This Guidelines summary covers the key points for primary care, please see the full guideline for recommendations on:
- commissioning and providing stop smoking interventions and services to meet local needs
- monitoring stop smoking services
- campaigns to promote awareness of local stop smoking services
- closed institutions
Evidence-based stop smoking interventions
- Ensure the following evidence-based interventions are available for adults who smoke:
- behavioural support (individual and group)
- nicotine replacement therapy (NRT)—short and long acting
- very brief advice (see the NCSCT training module on very brief advice)
- Consider text messaging as an adjunct to behavioural support
- Offer varenicline as an option for adults who want to stop smoking, normally only as part of a programme of behavioural support, in line with NICE’s technology appraisal guidance on varenicline
- For adults, prescribe or provide varenicline, bupropion or NRT before they stop smoking
- Agree a quit date set within the first 2 weeks of bupropion treatment and within the first 1 to 2 weeks of varenicline treatment. Reassess the person shortly before the prescription ends
- Agree a quit date if NRT is prescribed. Ensure that the person has NRT ready to start the day before the quit date
- Consider NRT[C] for young people over 12 who are smoking and dependent on nicotine. If this is prescribed, offer it with behavioural support
- Ensure behavioural support is provided by trained stop smoking staff (see the National Centre for Smoking Cessation and Training [NCSCT] training standard)
- Ensure very brief advice is delivered according to the NCSCT training module on very brief advice.
Engaging with people who smoke
- At every opportunity, ask people if they smoke and advise them to stop smoking in a way that is sensitive to their preferences and needs
- Encourage people being referred for elective surgery to stop smoking before their surgery. Refer them to local stop smoking support
- Discuss any stop smoking aids the person has used before, including personally purchased nicotine‑containing products (see the recommendations below on nicotine-containing products on general sale and advice on e-cigarettes)
- Offer advice on using nicotine-containing products on general sale, including NRT and nicotine-containing e-cigarettes
- See also recommendations 1, 7, and 9 in NICE’s guideline on Smoking: acute, maternity and mental health services.
Advice on e-cigarettes
- For people who smoke and who are using, or are interested in using, a nicotine-containing e-cigarette on general sale to quit smoking, explain that:
- although these products are not licensed medicines, they are regulated by the Tobacco and Related Products Regulations 2016
- many people have found them helpful to quit smoking cigarettes
- people using e-cigarettes should stop smoking tobacco completely, because any smoking is harmful
- the evidence[D] suggests that e-cigarettes are substantially less harmful to health than smoking but are not risk free
- the evidence in this area is still developing, including evidence on the long-term health impact.
If a person who smokes wants to quit
- Refer people who want to stop smoking to local stop smoking support
- Discuss how to stop smoking with people who want to quit (the NCSCT programmes explain how to do this)
- Set out the pharmacotherapy and behavioural options as listed above (see the section Evidence-based interventions), taking into consideration previous use of stop smoking aids, and the adverse effects and contraindications of the different pharmacotherapies
- Explain that a combination of varenicline and behavioural support or a combination of short-acting and long-acting NRT are likely to be most effective
- If people opt out of a referral to local stop smoking support, refer them to a professional who can offer pharmacotherapy and very brief advice
- Agree the approach to stopping smoking that best suits the person’s preferences. Review this approach at future visits.
If a person who smokes is not ready to quit
- If people are not ready to stop smoking:
- make sure they understand that stopping smoking reduces the risks of developing smoking-related illnesses or worsening conditions affected by smoking
- ask them to think about adopting a harm reduction approach (see NICE’s guideline on Smoking: harm reduction)
- encourage them to seek help to quit smoking completely in the future
- record the fact that they smoke and at every opportunity ask them about it again in a way that is sensitive to their preferences and needs.
- Ensure publicly sponsored telephone quitlines offer a rapid, positive and authoritative response. If possible, callers whose first language is not English should have access to information and support in their chosen language
- All staff should receive smoking cessation training (at least in brief interventions to help people stop smoking)
- Staff who offer counselling should be trained to the NCSCT Standard (individual behavioural counselling) and preferably hold an appropriate counselling qualification. Training should comply with the Standard for training in smoking cessation treatments or its updates.
Education and training
Local stop smoking services
- Ensure training and continuing professional development is available for all those providing stop smoking advice and support
- Ensure training complies with the NCSCT training standard or its updates.
Healthcare workers and others who advise people how to quit smoking
- Train all frontline healthcare staff to offer very brief advice on how to stop smoking in accordance with recommendations on discussing quitting and opting out of referral. Also train them to make referrals, if necessary and possible, to local stop smoking services
- Ensure training on how to support people to stop smoking is part of the core curriculum for healthcare undergraduates and postgraduates
- Provide additional, specialised training for those working with specific groups, for example people with mental health problems and pregnant women who smoke
- Encourage and train healthcare professionals to ask people about smoking and to advise them of the dangers of exposure to secondhand smoke
- For recommendations for secondary care providers see NICE’s guideline on Smoking: acute, maternity and mental health services.
[A] See information on bupropion hydrochloride in the British national formulary.
[B] See information on varenicline in the British national formulary.
[C] The UK marketing authorisation for nicotine replacement therapy products varies for use in children and young people under 18. Refer to the summary of product characteristics for prescribing information on individual nicotine replacement therapy preparations.
[D] See reports by Public Health England (E-cigarettes and heated tobacco products: evidence review), the British Medical Association (E-cigarettes: balancing risks and opportunities) and the Royal College of Physicians (Nicotine without smoke: tobacco harm reduction).
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.
Published date: 28 .