Today I learned something rather depressing about the NHS Stop Smoking service. They are financially incentivised not to give the best help they can.
I spent some time last week calling a lot of GP practices in a nearby town*. I wanted to talk to them about The Stop Smoking Man, and ask if maybe they would consider putting up a poster. This was a generally well-received phonecall, with the practice managers or receptionists I spoke to being interested in what I had to say and enthusiastic about the idea.
* I’m not going to be more specific than this as many of the NHS staff I have dealt with have been lovely.
Most of them said that they were happy to put a poster up, and a few said they would need to run it past one of their senior colleagues (because they were enthusiastic about the NHS Stop Smoking services) but thought it should be OK.
Today I drove to each of these practices to drop off posters and flyers, as I had said I would. The welcome (or lack thereof) I received was unexpected, to say the least.
The first few places I went to seemed very lukewarm, and most declined to allow me to speak to the practice manager or other person I spoke to last week, let alone put up a poster. Some seemed to be treating me like a competitor, which I found very strange indeed – aren’t we all just trying to help people stop smoking?
A different approach…
I was trying to figure out why there was this change in their response, so I decided to change my approach.
With the next few places, rather than explain why I was there or mention posters or the phone call last week, I went in cold and just asked for the practice manager. I explained that I was simply there to introduce myself and what I do, and to promote The Stop Smoking Man website.
This seemed to get a slightly more receptive response, however, over the course of a few different conversations with practice managers I managed to piece together a somewhat worrying, and morally questionable picture.
One practice manager explained to me that they actually could put my poster up, but that they were incentivised not to. I asked what she meant, and she explained that they get a referral fee for every person they send to an NHS Stop Smoking clinic, which means, of course, they don’t get anything for sending people anywhere else.
Armed with this information I was able to engineer a more open conversation with the next practice manager, who also confirmed about the incentives. I asked what they do when someone fails to stop using the NHS Stop Smoking service. She explained that they send them to a different one and get another fee. She said this with an ironic smile that seemed to say “yeah, I know, that’s bad, right?”
As tactfully as I could, I suggested that if the NHS stop smoking service was failing an individual but another service might help them, then maybe they should refer them to the other service, even if there was no money in it for them. I asked if she felt that meant they were actually being incentivised not to give these people the best help they could.
She sighed and said that things were so tight with money that they had no choice but to prioritise the kick-backs over actually sending them for the best help.
The next place I went to I had a not entirely dissimilar conversation with the next practice manager. He said that he would happily show the poster to everyone who worked there as “they wouldn’t use the NHS Stop Smoking service anyway”. I asked why this was and what he said was evasive, but he seemed to imply that they won’t use it because they know it doesn’t work very well.
I certainly don’t want to throw shade on anyone trying to help others stop smoking. I’ve heard generally good things about the NHS Stop Smoking Service, and I have nothing but respect for the NHS (they saved my life!), so I must assume that the above is simply one person’s opinion. My point is that at least he thinks the NHS Stop Smoking Service isn’t very good, and yet he’s incentivised to keep sending people to them.
Shouldn’t we all just be helping people stop smoking?
Is it me or is this simply wrong? Surely the idea of helping people stop smoking should simply be applauded and we should all encourage each other. I would have no hesitation in referring someone on if I thought another therapist or service could offer better help than I could, be it for smoking or anything else.
So, in summary, it seems that, intentionally or otherwise, there is a conflict of interests in this setup. If intentional then it borders on corruption in my opinion, but it’s at the very least morally questionable.