Cigarette smoking, more than any other known factor, reduces healthy life expectancy;1 so smoking cessation is a supremely important health-promotion target. How this is best achieved is the thrust of a massive report by West2 and colleagues in 2000. Although it included not a single ‘journeyman’ GP, this panel of ‘experts’ saw primary care clinicians as best placed to intervene effectively and recommended that, during routine consultations, GPs should be advising smokers to stop. But even before the report appeared, the practicality of this edict was being questioned: smoking habit is discussed in only 20–30% of everyday GP consultations with smokers.3 Merely urging GPs to advise smoking cessation seems unlikely to succeed; the gulf between ‘symptom-led’ activity and ‘population-based’ interventions is too wide. How, then, should we close the gap between ambition and reality? The obvious answer would seem to be for GPs being primed — to know, in advance, which patients are most likely to be smokers and for this additional burden in consultations to be embarked on only where relevant. After all, consultations in UK general practice are events that are already uncomfortably overcrowded.
We wondered whether the council tax valuation band (CTVB) of patients' addresses might provide a means of so ‘spotting’ smokers, and tested the hypothesis that CTVB is associated with household smoking rates. Four-hundred and fifty practice households were randomly selected from our practice list, and were telephoned during the summer of 2003. Responders were asked: ‘Are there any cigarette smokers living at your address?’. Responses were recorded, categorically, as either ‘yes’ or ‘no’: no attempt was made to identify individual smokers nor the number of cigarettes smoked. CTVBs of the responding households (96%) were obtained from the Council Tax website.4
It is clear from the findings (Table 1) that CTVB locates smokers and could be used to flag those consultations in which discussion of smoking habit would more often be time-effective. Though daunting, it is a simple task to append registration details of patients with the CTVB of their current address using the website.4 Armed with this information, one knows the likelihood of being with a patient from a smoking household to be 50% for those living in CTVBs ‘A’ or ‘B’, as opposed to a 20% chance for their CTVB ‘D’ and above counterparts. Thus, GPs and nurses in primary care can know when smoking advice is more likely to be needed and make time for it; and UK general practices ‘loaded’ with many patients in lower CTVBs can justify enhanced resources for smoking cessation activity.
- © British Journal of General Practice, 2005.