Smokers have been getting more support for quitting, and the numbers of smokers have reduced, since the introduction of performance-related incentives for UK general practitioners, according to new research published in the Canadian Medical Association Journal. "Pay for performance" incentives, introduced in April 2004, mean that general practitioners are paid more if they succeed in meeting performance targets set by the government. The research team from Imperial College London looked at patients with diabetes, registered in Wandsworth, South London. They found that the percentage of smokers with diabetes who were given cessation advice by primary care staff increased from 48% to 84% between 2003 and 2005. More patients with diabetes had their smoking status recorded in 2005 (99%) than in 2003 (91%). The percentage of people with diabetes who smoked decreased from 20% in 2003 to 16% in 2005. Under "pay-for-performance," practices are judged against 146 quality indicators, as part of the new GP contract introduced in 2004. Several of these quality indicators encourage GPs to identify people with a chronic disease, such as diabetes or heart disease, who smoke and provide advice and support to help them quit smoking. About one quarter of GP income is currently derived through meeting quality targets in the treatment of such chronic diseases. Previous studies had showed that GPs were not routinely offering cessation advice during consultations, in spite of evidence showing that it improves quit rates, because some found it too time-consuming, considered it to be ineffectual, or felt that they lacked the appropriate skills. The researchers' findings suggest that the new incentive scheme is likely to be a key contributor to changes in help offered to smokers. However, they caution that some of the improvements seen may have occurred without the introduction of financial incentives. Christopher Millett, one of the authors from the study from the Department of Primary Care and Social Medicine at Imperial College London, said: "Financial incentives introduced in UK primary care appear to have increased cessation advice being given by primary care staff and reduced the percentage of people with diabetes who smoke. "Improvements were generally greatest in the groups with the poorest performance before these incentives were introduced and among ethnic minorities - populations that often receive lower quality care. "Supporting people with diabetes to quit smoking is very important because they are at an increased risk of developing cardiovascular disease" he added. Deborah Arnott, Director of the health-campaigning charity ASH, commented: "This study backs up what we've always known, that patients listen to advice from their doctors. Unfortunately GPs are only currently being funded to give advice to stop smoking to patients who have already developed smoking-related diseases. GPs should be giving this advice to all smokers, before they develop specific smoking-related diseases. That's what the NICE (National Institute for Health and Clinical Excellence) guidance says, and that's what would be best for smokers and best for the NHS." ### Contact: Laura Gallagher

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