Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

doi:10.1136/bmj.323.7310.432

BMJ 2001;323:432 ( 25 August )

Primary care

Qualitative study of pilot payment aimed at increasing general practitioners' antismoking advice to smokers

Tim Coleman, senior lecturer, ^a Alison T Wynn, research associate, ^a Keith Stevenson, lecturer, ^a Francine Cheater, professor of public health nursing. ^b

^a Department of General Practice and Primary Health Care, Leicester Warwick Medical School, Leicester General Hospital, Leicester LE5 4PW, ^b School of Health Care Studies, University of Leeds, Leeds LS2 9LN

Correspondence to: T Coleman tjc3{at}le.ac.uk

Objectives: To elicit general practitioners' and practicenurses' accounts of changes in their clinical practice or practiceorganisation made to claim a pilot health promotion payment. Todescribe attitudes towards the piloted and previous health promotionpayments.
Design: Qualitative, semistructured interviewstudy.
Setting: 13 general practices inLeicester.
Participants: 18 general practitioners and 13 practicenurses.
Results: Health professionals did not report substantiallychanging their clinical practice to claim the new payments andmade only minimal changes in practice organisation. The new healthpromotion payment did not overcome general practitioners' resistancetowards raising the issue of smoking when they felt that doingso could cause confrontation with patients. General practitionerswho made the largest number of claims altered the way in whichthey recorded patients' smoking status rather than raising thetopic of smoking more frequently with patients. Participants hadstrong negative views on the new payment, feeling it would alsobe viewed negatively by patients. They were, however, more positiveabout health promotion payments that rewarded "extra" effort $---$ forexample, setting up practice based smoking cessationclinics.
Conclusions: General practitioners and practice nurseswere negative about a new health promotion payment, despite agreeingto pilot it. Health promotion payments do not automatically generateeffective health promotion activity, and policymakers should considercareful piloting and evaluation of future changes in health promotionpayments.

What is already known on this topic
Health promotion payments have been made to UK general practitioners since 1990, but their effectiveness is unknown

What this study adds
Primary care staff held strong negative views about the pilot payments to promote smoking cessation and previous health promotion payments

The highest claiming practitioners altered their methods of recording smoking status rather than increasing the frequency with which they advised patients against smoking

Future changes in health promotion payments should be carefully piloted

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