Abstract
BackgroundThe English National Health Service’s (NHS) Stop Smoking Services (SSSs) constitute one of the most highly developed behavioural support programmes in the world. However, there is significant variation in success rates across the approximately 150 services, some of which may be due to variation in practice. This study aimed to assess these differences in practice.MethodsTwo online surveys were administered. All commissioners (people who purchase services for the NHS) and managers (those who run the services) of NHS SSSs in England were invited to participate. Items included details of current practices and services provided, what informed the commissioning of SSSs, what targets were included within service specifications and whether the types of treatment model to be delivered were specified.ResultsBoth surveys had a response rate of 35%, with 50 commissioners and 58 managers participating. There were no significant differences between the characteristics of the Primary Care Trusts (PCTs) from which commissioners and managers responded to this survey and those PCTs from which there was no response. Managers reported that the treatment model most frequently offered by SSSs was one-to-one (98%). A total of 16% of managers reported that some approved medications were not available as first-line treatments. Just over one third (38%) of commissioners reported consulting national guidelines or best evidence to inform local commissioning. Almost one third (30%) of commissioners reported that they specified the types of stop smoking interventions to be delivered by the providers.ConclusionsA substantial part of commissioning of Stop Smoking Services in England appears to take place without adequate consultation of evidence-based guidelines or specification of the service to be provided. This may account for at least some of the variation in success rates.
Highlights
The English National Health Service’s (NHS) Stop Smoking Services (SSSs) constitute one of the most highly developed behavioural support programmes in the world
The Primary Care Trusts (PCTs) from which the samples of commissioners and managers participating in the current study were drawn did not differ from those who did not participate in a number of important variables
There were no differences between PCTs with participating commissioners and those where commissioners did not participate, in self-reported (responder mean = 50.1%, vs. non-responder mean = 49.2%, t(150) = −0.63, p = .53) or CO-validated quit rates (35.9% vs. 34.5%, t(150) = −0.82, p = .41), number setting a quit date at the SSS (5764.5 vs. 5073.95, t(150) = −1.38, p = .17) and PCT IMD score (24.1 vs. 23.4, t(150) = −0.48, p = .63)
Summary
The English National Health Service’s (NHS) Stop Smoking Services (SSSs) constitute one of the most highly developed behavioural support programmes in the world. In 1999, the UK government’s tobacco control strategy, published in the White Paper ‘Smoking Kills’[1], established the treatment of smokers as an integral part of the effort to reduce smoking prevalence [2]. This led to the formation of the English National Health Service’s (NHS) Stop Smoking Services (SSSs). Priorities are determined which would inform service specifications and performance indicators, against which providers would be performance managed Whilst such processes may allow services to be responsive to local needs, they may have contributed to a drift away from the evidence-base. Rates of biochemical validation (by expired air carbon monoxide) provide explanation for some of this variation, yet even when self-reported (non-verified) quits are considered, the variation remains wide, from 31–70%, with an average of 49% [9]
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