Friday 26 June 2020

If you are going to give up smoking, this is a very good moment to do it

In today’s Fuse blog Rachel McIlvenna, from Public Health South Tees, writes about managing a local specialist stop smoking service during the COVID-19 pandemic.

Casting my mind back to when the news started reporting increasing numbers of confirmed cases of COVID-19 in the UK feels like a lifetime ago. Chief on my mind pre-lockdown, was to re-emphasise the need for adhering to our robust infection control procedures, but also given the new threat to health, ensure we had sufficient stock of disposable gloves for clinic venues where there were no hand washing facilities. Looking back now, those days feel like a different era and my team, I and perhaps most people in the UK were unaware that our world was going to be turned upside down. 

In the weeks that followed things changed at a dizzying pace resulting in me activating our continuity arrangements earlier than anticipated, largely dictated by the shifting landscape that depended in part on what we heard from the Government’s daily press briefings but also from our strategy and plans as a Local Authority.

As the rates of infections started to increase exponentially, many services scurried to shut down for the foreseeable future and rightly so; everyone had to do their part to flatten the curve. We, as a service, didn’t have such a luxury by virtue of the fact that stopping support midway through a treatment pathway was not an option. The chances of a client successfully quitting smoking increase with regular behavioral support and uninterrupted access to treatments, like Nicotine Replacement Therapy (NRT) and Champix tablets.

Being responsible for the care of over 200 clients during a pandemic needs careful consideration. Our contingency plans made provision to stop face-to-face consultations in March with interim arrangements to supply stop smoking treatments during the pandemic. This challenge was further amplified when we received guidance from the National Centre for Smoking Cessation and Training (NCSCT) about ceasing all face-to-face consultations immediately and further news that the local community hubs, where clinics would normally be held, were shutting down completely to the public. So, without a location where clients could come and pick up their prescriptions regardless of social distance measures in place, we had to adapt our plans. Eventually and after several phone calls, we managed to support most of the clients via telephone and put arrangements in place for collection of scripts.

It didn’t end there though, as we then had the concern of how we would support new clients who wished to stop smoking, particularly pregnant women who were referred from maternity. Constant in my mind was safeguarding my staff and the public, so I knew that a long-term solution needed to be sought to minimise risk. After talking to several colleagues on the pros and cons of electronic vouchers and other options, we settled on posting prescriptions directly to clients (1st Class and with trackable labels) as it was the least restrictive option.

The next challenge was to introduce this very new way of working to my team, by explaining and demonstrating why this approach was best in these circumstances. Thankfully, a close colleague had helped me to draft a Standard Operating Procedure (SOP), which was soon amended and rolled out. This new way of dealing with scripts hasn’t been without its drawbacks. Sometimes the prescriptions have been delayed in the post for up to 10 days, which has meant that the staff have had to think 2-3 weeks ahead to ensure clients don’t run out of medication. But it has meant that we have minimised risk and enabled the team to work remotely from home, without the need to come to a central location to arrange for medication or go out to pharmacies, which have seen an increased demand during the pandemic.

The last few weeks have now been spent amplifying the #Quit4Covid message, learning from areas like Hertfordshire, Sheffield and Newcastle, and putting our own spin on these messages to engage smokers. This has included sending proactive text messages to unsuccessful quitters, bespoke postcards to homes of known smokers (who have given consent) and using social media. To date, we have seen promising results with many smokers engaging, and I am hopeful that there will be more dividends in future weeks.

What has been insightful for me has been the opportunity to lead our fantastic team of nurses during this period and observe their reactions to the unprecedented changes in their way of working and providing support for smokers. As a manager, it has been a privilege to help them navigate and accept the new realities that COVID-19 presents to all of us. Don’t get me wrong, it’s not all been smooth sailing, there have been several minor blips with a fair dose of IT challenges, to name just one. In the last few weeks, I have felt a quiet steadying as my nurses have become more confident about the change in work practices that they were long accustomed to as clinical staff. The challenges of remote consultations have been accepted, as has the notion that for some clients our weekly or fortnightly contact is literally a lifesaving form of communication.

The emerging evidence around adverse outcomes for smokers with COVID has reinforced what I have believed for a long time. Supporting people to stop smoking is one of most important public health interventions and not just for a host of non-communicable diseases associated directly or indirectly with smoking, but now with the threat of a communicable disease like COVID-19. To echo the words of England’s Chief Medical Officer Prof Chris Whitty to the Health Select Committee:

“If you are going to give up smoking, this is a very good moment to do it”

Rachel McIlvenna works as an Advanced Public Health Practitioner for Public Health South Tees and leads on tobacco dependency and long term conditions. Her portfolio also includes managing the in-house specialist stop smoking service, which includes a small team of vibrant nurse prescribers.

For information on stopping smoking in Middlesbrough / Redcar & Cleveland, visit:

Image attribution
3: "Dominic Raab Covid-19 Presser 06/04" by Number 10 via, copyright © 2020: (CC BY-NC-ND 2.0)