Smoking cessation services in England have trebled their impact in helping smokers to give up over the past decade, a study in the BMJ has found. However, a wide variation across local services was noted.

The researchers analysed the performance of stop smoking services across England from 2001/02 to 2010/11, asking the questions: How has the performance of the services changed? How well have the services met the needs of different groups including economically disadvantaged smokers? How much local variation has there been in success rates?

Data submitted quarterly by each service to the Department of Health were analysed.

National stop smoking service throughput increased from 227,335 patients setting quit dates in 2001/02 to 787,527 in 2010/11 with the annual number of four-week quitters rising from 79,767 to 269,293 over the same period.

Stop smoking services provide a range of psychological support interventions together with prescribed medication to help those trying to stop and sustain abstinence. Making the assumption that some of those patients would have quit anyway, the authors adjusted for this and estimated that the number of four-week quitters beyond what would have been expected with medication alone, i.e. the ‘impact’ of the stop smoking services, rose from 22,933 in 2001/02 to 72,411 in 2010/11.

Across England services attracted smokers predominantly in the over 35 age range, though this fell from 74% to 66% over the study period, and women more frequently than men (falling from 57% in 2001/02 to 52% in 2010/11).

The proportion of smokers from ethnic minority groups almost doubled from 4% to 7% over the study period.

Data were collected for attendees who were eligible for free prescriptions only from 2008/09, but those eligible increased from 44% to 54% over the three-year period up to 2010/11.

Throughout the study nicotine replacement therapy was the predominant prescribed medication, accounting for around two thirds of prescriptions at the start and the end of the study. Bupropion prescribing had dropped from 19% in 2001/02 to only 1% by 2010/11, whereas varenicline increased steadily from 14% following its introduction in 2007/08 to 26% by 2010/11.

Variation between services in terms of throughput, four-week quit rates and impact was high, with a factor of more than six separating the highest from the lowest performing services in all measures. The authors comment that the substantial local variation remains largely unexplained and is in need of further study. Services with higher throughput generally had lower quit rates.

The authors conclude that English stop smoking services have had an increasing impact since 2001, with greatly increased throughput and four-week quit rates. They have been increasingly successful in reaching different groups and economically disadvantaged smokers.

However, quit rates at 35% have been below what might have been expected from optimal stop smoking services. Previous research has shown that for optimally run services the proportion of users who stop for four weeks can be around 50%, with 15% managing abstinence for 12 months. This compares with 15% at four weeks and less than 5% at 12 months for smokers who stop unaided.

Dr Jez Thompson 

• West R, May S, West M et al. Performance of English stop smoking services in first 10 years: analysis of service monitoring data BMJ 2013;347:f4921