NATIONAL INSTITUTE FOR HEALTH AND CARE
EXCELLENCE
Indicators for the NICE menu for the QOF
Indicator area: Smoking
Indicator: NM126
Indicator: NM126
The percentage of patients with any or any combination of the following
conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD or
asthma whose notes record smoking status in the preceding 12 months.
Introduction
Smoking is the main cause of preventable illness and premature death in
England. It is the primary reason for the gap in healthy life expectancy
between rich and poor. A wide range of diseases and conditions are caused
by smoking, including cancers, respiratory diseases, coronary heart disease
and other circulatory diseases, stomach and duodenal ulcers, erectile
dysfunction, infertility, osteoporosis, cataracts, age‑related macular
degeneration and periodontitis.1
Rationale
This indicator measures the percentage of people with CHD, PAD, stroke or
TIA, hypertension, diabetes, COPD, CKD or asthma who have their smoking
status recorded in the previous 12 months. The aim is to identify people who
smoke so they can be offered smoking cessation treatment or advice.
NICE and NICE-accredited guidance recommends smoking cessation
treatment and support for people with the conditions outlined in the indicator
wording. This is because people with these conditions face increased risks
from smoking (for example, increased risk of cardiovascular disease)
compared with the general population. In addition, there is evidence that
people who smoke are receptive to smoking cessation advice in all healthcare
1
National Institute for Health and Care Excellence (2013) Smoking cessation: supporting
people to stop smoking NICE quality standard 43
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settings and that healthcare professionals are effective in helping people to
stop smoking. Healthcare practitioners should therefore ask people if they
smoke, and offer advice on how to stop smoking. A different smoking indicator
(NM127) measures the percentage of smokers who receive an offer of
support.
Source guidance and recommendations
 Risk estimation and the prevention of cardiovascular disease (2007) SIGN
guideline 97
 Recommendation: All people who smoke should be advised to stop and
offered support to help facilitate this in order to minimise cardiovascular
and general health risks.
 Type 1 diabetes (2004) NICE guideline CG15
 Recommendation 1.10.2.1: Adults with type 1 diabetes who smoke
should be given advice on smoking cessation and use of smoking
cessation services, including NICE guidance-recommended therapies.
The messages should be reinforced in continuing smokers yearly if precontemplative of stopping and at all clinical contacts if there is a prospect
of their stopping.
 Lower limb peripheral arterial disease (2012) NICE guideline CG147
 Recommendation 1.2.1: Offer all people with peripheral arterial disease
information, advice, support and treatment regarding the secondary
prevention of cardiovascular disease, in line with published NICE
guidance on:
 smoking cessation
 diet, weight management and exercise
 lipid modification and statin therapy
 the prevention, diagnosis and management of diabetes
 the prevention, diagnosis and management of high blood pressure
 antiplatelet therapy.
 Management of patients with stroke or TIA (2008) SIGN guideline 108
 All people who smoke should be advised to stop and offered support to
help facilitate this in order to minimise cardiovascular and general health
risks.
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 Hypertension (2011) NICE guideline CG127
 Recommendation 1.4.8: Offer advice and help to smokers to stop
smoking.
 Chronic obstructive pulmonary disease (2010) NICE guideline CG101
 Recommendation 1.2.1.2: All COPD patients still smoking, regardless of
age, should be encouraged to stop, and offered help to do so, at every
opportunity.
 Chronic kidney disease (2014) NICE guideline CG182
 Recommendation 1.4.6: Encourage people with CKD to take exercise,
achieve a healthy weight and stop smoking.
Reporting and verification
See indicator wording for requirement criteria. The contractor should report
smoking status using the following guidance:
Smokers
For people who smoke, smoking status should be recorded in the previous
12 months.
Non-smokers
It is recognised that life-long non-smokers are unlikely to start smoking and
repeatedly asking smoking status can be unnecessary. Smoking status for
this group of people should be recorded in the previous 12 months until the
end of the financial year in which the person reaches the age of 25.
Once a person is over 25 (for example, in the financial year in which they
reach 26 or any year after that) to be classified as a non-smoker they should
be recorded as:
 never smoked, which is both after their 25th birthday and after the earliest
diagnosis date for the disease which led to the person’s inclusion on the
NM126 register (for example, one of the conditions listed in the indicator
wording for NM126).
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Ex-smokers
Ex-smokers can be recorded as such in the previous 12 months for NM126.
Practices may choose to record ex-smoking status on an annual basis for
3 consecutive financial years and after that smoking status need only be
recorded if there is a change. This is to recognise that once a person has
been an ex-smoker for more than 3 years they are unlikely to restart.
For the purposes of QOF, users of electronic cigarettes who have never
smoked or have given up smoking should be classified as non-smokers or exsmokers, respectively.
The disease register for the purpose of calculating smoking prevalence for
NM126 and NM127 is defined as the sum of the number of patients on the
disease registers for each of the conditions listed in the indicator wording.
People with one or more co-morbidities, for example, diabetes and CHD, are
only counted once.
Further information
This is NICE indicator guidance for QOF, which is part of the NICE menu of
indicators. This document does not represent formal NICE guidance. The
NICE menu of indicators for QOF is available online at:
http://www.nice.org.uk/standards-and-indicators/qofindicators
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