Implementing a national treatment service for dependant smokers: initial challenges and solutions

Background Before 1999, few treatment services for nicotine-addicted smokers existed in England. When national treatment services were introduced, those responsible for setting them up liaised closely with primary care health services. Setting up an entirely new national service, treating a new category of patient (smokers motivated to stop) was an ambitious aim and this paper documents the problems encountered in the early stages of this process. Objectives To describe the principal challenges encountered and solutions employed by those setting up the services during the initial period of smoking cessation service implementation. Methods Qualitative, semistructured interviews with 50 smoking cessation staff in two former English health regions conducted in autumn 2001. Findings Two principal factors which slowed the initial development of smoking cessation services were: (i) the lack of a work-force with experience in smoking cessation methods and (ii) the fact that services were set up outside existing primary and secondary care health services in England. As few training courses in smoking cessation were available, many services provided their own in-house training for staff appointed as smoking cessation advisers. Consequently, senior service staff devoted a lot of effort to training new staff which meant that they had less time to spend on other important tasks which were necessary for service implementation. Smoking cessation services needed to develop relationships with primary care health services in order to generate referrals and find venues for the delivery of smoking cessation interventions. Liaising with primary care physicians was time-consuming, however, and some primary care physicians were opposed to the ideas that service staff had for the interface between primary care and smoking cessation services. As new smoking cessation services were not set up within existing primary or secondary health care services, service staff had to spend large amounts of time on this process of negotiation and overcoming scepticism from some primary health care physicians. Conclusions If smoking cessation services are set up in other countries, rapid implementation would be facilitated by ensuring that adequate numbers of health professionals trained in smoking cessation methods are available to staff services. Additionally, locating new smoking cessation services within existing health providers' services may speed up service implementation, but this option may not suit all health systems.