As a FHO2 (Foundation Year 2 House Officer) in general practice, I recently performed an audit on smoking cessation practice at my surgery. Naturally I turned to ‘Gold Standard’ national guidelines to set my audit criteria. However, I was rather disturbed by the discrepancies between the 2006 QOF criteria1 for monitoring smoking status and management of smokers and the 2006 NICE Public Health Guidance on smoking cessation.2
The NICE guidance is the first public health guidance issued on smoking cessation with the emphasis being on prevention of smoking-related complications. The guidelines advocate the use of ‘Brief Interventions’ (simple opportunistic advice to stop which can be performed by clinicians across the board) and early referral to smoking cessation services.
Using QOF targets we are currently identifying: 1) smokers, 2) smokers with chronic disease, 3) smokers with chronic disease who get advice/referral. We do not routinely know: 1) the smoking status of all those on GP lists every 15 months, 2) if the smoking status of non-smokers has changed, 3) if smokers without chronic disease are getting advice/being referred/being offered pharmacotherapy. As part of the 2006 guidelines, NICE publish recommended audit criteria which are poorly comparable to the QOF targets but which tackle these shortfalls mentioned. I find this particularly surprising considering that the NICE guidance preceded the publication of the GMS contract.
In the current environment where smoking-related disease, and more specifically, cardiovascular disease, is the number one burden to the NHS, I agree that we need to embrace a more comprehensive set of guidelines for the management of smoking. In order to achieve this goal, however, there needs to be some clarity and stream-lining of guidance between primary care and major clinical governing bodies. I would like to see accelerated efforts to establish this relationship and encourage a response to this letter from both parties.
- © British Journal of General Practice, 2007.