Smoking is the biggest preventable cause of ill health in the UK. Although overall death rates from smoking are falling, it continues to be a burden on the health of our population in Hywel Dda, Pembrokeshire, Wales. Apart from causing ill health in people, smoking also places a great demand on the resources of Hywel Dda University Health Board’s Health and Social Care services and on partner health organisations.
In April 2013, the Welsh government set health boards a tier 1 performance indicator related to smoking cessation: the target is that 5% of smokers in Wales make an attempt to quit via smoking cessation services, with at least 40% of them successfully quitting at four weeks (validated via a carbon monoxide breath test).
There are around 57,295 adults — 18% of the population of Hywel Dda — who smoke. During 2014–15 the only smoking cessation services available to smokers were those provided by Stop Smoking Wales (an NHS organisation run by Public Health Wales), the in-hospital smoking cessation service in Glangwili General Hospital in Carmarthen, and Prince Philip Hospital in Llanelli, and a small pilot service delivered by the mental health charity Mind in Hywel Dda.
Approximately 6 million people are seen by community pharmacists every day in the UK. Community pharmacies are accessible within communities, at times when other primary care services are not, including evenings and weekends. Pharmacy staff routinely have contact with individuals who are in good health or unwell, and have the opportunity to provide both preventive advice and treatment. Smoking cessation fits within this role because all pharmacists have the opportunity to assist smokers in quitting.
In 2014, a business case was developed by Hywel Dda primary care team and Public Health Wales to introduce a Pharmacy Level 3 Smoking Cessation scheme with the aim of supporting the health board to achieve its tier 1 targets for smoking cessation. In September 2015 funding was granted to roll this service out across the Hywel Dda area.
Of the 99 community pharmacies in Hywel Dda, 33 now provide the service. As a result the percentage of smokers treated last year rose to 2% (from 1.5% in 2015–16). A total of 249 smokers were treated under the pharmacy service (April 2015 to March 2016). This is still someway short of the 5% target set by the Welsh Government. The carbon monoxide breath test at four weeks validated the quit rate for community pharmacy-treated smokers. As of September 2016 we achieved just over the target figure of 40% successfully quitting smoking via the service.
Interestingly, the top two performing pharmacies treated over 30% of all smokers and had quit rates of over 60%. It is also important to remember that the community pharmacy based level 3 smoking cessation programme is just one constituent of the overall strategy to reduce the number of smokers in Hywel Dda. The longer established Stop Smoking Wales and Hospital Cessation Services already treat considerable numbers of smokers but the promotion of a smoking cessation service that uses the expertise, locations and accessibility of community pharmacies is, perhaps, our greatest opportunity to improve the health and life expectancy of this large percentage of our friends and neighbours.