GPAtlas🧭 When to offer support
Smoking remains the leading preventable cause of illness and premature death in the UK, and stopping is the single most effective thing a patient can do for their health. The opportunity in primary care is constant: ask every patient whether they smoke at every contact, advise them that stopping in one go is the best approach, and act by offering help. This is the Very Brief Advice (VBA) model – Ask, Advise, Act – and it takes under a minute.
Two skills convert that opportunity into a quit. First, pair every quit attempt with behavioural support; a medicine or a vape roughly trebles success only when combined with support, not willpower alone. Second, match the intensity of treatment to the degree of dependence – the quickest marker is how soon after waking the first cigarette is smoked.
The National Institute for Health and Care Excellence (NICE) groups the licensed options – nicotine replacement therapy (NRT), varenicline, cytisinicline, bupropion and nicotine-containing e-cigarettes (vapes) – by how likely they are to succeed when combined with behavioural support:
| Option (with behavioural support) | NICE effectiveness tier |
|---|---|
| Cytisinicline | More likely to succeed |
| Combination NRT (long-acting patch + a short-acting product) | More likely to succeed |
| Varenicline | More likely to succeed |
| Nicotine-containing e-cigarettes (vapes) | More likely to succeed |
| Bupropion | Less likely to succeed |
| Single-form NRT (a patch or a short-acting product alone) | Less likely to succeed |
Behavioural support, very brief advice and the Allen Carr Easyway in-person seminar are also offered routinely, and the recommended outcome measure is a carbon monoxide (CO)-validated quit at 28 days.
Source: NICE NG209
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