Stopping smoking
Stop smoking for the last time
One of the most effective things you can do for your health, and one of the hardest. Medication plus proper support works far better than willpower alone — but the first job of this consultation is not the quit plan.
Fully online. Video consultation with Dr Qurbain, medication dispensed to your door, and no need to travel anywhere.
Stopped before, and started again?
If any of these sound familiar, this consultation was built for you.
You already know why you should. That was never the problem.
You want the thing that actually shifts the odds, not willpower advice.
You want someone who does not make you feel judged for slipping.
You want a quit date, and support around it.
Before we talk about quitting, we look for what smoking may already have caused.
If you are coming to stop smoking, you are by definition in the highest-risk group for lung and throat cancer. Red-flag screening therefore comes before any discussion of medication — because treating the dependence while missing a cancer is the single biggest clinical risk this service carries.
That screen is specific, and it catches more people than you would expect. An unexplained cough in anyone over 40 who has ever smoked warrants an urgent chest X-ray under national guidance — which, in a stop-smoking service, is close to everyone. If you need that X-ray, arranging it is more valuable than anything else we do that day.
How it works
Four steps, all from home
The red-flag screen, first
Cough, coughing blood, hoarseness, weight loss, appetite loss, fatigue, difficulty swallowing, persistent sore throat, mouth ulcers, any lump in the neck, chest pain, breathlessness, recurrent chest infections. Anything that triggers a referral is referred before cessation treatment, or alongside it.
Your smoking, and your history
Pack-year history, when you started, what you smoke now, and how dependent you are, measured properly — time to first cigarette, night-time smoking. Previous attempts: what you used, how long it lasted, what caused the relapse. Mental health history and current mood.
A quit date, and a plan
A set quit date, behavioural support at every contact, written relapse-prevention strategies, and the medication options discussed honestly. You are also offered and encouraged to use your local NHS stop smoking service, which is free and more intensive than a remote service can be.
Reviewed where it matters
One to two weeks after your quit date, then four weeks, then twelve. Mood is asked about and recorded at every single review. Your GP is told the agent, the quit date and the review plan.
Why we screen before we prescribe
Anyone coming to stop smoking is, by definition, in the highest-risk group for lung and throat cancer. Treating the dependence while missing a cancer is the principal clinical risk of this service, so the screen comes first.
40+
Unexplained cough, ever smoked
Warrants an urgent chest X-ray under national guidance — which in a stop-smoking service is close to everyone. If you need one, arranging it is the most valuable thing we do that day.
45+
Persistent unexplained hoarseness
Prompts consideration of a suspected cancer referral for laryngeal cancer — a different age threshold and a different pathway from cough.
Any age
Coughing blood
Referred under the suspected cancer pathway.
Every review
Mood asked about
For anyone on either prescription option, mood is asked about and the answer recorded at every single review.
What treatment involves
Nicotine replacement
- Combination therapy — a patch plus a short-acting form — which works better than a single product and is first line for most people
- Correct use, patch site rotation, and the point most people get wrong: continued craving usually means the dose is too low, not that it is not working
Prescription medication
- A licensed prescription stop-smoking medication, started one to two weeks before your quit date and continued for twelve weeks
- An alternative prescription option where that one is unsuitable
- Dose adjusted where your kidney function requires it
- Mood is monitored at every review for anyone on either — asked, and the answer recorded
Also discussed
- E-cigarettes — not prescribed, but discussed as an effective route for some smokers, with the evidence and the uncertainties given honestly
- Medicines whose levels change when you stop smoking — your GP is told before your quit date so doses can be watched
- Referral to your local NHS service alongside this one, not instead of it
What helps, and what nobody tells you
Medication combined with behavioural support has a stronger evidence base than willpower alone — that is the honest framing, and we are not going to quote you a quit rate as though it were a promise. Two practical things: relapse is common and it is not failure, and people who come back after a relapse do better than people who do not come back at all. One limitation we will name: carbon monoxide verification is not possible remotely, so abstinence here is self-reported. If you want verified quitting, your NHS service can do that and we will point you to it.
What you need to know before starting
Side effects, and what to do about them
Read
The mood warning is the one that matters most, and it applies to both prescription options.
- Any new or worsening low mood, agitation, unusual behaviour, or thoughts of harming yourself — stop the medicine and contact us or your GP urgently. This is reinforced at every review, and you are asked directly each time.
- Seizure risk with one of the two options — stop and seek advice immediately if a seizure occurs or a rash develops.
- Nausea, vivid or abnormal dreams and disturbed sleep are common with the other — take it with food and water, and take care driving if it affects you.
- Stopping smoking changes how your body handles certain medicines. If you take theophylline, clozapine, olanzapine or warfarin, your GP or specialist must know before your quit date so doses can be monitored. Caffeine will also hit you harder.
- If you have diabetes, your insulin needs may fall on stopping — monitor more closely.
- Neither prescription option is used in pregnancy or breastfeeding.
When we will not prescribe
Who this service cannot treat, and why
Read
Some of these mean referral first and treatment after; others mean a different service entirely.
- Any red flag above, until it has been assessed and resolved
- Pregnancy or breastfeeding — both prescription options are contraindicated. Referred to your midwife and the NHS service, which has specific pathways; nicotine replacement in pregnancy is a GP or specialist decision, not a remote one
- Unstable significant mental illness, or a current psychiatric crisis
- Current suicidal thoughts or self-harm — escalated and supported, not prescribed for
- Treatment for substance dependence needing specialist coordination
- Any history of seizure, or a condition lowering the seizure threshold — rules out one option
- Bipolar disorder, or a current or past eating disorder — rules out one option
- Severe liver cirrhosis, or certain antidepressants taken now or in the last 14 days
- End-stage kidney disease
- No genuine intention to stop, and no quit date — the medication does not work on its own
- Anyone under 18
Suspected undiagnosed COPD, asthma or cardiovascular disease is referred for proper assessment and breathing tests, because those change what you need as much as stopping does.
Reviewed, with mood asked every time
The full review and monitoring schedule
Read
At one to two weeks after your quit date: how you are getting on with the medicine, side effects, craving control, dose adjustment, and mood specifically asked about and recorded. At four weeks: abstinence, mood, tolerability — this is the standard outcome point. At twelve weeks: the end-of-course review, and any extension justified and recorded rather than automatic. Supply never exceeds the interval to the next review, and mood is asked about at every single review for anyone on either prescription option.
Your quit schedule
Medication starts before your quit date, not on it. Supply never exceeds the interval to the next review.
1–2 weeks before
Medication starts
Prescription medication is started one to two weeks ahead of your quit date so it is working by the time you stop.
Quit day
Your set date
A date you choose and commit to, with written relapse-prevention strategies already in hand.
1–2 weeks after
First review
Adherence, side effects, craving control, dose adjustment, and mood specifically asked about and recorded.
4 weeks
The outcome point
Abstinence, mood and tolerability. This is the standard measure of whether a quit attempt has taken.
12 weeks
End of course
Any extension justified and recorded rather than automatic.
Our approach follows current national guidance. See the guidelines we work to.
Initial consultation
Your initial consultation is paid when you book, before the consultation, and is charged whether or not treatment is prescribed. A follow-up review is paid when it happens, and only if you or your doctor decide you need one.
Joining the waiting list is free. Medicine, if prescribed, is bought separately from the dispensing pharmacy and its cost is confirmed with you before you pay for each supply.
Video consultation, the cancer red-flag screen, dependence assessment, a written quit plan with relapse-prevention strategies, and the review schedule. Medication, where prescribed, is dispensed separately by a registered pharmacy and priced before you pay.