Improving the provision and uptake of smoking cessation treatment in primary care in the United Kingdom

Smoking is a major risk factor for cancer, COPD, stroke and heart disease. The UK has a comprehensive tobacco control strategy and adult smoking prevalence has reduced considerably over the past decades, from 45% in 1974 to 14.1% in 2019. However, smoking remains one of the leading preventable causes of illness and premature death in the UK and worldwide. There is a "smoke-free 2030" ambition which aims for the smoking prevalence in England to be (less or equal to) 5% by the year 2030. However, the recent 2021 Royal College of Physicians report emphasised that current policies will not achieve the smoke-free target until after 2050. One of the challenges is inequalities, as smoking prevalence is considerably higher in disadvantaged groups.

The overarching aim of my PhD is to investigate how smoking cessation treatment is delivered in primary care in the UK and how this could be improved to further reduce the prevalence of smoking and meet the smoke-free 2030 target, including reducing the prevalence of smoking in disadvantaged groups.

This will be achieved by:

1. systematically reviewing the literature to identify what strategies to increase the provision and uptake of smoking cessation treatment in primary care have been implemented in a 'real world' setting internationally and which of these have been effective,

2. investigating (with interrupted time series analysis) the effect of policy changes on the rate of prescription of varenicline to smokers with mental health conditions,

3. exploring if and how e-cigarettes have been discussed and recorded in consultations between smokers and GPs,

4. qualitatively investigating the barriers and facilitators for GPs to prescribe e-cigarettes and smoking cessation treatments, particularly varenicline.