Just last month, we published a blog describing how government messages on reduced risk products are not getting through to the NHS. You can read the whole thing here but this was the summation.

We are in the second decade of the 21st century but NHS trusts seem to be stuck in the past and not yet caught up on where the government is going. If NHS England truly seeks to reduce smoking by any means, it should be more imaginative in its approach and, if nothing else, at least listen to the messages coming from government and its institutions.

This week, we were also contacted by the Daily Express about new research that revealed only a pitiful 7% of GPs felt confident enough to recommend e-cigarettes to smokers who present themselves to surgery. The NNA was quoted in the article.

Martin Cullip, a trustee of the New Nicotine Alliance, a charity which raises awareness of safer nicotine products, said more education was needed for doctors.

“This is a common theme I’ve come across before where many GPs believe vaping to be harmful,” he said.

“Vaping takes most of the harmful chemicals out – any that are left in there are at very low levels - so you’re delivering the nicotine in a much cleaner form.

“There’s no reason why doctors cannot recommend these devices but if they are not aware of the reduction in harm then they’re not going to do that.”

It is very disappointing that we should still have to make these arguments on the deficiencies of the health system considering the resounding support for vaping as an option for smokers wishing to switch to safer nicotine delivery by groups such as, and not restricted to, The Royal College of Physicians, Public Health England, Cancer Research UK, The Royal Society of Public Health and Action on Smoking and Health.

As our trustee pointed out, the lack of understanding amongst GPs is a recurring theme and does not appear to be receding. In 2013, Nursing In Practice reported on the clear disconnect between government advice and what is being relayed by GPs to their smoking patients:

The survey findings show that a substantial proportion of GPs (40%) believe nicotine to be the first or second riskiest component of cigarettes, incorrectly identifying it as more harmful than smoke.

Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.

“Although GPs clearly understand that smoking is more dangerous than NRT use, it is worrying that so many associate nicotine with cancer.

This may have been an understandable mistake six years ago, but it certainly isn’t now. Late last year, another study from the University of Oxford came to the same conclusion.

Current dissemination strategies for guidelines are not effective in reaching practitioners, who are offering more cautious advice about e-cigarettes than guidelines suggest is reasonable.

We are now into 2019, with a government so committed to harm reduction as an option for smokers who choose to quit that they see reduced risk products as a core part of the Tobacco Control Plan; that e-cigarettes have been included in stop smoking adverts during Stoptober for two years; and a government which has also fully endorsed vaping following a report by the Science and Technology Committee which called for more acceptance of safer nicotine delivery to tempt smokers to choose safer options.

Yet here we still are with GPs disappointingly badly informed. This statistic from the Express article is starkly damning.

“A worrying 93 percent of healthcare professionals were unaware of Public Health England’s position that vaping is at least 95 percent less harmful than smoking.”

You have to wonder about what messages are being promoted by government institutions if this is the current state of play with GPs. NNA Trustee Louise Ross was particularly surprised on Twitter.

LR PHE tweet

We obviously share her concern. It is disturbing that there is so much misunderstanding still prevalent amongst GPs who are the first responders in the NHS to people who smoke. Something is going desperately wrong here if official guidance from high level public health organisations is not filtering down to GPs who are tasked with meeting smokers face to face.

There is an urgent need for a framework whereby the national guidance on safer nicotine products feeds down to where the knowledge is most needed, which is quite clearly not happening now.

There is no point whatsoever in proposing policies on a macro level if those who meet the public daily do not know of its existence. It certainly does exist, and the Royal Society of General Practitioners has also presented a fact sheet on the subject fairly recently. It is disappointing that GPs are either unaware of, or are wilfully ignoring, the advice of their own professional association along with guidance from national government-backed institutions.

GPs need to be better informed; their misunderstanding has not only continued for six or seven years but it doesn’t seem to be abating. It is well past time that there was a mechanism to ensure that they are more educated about the difference between nicotine and smoking.