A group of GP practices working together in inner-city Gloucester are reaching out to a diverse local community with specialist support to help people stop smoking and the response is impressive.

Harnessing data is enabling the Gloucester Inner City Primary Care Network (GIC-PCN) team to tailor its approach to tackling tobacco dependency to meet the needs of the local population.

Exploring data revealed that after English patients, the largest number of smokers within the patient population at GIC-PCN is from Eastern Europe.

There are nearly 800 Polish, Czech and Slovak speaking patients who smoke being looked after by the group of practices which includes Gloucester Health Access Centre (GHAC), Severnside Medical Centre, Partners in Health and Kingsholm.

Areas of inner-city Gloucester served by this PCN include Westgate, Matson and Barton.

Population Health Management (PHM) is an approach aimed at improving the physical and mental health and wellbeing of a local population. Clinicians at the PCN have embraced this way of working and its ability to generate positive results.

Senior Respiratory Specialist Nurse Sonia Silk said:

“We took a PHM approach looking at language and postcode area. You could apply the same principle to any PCN.

“We have very high levels of smoking in this area. Nationally it’s around 13% compared to 23% of our local population.

“This is a unique group and with some of our diverse communities, smoking and mental health are linked to social deprivation.

“Not everyone who needs services will ask to access them, particularly those whose first language is not English,” she added.

Smoking is one of the country’s biggest killers, with 64,000 people dying from smoking related illnesses every year.

It is no longer considered a ‘lifestyle choice’ by healthcare professionals. Instead, it is recognised as a chronic, relapsing condition for which people need help, with nicotine addiction peaking in areas where people face a greater number of challenges and have fewer opportunities for help.

Smoking is described as one of the biggest contributors to health inequalities in the UK (health inequalities are unfair and avoidable differences in health across a population).

Krzysztof Habicht, is a Polish in-house Smoking Cessation Coach (who also speaks Slovak and Czech) working at the PCN, offering patients 1:1 help in their own language.

He said: “People are too afraid sometimes to even answer the phone because they feel they can’t communicate.

“Behaviour change is very important as is the relationship with the patient, so speaking the same language removes a barrier.”

Krzysztof is interested in the use and effects of drugs (pharmacology) and through the project has had contact with over 350 patients with more than 100 accepting support.

“My role is to explain everything at the first appointment and put the person at ease,” he explained.

“When it comes to Nicotine Replacement Therapy (NRP) some people might know what the options are but they may not have the technique.

“Explaining the mechanism of how things work, like the nicotine receptors in your brain, helps people understand what is happening to them.”

As well as sending text messages to patients in Czech and Polish, the team has also produced posters and leaflets in different languages.

Working together has also been key to the success of the project.

Sonia said: “A lot of my respiratory patients are seen by Krzysztof so we’re really offering joined up care.

“We’re seeing the whole person and this kind of holistic way of working is key.”