GPAtlas🧭 When to offer support
Smoking remains the leading preventable cause of illness and premature death in the UK, and stopping is the most effective thing a patient can do for their health.
The opportunity in primary care is constant. The Very Brief Advice (VBA) model – Ask, Advise, Act – takes under a minute:
• Ask every patient whether they smoke at every contact.
• Advise them that stopping in one go is the best approach.
• Act by offering help.
Two skills convert that opportunity into a quit:
• Pair every quit attempt with behavioural support: a medicine or a vape roughly trebles success only when combined with support, not willpower alone.
• 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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