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GPs and pharmacists have cut quit-smoking prescriptions by 75%

CCGs must retract all guidance that withdraws GPs’ right to prescribe stop-smoking medications

Louise Prime

Tuesday, 17 July 2018

Clinical commissioning groups (CCGs) must immediately retract all guidance that withdraws GPs’ rights to prescribe stop-smoking medications, the British Lung Foundation (BLF) has demanded. The charity has reported a 75% cut in the number of quit aids dispensed in England over the past decade, as well as huge regional variation in CCGs’ prescribing levels. It warned that the “foolhardy” move is a false economy because supporting people to quit potentially saves the NHS “millions”.

The BLF claimed in Less help to quit that smokers in Britain are being discriminated against – and it warned that CCGs “are prioritising saving money over saving lives and flouting the basic principles of the NHS, to care for people”. It said CCGs’ tactics are discouraging GPs from giving their nicotine-addicted patients the clinically proven tools that they need to help them to quit, and it noted: “It’s vital to understand that tobacco dependency is an illness that requires urgent treatment.”

The report’s main findings are:

  • In England there was a 75% decline in the number of stop-smoking aids dispensed in 2016- 17 compared with 2005-6.
  • Scotland saw a 40% drop in stop-smoking aids prescribed, while in Wales, the number of all stop-smoking products dispensed in 2016-17 fell to just a third of what was dispensed in 2007-08.
  • Regional variation of CCG prescribing levels is huge. There are many areas where prescriptions are extremely low, even in areas with high numbers of smokers.
The report’s authors include specific examples. In one, the local authority in Worcestershire fully decommissioned its stop-smoking services in April 2016; and then neighbouring CCGs advised GPs to issue new patients “no prescriptions” for nicotine patches, gum, lozenges and sprays. As a result of these two steps, said the BLF, the number of items prescribed through primary care in each CCG has plummeted in the area. And in another area, the City of York, services are open only to those patients in a priority group; GPs have been asked to not prescribe because of the cost implications for the CCG; and the free nicotine replacement (NRT) voucher scheme in the area was also stopped – leaving some smokers without any route to support.

The charity argued that the NHS’s future sustainability is linked to the success of preventive health services, to reduce the occurrence of long-term conditions. BLF director of policy Alison Cook said: “People who smoke are likely to be high users of NHS services. 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.

“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 BLF recommends that:
  • The UK government reverses the cuts to public health funding for local authorities.
  • Commissioners of stop-smoking services remove from contracts any unfair restrictions on which, and how many, approved stop-smoking products can be prescribed. 
  • The Scottish government maintains its commitment to sustainable funding of stop-smoking services in its new Tobacco Control Strategy.
Alison Cook demanded: “CCGs should immediately retract all guidance to GPs which withdraws their right to prescribe stop-smoking medications. We are making a big mistake as these services could potentially save an NHS immersed in financial difficulties, millions.”

Cancer Research UK’s senior cancer prevention manager, George Butterworth, added: “GPs must be supported to help patients who smoke to quit. CCGs need to remove restrictions that prevent GPs from prescribing these important medications. And they must make sure GPs get the appropriate training.”

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