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Less than half of local authorities in England commission stop smoking services in community pharmacies. But data from Scotland’s service indicates national commissioning could lead to huge increase in provision, as Victoria Goldman explains… 

According to the Company Chemists’ Association (CCA)’s Expanding smoking cessation support through community pharmacy report, published in February this year, smoking rates have fallen to 12 per cent of the population.

However, there are still over five million adult smokers in England. Ten per cent of smokers surveyed said they intended to quit within the next month, yet access to NHS and local authority-funded smoking cessation support is variable, with less than half the number of people who wish to quit every year receiving support.

Despite the importance of stop smoking advice through healthcare professionals, there is still no national pharmacy smoking cessation service in England.

Fewer than half of local authorities commission stop smoking services through community pharmacies. Data from the nationally commissioned service in Scotland, when modelled to English health systems, indicates that national commissioning could lead to a more than ten-fold increase in provision.

“Community pharmacies already play an important role in supporting people to quit through brief interventions, advice and access to smoking cessation treatments,” says Malcolm Harrison, chief executive of the CCA.

“Many pharmacies also provide locally commissioned stop smoking services, but access varies significantly depending on where a person lives.

“As a result, many smokers are unable to access support from one of the most accessible healthcare settings in their community.”

Current services

Smoking accounts for around 75,000 deaths every year. In England, hospitals can refer discharged patients through the national smoking cessation service (SCS) to a community pharmacy (of the patient’s choice) to continue the stop smoking journey they started in hospital.

Yet this service is vastly underused and is only available from a small proportion of pharmacies. The CCA’s report found that fewer than five per cent of pharmacies currently receive referrals through this pathway.

“Community pharmacists used to do mainly locally commissioned smoking cessation services very successfully,” says Lindsey Fairbrother, a specialist consultant in independent prescribing.

“Now, there is only the discharge service with hardly any eligible patients and few referrals, but there are still many other smokers wanting to start NRT and expecting free medicines alongside behavioural support. Ideally, there should be a national solution, with tools and frameworks for local commissioning.”

Around a third of all adult smokers live in the most deprived communities, contributing to health inequalities. According to a spokesperson for the Local Government Association: “Many councils direct resources into specialist outreach in the most deprived communities where smoking is often most concentrated and where harder-to-reach smokers are.

“Pharmacy sits alongside this resource in many areas. The 2026-27 settlement, with multi-year certainty and a ringfenced minimum spend on stop smoking services, gives councils the planning horizon to develop sustainable pathways. We expect commissioning to evolve as the new arrangements are embedded.”

Harrison says a nationally commissioned walk-in smoking cessation service would provide a consistent offering across England, ensuring that anyone who wants to quit via community pharmacy can do so.

“Support is not consistently available where need is greatest,” he says. “Community pharmacies are uniquely placed to address this challenge. In contrast to other healthcare providers, there are more pharmacies in the more deprived communities. This is what has been described as the ‘positive pharmacy care law’.”

Kenny Chan, Numark’s lead information services pharmacist, says several groups can be particularly challenging to reach when it comes to smoking cessation – these include young people and those who smoke heavily or have been smoking for a long time.

“Low-income individuals often have higher rates of smoking and may lack access to resources that can help them quit,” he says.

“Smoking rates are also significantly higher among people with mental health conditions. These individuals may use smoking as a coping mechanism, making cessation more difficult.

“Approaching these groups tactfully requires understanding, empathy and a tailored approach. Pharmacies are key to patient accessibility.”

Nationally commissioned support

The CCA’s report indicated that a nationally commissioned community pharmacy walk-in smoking cessation service would help over 225,000 people to quit smoking each year and address the current postcode lottery of access.

If every pharmacy offered a walk-in service, more than 225,000 people could be supported annually, compared to the current 15,000 – a more than ten-fold increase. 

“Targeted support for groups at greater risk of smoking-related harm remains important,” says Mahendra Patel, chair of the Royal College of Pharmacy's English National Pharmacy Advisory Council.

“However, everyone who wants to quit smoking should be able to access appropriate support and advice from healthcare professionals, including community pharmacists.

“A consistently commissioned walk-in smoking cessation service, backed by sustainable funding and support for pharmacy teams, could help remove barriers to care.

“In areas of high deprivation and in communities with large ethnic minority populations, language and cultural barriers can make it more difficult to access healthcare services.

“Community pharmacy teams are well placed to help overcome these barriers and improve access to smoking cessation support.”

The CCA report recommends implementing booking and referral systems so that other healthcare professionals can easily electronically refer patients to community pharmacy for smoking cessation support and advice.

It urges policymakers to support pharmacies to invest in their workforce. These systems are already being introduced for urgent care services (e.g. Pharmacy First) but need to be applied to smoking cessation. Patients should also be able to access pharmacy smoking cessation services directly through the NHS app.

“There needs to be a walk-in service, but it’s also a matter of timing and time, as pharmacy consultations are getter busier and busier,” says Nick Hunter, chief officer at Community Pharmacy Nottinghamshire.

“What may work better is a combined approach involving the whole pharmacy team – not just pharmacists. A walk-in smoking cessation service could involve an initial conversation with the pharmacy team, and then a more detailed conversation booked in with the pharmacist at a future date.”

All smoking cessation services need to be tailored to the individual. Although many smoking cessation self-care products, such as NRT, are available to buy over the counter from pharmacies, the price of these can be a barrier for patients.

And not all local pharmacy services are able to offer behavioural support or prescription-only medicines. Vaping is another issue that needs to be addressed nationally.

“Everyone who vapes is still nicotine dependent,” Lindsey says, “and a lot of people who have taken it up have never smoked, including young people.

“Pharmacists may need more training on vaping, as the main focus has been on smoking and its risks, but vaping should be part of a nationally commissioned pharmacy service in the future.”

Nicorette senior brand manager Jodie Sanassy provides her tips for pharmacists to start conversations with patients…

Bringing up smoking with a patient can be tricky. Some may feel judged even at the mention of it, while others may shut down immediately.

A non-judgemental question can give patients permission to take the lead. Something like ‘how do you feel about your smoking at the moment?’ can help gently start the conversation.

From there, you can explore what prompted any previous quit attempts, how ready the patient feels, and how confident they are about stopping.

It also helps to pinpoint the triggers behind the habit – perhaps stress or diet, alcohol consumption or certain times of the day – to talk through practical ways to manage them.