Prescribing of smoking cessation products plummets after funding cuts

The number of primary care prescriptions for nicotine replacement therapy (NRT), varenicline and bupropion has fallen in England, Wales and Scotland at much steeper rates than the fall in smoking.

NICE guidance says that pharmacological options to aid smoking cessation should be available to those who need them. | CORDELIA MOLLOY/SCIENCE PHOTO LIBRARY
NICE guidance says that pharmacological options to aid smoking cessation should be available to those who need them. | CORDELIA MOLLOY/SCIENCE PHOTO LIBRARY

A new report by the British Lung Foundation shows that the number of prescriptions issued in primary care in England for nicotine replacement therapy (NRT) fell by 75% between 2005/6 and 2016/17 and dispensing rates for varenicline fell by more than 50% between 2010/11 and 2016/17.

In Wales, the number of smoking cessation products dispensed in 2016/17 was two-thirds less than in 2007/8. In Scotland, there was a 40% drop in the number of products dispensed between 2012/13 and 2014/15.

The decline in prescriptions of smoking cessation products has greatly outpaced the decrease in smokers. Between 2010/11 and 2016/17 smoking prevalence in England fell by 22%, while prescription rates fell by 60%.

The British Lung Foundation said the results were 'the result of the erosion of government funding for stop-smoking support’.

Regional variation

According to figures from NHS Digital, GP practices are the most common first port of call for smokers in England seeking help to quit, with 38% choosing this route. However, the British Lung Foundation's report, entitled 'Less help to quit', shows that decisions are being taken by a growing number of CCGs to stop GPs from prescribing smoking cessation treatments.

In Worcestershire the local authority decommissioned its stop smoking services in April 2016 and CCGs advised GPs not to prescribe NRT, bupropion or varenicline for any new patients because the local authority would no longer reimburse the costs.

Across the area just 98 people were supported to stop smoking in 2016/17 compared with 2,208 in the previous year, and there were no recorded quit attempts made through general practice.

The report also found that some areas with higher than average smoking prevalence had 'incredibly low' prescribing rates. On average one prescription for stop smoking products is dispensed for every seven smokers in England. However, the research found that this figure drops to 1 in every 176 smokers in Bracknell and Ascot CCG in Berkshire and 1 in 55 smokers in Hackney CCG in east London.

Items prescribed per 1,000 population are also much lower in England than in Scotland, and this gap is widening, the report added.

False economy

The British Lung Foundation warned that the use of e-cigarettes, which are not available on the NHS, could not be guaranteed to fill the gap created by the drop in prescriptions. E-cigarette use had plateaued among smokers since early 2013 and their use among recent ex-smokers had declined from a peak in 2016.

The British Lung Foundation said all smokers should be able to expect their GP to provide access to stop smoking medication, either by issuing a prescription or via referral to a specialist service.

The charity is calling on commissioners to remove any unfair restrictions on the types and number of approved smoking cessation products that can be prescribed.

Responding to the report, Deborah Arnott, chief executive of the campaign group ASH - Action on Smoking and Health, said: 'The shocking drop in prescriptions as a cost-saving tactic by commissioners is a false economy of the cruellest kind; undermining smokers trying to quit to save small sums now while increasing the chance they will develop a costly illness in the long-run.'

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