum from shops, evidence shows these medicines work most effectively when prescribed. The shocking drop in prescriptions as a cost saving tactic by commissioners is a false economy of the cruellest kind; undermining smokers trying to quit to save small sums now while increasing the chance they will develop a costly illness in the long-run."

The Department of Health and Social Care said it had taken a number of initiatives to reduce adult smoking rates to 12% or less by 2022. A spokesperson said: "There are now fewer smokers in this country than ever before thanks to our bold and effective plans, including standardising packaging for cigarettes and covering up tobacco products in shops.

"However, 78,000 people still die from smoking in England each year, which is why we recently launched a new Tobacco Control Plan and will give councils £16 billion to provide public health services for their communities."
 

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