The Pharmaceutical Journal
Vol 270 No 7240 p355
15 March 2003

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GPs too busy to advise on smoking

Smokers believe that general practitioners do not have time to discuss their habit with them, new research shows. And they complain about GPs responding in an unhelpful manner, offering little or no explanation of products and services on offer to help them stop.

The research, a series of focus groups carried out by the charity No Smoking Day, also suggests GPs are reluctant to give opportunistic advice on giving up smoking. Work overload and time pressures are among the reasons why doctors do not give such advice to smokers. GPs also consider such activity unrewarding, annoying for patients and ineffective. Instead, they tend to focus interventions on "relevant" patients, such as those with chest infections, asthma, heart and vascular disease.

Given work and time pressures, GPs also say they are uneasy about publicity campaigns encouraging more smokers to seek their help.

Doctors who took part in the research also said that they were less likely to raise smoking with socially disadvantaged patients, who were generally seen as more dependent on cigarettes, less able to stop, and most likely to be annoyed by GPs querying their behaviour.

The GPs thought they were generally positive about patient-initiated consultations concerning smoking. But most smokers said it would not occur to them to make a GP appointment to discuss their habit, especially as GPs were already "too busy".

A No Smoking Day report, which details the research findings, says that GP understanding of specialist cessation services is patchy with many doctors wanting to know more, particularly about local schemes. Smoker awareness of such services is high, but inaccessibility, rumours of long waiting lists and scepticism about effectiveness often deter them from seeking help. Many smokers were "surprised and impressed" to learn of a 40–50 per cent short-term success rate.

In the wake of the report, the Royal Pharmaceutical Society and the charity PharmacyHealthLink are calling for better use of pharmacy services to provide smoking cessation.

Miriam Armstrong, chief executive, PharmacyHealthLink, said: "Pharmacists are perfectly placed to help GPs in their fight against smoking. They are trusted health professionals with an in-depth knowledge of how to help people quit. They can also supply the most effective stop-smoking treatments on the NHS — nicotine replacement therapies and bupropion [Zyban] — directly to patients if a local patient group direction is in place.

"However, at present there are too few PGDs for smoking cessation, which is why GPs may be feeling swamped by demand. Setting up a PGD will help deflect smokers away from GP surgeries and towards other health professionals who can offer the excellent advice and also supply NRT and Zyban on the NHS."

Marshall Davies, President of the Royal Pharmaceutical Society, said: "Pharmacists have an important role to play in supporting those people who want to stop smoking. Giving up smoking requires planning, encouragement, support and motivation. Pharmacists together with NRT are a very effective combination."