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Hertfordshire County Council


Smoking remains the single largest cause of preventable deaths and one of the largest causes of health ineqaulity in England. There are 7.3 million adult smokers and over 200 people a day die from a preventable smoking related illness.

Smoking accounts for approximately half the difference in life expectancy between the richest and poorest in society.



Key messages

  • 13.5% of adults in Hertfordshire smoke.
  • 28.9% of routine and manual workers in Hertfordshire smoke.
  • 3% of 15 year olds regularly smoked in Hertfordshire in 2015.


Referral and pathways

The Stop Smoking Service is provided across the county by level 2 advisors within GP surgeries, community phramacies and local community venues. The service will work with smokers using an e-cigarette to support them to stop using tobacco. E-cigarettes are 95% safer than smoking tobacco and are a useful tool to support people that want to stop smoking.

E-cigarettes should only be used by smokers or ex smokers. They should only be sold to people over 18.

Pregnant smokers and people with mental health conditions should be offered e-cigarettes to support their quit attempts.

Referral process

1st contact

A service user will approach the stop smoking service at a local pharmacy, GP or community centre.

They will complete a health questionnaire, receive a booklet on stopping smoking and arrange their first appointment. Consider referring them to a specialist if they are pregnant, have a mental health condition or complex needs, or have not successfully quit with your service previously.

1st appointment

The 1st appointment is usually pre quit-attempt, and lasts 30 - 45 minutes.

The completed health questionnaire will be used to note relevant medical history information, as well as the user's smoking history and current dependency (Fagerstrom test). Their motivation and confidence to quit will be assessed too.

A QuitManager consent statement will be completed and and a quit date is negotiated, alongside a discussion in planning for it.

Appointments 2, 3 and 4

These appointments are weekly and usually 10 - 15 minutes long, happening shortly after the quit date.

Assess progress so far. Congratulate the service user on any constructive behaviour change efforts.

Confirm the quit date.

Monitor their use of medication - ensure adequate use and monitor side effects (adjust dose or change medication if there are severe adverse effects).

Final appointment

The final appointment is between 20 and 42 days after the quit date (NHS reporting deadlines).

Assess their progress so far - have they quit or not quit at this 4 week follow up?

Ensure that the service user has a sufficient supply of NRT, varenicline or bupropion to complete full course of medication.

Complete a CO reading - it must be less than 10ppm to validate their non-smoking status.

Congratulate their success if appropriate, and encourage staying stopped.

For those who haven't quit, encourage them to return for another course when they're ready.


For more information contact Hertfordshire Health Improvement Service on:

01442 453 655