We need to let patients know that it’s not easy to quit smoking but that you are there to support them

Dr Steve Holmes, a General Practitioner in Shepton Mallet, Somerset, has an interest in medical education and respiratory conditions. Here he gives tips and insights into how to deliver Very Brief Advice (VBA). 

Helping someone to stop smoking is one of the most effective interventions we have

When I started my career as a General Practitioner (GP), I was lucky to join at a time of great change in general practice. I enjoyed the wide diversity of clinical challenges (rather than just looking at one clinical area), and the opportunity to focus on the importance of the person and their family, alongside the wider psychosocial issues in health.  

Steve Holmes, GP

A nurse colleague in my practice encouraged me to learn more about asthma and chronic obstructive pulmonary disease (COPD). I took the opportunity to attend a conference from a group that later became the Primary Care Respiratory Society. I met many enthusiastic colleagues across different healthcare specialities. The enthusiasm and passion I felt then, has remained with me ever since. Our professional career is very much about wanting to make an effective difference to the health of our patients. Helping someone to stop smoking is one of the most effective interventions we have, across all specialities. 

I’ve always encouraged patients to stop smoking 

Having been a GP for more than thirty years, I have seen the impact that cigarette smoking can have on patients, their families and children many times – a devastating legacy.  

I’ve always encouraged patients to stop smoking and have been using Very Brief Advice (VBA) type interventions since around the year 2000, when I learnt these techniques amongst others to develop my consultation skills. I do wish I had realised how useful this technique had been earlier. It would have saved me so much time and probably helped even more patients to stop smoking.  

VBA is about asking a patient if they smoke. If they do, it’s about letting them know that the most effective way to successfully quit smoking is a combination of proven medical treatments and professional support. When providing VBA, you can direct people to local smoking cessation services. It doesn’t matter how many cigarettes the person smokes or the reasons. And if the time isn’t right, it’s a good opportunity to let them know that it is important to stop smoking. Perhaps they will be interested in stopping in the future.  

It doesn’t help the patient to become entrenched in an argument with you 

When I speak to health care colleagues at conferences, advising about smoking cessation, the majority will nod when I ask whether they have ever spent three or four minutes arguing with a patient over smoking. It is so easy to get involved in a protracted debate about the timings of stopping smoking, or for a clinician to lecture a patient about why it is important to stop. But most patients now know smoking is not good for their health.  

For success with our patients, it’s about not being judgemental, it’s about offering support and effective advice that is proven to work. Usually, if we get involved in an argument about smoking there is no definite winner – though both may feel they have said their piece –  and  no satisfaction for either side of the argument. The object should be to work with patients to improve their health outcomes, not argue with them.  

VBA is about letting people know that quitting smoking is important 

Most patients are thinking about stopping already as they don’t want to be smoking. And many will have tried several times before they finally succeed. I have been in the same clinical workplace for more than 15 years and have gotten to know the patient population over this time. Lots of patients who have been given VBA stop successfully, but quite a few will say they don’t want to give up at the time I see them. However, with VBA, the number who will come back and say “I’ve remembered what you said, and I thought I’d let you know; I’ve done it. I have stopped” is incredible. It is lovely to be able to give a big smile and recognise their achievement and congratulate them.  

VBA is worthwhile. It’s not about hassling the patient. It’s letting them know that giving up smoking is important and the most effective way to quit is with the medications available, alongside professional support from trained smoking cessation advisors. It makes it easier for them and it makes it more realistic. 

I would recommend giving VBA a go 

Using VBA with patients shouldn’t feel confrontational because it is really quick and effective – it usually takes less than 30 seconds. It is proven to make quitting successfully more likely.  

A typical VBA intervention might look like this; You might ask a person if they smoke, and the patient will respond, “Yeah, I’m afraid I am smoking”. You can reply with, “Oh, did you know, the best way to stop smoking is with professional support and some of the medical treatments available. Do you want some help?” and if they respond “No” reply without judgement with, “Okay, perhaps next time you’ll do it” and move on. If they say “Yes” – have the information to hand and encourage them.  

I would recommend giving VBA a go – it is well worth your while doing the free and quick national training available at the National Centre for Smoking Cessation and Training. It takes less than an hour and if you want to make a difference to the health of the population – but don’t want protracted arguments – it makes sense, saves lives and saves the clinician time. Winning all the way.  

The Taskforce for Lung Health, along with Asthma UK and the British Lung Foundation, are calling for training in VBA to be routine for all health care professionals. Read the Taskforce's recommendations for smoking cessation, here.


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9 March 2021