Smoking (SMOK) - QOF indicator

Smoking indicators

The smoking domain covers recording smoking status in patients with specified conditions and offering cessation support and treatment to current smokers. For 2026/27, the requirements include a preceding 12 months recording period for SMOK002 and a preceding 24 months treatment-offer period for SMOK004, with specific recording rules for people who have never smoked, former smokers and people who vape.

Why smoking is included

In England, smoking is the leading modifiable contributor to ill health and early death. It also drives substantial inequalities in health and can keep people out of work. More than 1 in 10 people in England smoke, with higher rates among deprived populations. Smoking prevalence is 19.2% among adults in routine and manual occupations, 24% among people with long-term mental health conditions and over 40% among those with severe mental illness.

More than 100 conditions can be caused or worsened by smoking. These include cancers, respiratory and cardiovascular disease, depression, psychosis and schizophrenia. During pregnancy, smoking increases the risks of miscarriage, premature birth, stillbirth, low birth weight and sudden unexpected death in infancy. Its harmful effects extend through infancy into childhood.

The domain seeks to make more quit attempts successful by ensuring access to the best available treatment. Evidence indicates that offering both support and treatment can prompt some people to try stopping who would not attempt to quit after brief advice alone.

For this domain, offering treatment involves referral to an adviser in a local Stop Smoking Service alongside pharmacotherapy. The adviser may work within the practice. If the patient does not find this approach acceptable, a different form of brief support can be offered, such as follow-up with a GP or practice nurse who has smoking cessation training.

NICE tobacco guidance identifies the following evidence-based options for adults who smoke:

• Individual or group behavioural support.

• Very brief advice.

• Bupropion.

• Short- and long-acting nicotine replacement therapy (NRT).

• Varenicline.

• Cytisinicline (cytisine).

• E-cigarettes (vapes) containing nicotine.

People who have stopped may return to smoking within three years of cessation. Good clinical practice therefore includes checking current smoking status in patients who have previously smoked and providing treatment and advice when needed. For newly registered patients, practices should also ask about and document smoking status, offering support and treatment where appropriate.

SMOK002 (based on NICE IND97)

Rationale

The reasons for including SMOK002 are those described for the smoking domain above.

Reporting and verification

The indicator definition in the table sets out the criteria that must be met.

For the SMOK002 APDF calculation, the register brings together patients on the disease registers for all conditions named in the indicator. Each patient contributes only once to the total, even if they have multiple listed conditions, such as diabetes and CHD.

Practices should use the following rules when reporting smoking status.

Patients who smoke

A smoking-status entry is required within the preceding 12 months for patients who currently smoke.

Patients who have never smoked

As people who have never smoked are unlikely to start, repeated checks may not always be needed. However, a smoking-status record from the preceding 12 months is required until the end of the financial year in which the patient reaches 25.

For patients over 25 years — meaning the financial year in which they reach 26 or any later financial year — classification as a non-smoker requires:

• A record that they have never smoked, dated after both their 25th birthday and the earliest diagnosis of a condition that placed them on the SMOK002 register.

Patients who have stopped smoking

For SMOK002, a record of ex-smoking status within the preceding 12 months can be used. Alternatively, practices can document this status annually for three consecutive financial years; subsequent recording is then needed only when the status changes. This reflects the low likelihood of restarting once someone has stopped for more than three years.

QOF classification for people using electronic cigarettes (vapes) depends on their smoking history. Those who have never smoked are non-smokers, while those who have stopped smoking are ex-smokers. Anyone using both cigarettes and electronic cigarettes remains a smoker for classification and treatment purposes.

SMOK004 (based on NICE IND99)

Rationale

SMOK004 shares the rationale set out above for the smoking domain.

Reporting and verification

Use the indicator definition in the table to establish the qualifying requirements. SMOK004 does not have an APDF calculation.