Smoking :: Smokers given more help to quit since GP performance pay introduced

Smokers have been getting more support for quitting, and the numbers ofsmokers have reduced, since the introduction of performance-relatedincentives for UK general practitioners, according to new researchpublished today in the Canadian Medical Association Journal.

“Pay for performance” incentives, introduced in April 2004, mean thatgeneral practitioners are paid more if they succeed in meetingperformance targets set by the government.

The research team from Imperial College London looked at patients withdiabetes, registered in Wandsworth, South London. They found that thepercentage of smokers with diabetes who were given cessation advice byprimary care staff increased from 48% to 84% between 2003 and 2005. Morepatients with diabetes had their smoking status recorded in 2005 (99%)than in 2003 (91%). The percentage of people with diabetes who smokeddecreased from 20% in 2003 to 16% in 2005.

Under “pay-for-performance,” practices are judged against 146 qualityindicators, as part of the new GP contract introduced in 2004. Severalof these quality indicators encourage GPs to identify people with achronic disease, such as diabetes or heart disease, who smoke andprovide advice and support to help them quit smoking. About one quarterof GP income is currently derived through meeting quality targets in thetreatment of such chronic diseases.

Previous studies had showed that GPs were not routinely offeringcessation advice during consultations, in spite of evidence showing thatit improves quit rates, because some found it too time-consuming,considered it to be ineffectual, or felt that they lacked theappropriate skills.

The researchers’ findings suggest that the new incentive scheme islikely to be a key contributor to changes in help offered to smokers.However, they caution that some of the improvements seen may haveoccurred without the introduction of financial incentives.

Christopher Millett, one of the authors from the study from theDepartment of Primary Care and Social Medicine at Imperial CollegeLondon, said: “Financial incentives introduced in UK primary care appearto have increased cessation advice being given by primary care staff andreduced the percentage of people with diabetes who smoke.

“Improvements were generally greatest in the groups with the poorestperformance before these incentives were introduced and among ethnicminorities – populations that often receive lower quality care.

“Supporting people with diabetes to quit smoking is very importantbecause they are at an increased risk of developing cardiovasculardisease” he added.

Deborah Arnott, Director of the health-campaigning charity ASH,commented: “This study backs up what we’ve always known, that patientslisten to advice from their doctors. Unfortunately GPs are onlycurrently being funded to give advice to stop smoking to patients whohave already developed smoking-related diseases. GPs should be givingthis advice to all smokers, before they develop specific smoking-relateddiseases. That’s what the NICE (National Institute for Health andClinical Excellence) guidance says, and that’s what would be best forsmokers and best for the NHS.”

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