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GMS Contract Guide - Smoking

The revised quality and outcomes framework for 2006/7 has removed smoking indicators from individual disease areas and placed them in two separate indicators covering all previous requirements.

Smoking: Clinical Indicators
Target (%)Points
Ongoing management
Smoking status recorded in past 15 months (non-smokers once only) in patients with any of following: asthma, CHD, COPD, diabetes, hypertension, stroke, TIA9033
Smoking cessation advice (or referral to specialist service) offered in past 15 months in patients with any of following: asthma, CHD, COPD, diabetes, hypertension, stroke, TIA9035
Total 68

ACTION PLAN

Overview

  • The indicator set is worth a total of 68 points, generating a payment of £8,472 for the practice with average list size and prevalence.

  • Latest prevalence figures for smoking show that in 2004/5, a total of 25 per cent of adults aged over 16 smoked cigarettes. Prevalence is slightly higher in men than women, with 26 per cent of men smoking compared with 23 per cent of women.

  • The guidance sets out the evidence on the effects of smoking for patients in each of the six disease areas covered by this indicator set.

  • Points are also available for recording smoking status in several indicators in the organisational domain.

  • One of the indicators, which previously rewarded practices for making a once-only note on smoking status of patients aged 15 to 75, has been changed, so the upper age limit has been dropped and smoking status has to be recorded within the past 27 months, except for non-smokers.


Step 1: Smoking status and cessation advice


  • Smoking status should be recorded annually for all patients who are on the registers for CHD, stroke or TIA, hypertension, diabetes, COPD, or asthma. For those who have never smoked, status need only be recorded once.

  • The second indicator requires practices to offer smoking cessation advice or referral to a specialist service to patients from the relevant disease registers who do smoke. Advice or referral needs to be recorded annually for smokers.

  • Decide how the practice is going to tackle these indicators in what will be a very large group of patients. It is likely a combination of approaches will need to be adopted, including checking status and recording advice when patients present opportunistically, as part of more extensive reviews involving other indicators and by a call and recall system for those who might fall through the net.

  • Note that if a practitioner discusses referral to a PCO specialist smoking clinic with a patient, this should be recorded as giving smoking cessation advice.

  • For non-smokers, although you need only record ‘never smoked' once, it must be recorded after the relevant diagnosis.

  • Produce or review existing smoking cessation strategy for the practice and ensure it includes providing literature and offering appropriate therapy to patients.


Step 2: From now onwards


  • Aim to assess patients' smoking status at every opportunity.

  • Advise all smokers to stop and assist those who are interested in doing so. Document all cessation advice offered or referrals to specialist services.

  • Make sure you have a system to follow up non-attenders.



Step 3: December onwards


  • Smoking cessation advice could be covered in a letter to patients on the register who have failed to attend for review.


References for Smoking

1. National Institute for Health and Clinical Excellence (NICE)
2. European Society of Cardiology
3. GOLD Guidelines
4. Joint British Societies Risk Charts and Calculators
5. National Institute for Health and Clinical Excellence (NICE) - NRT and buproprion
6. Scottish Intercollegiate Guidelines Network (SIGN):
- angina
- CHD
- stroke

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