Start with an open question

Confirm the reason for attendance before assuming Ilyas is ready to stop.

“It says in your notes that you’re interested in some help to stop smoking. Is that what you wanted to talk about today?”

This works well because it:

1. Shows interest and preparation.
2. Establishes Ilyas’ agenda.

Then use an open question to explore motivation:

“Can you tell me what made you decide to give stopping smoking another try?”

Time-efficient data gathering

Use open questions first, then targeted questions to fill gaps. Avoid turning the consultation into a long checklist.

Key areas to clarify include:

• Why Ilyas is thinking about stopping now.
• Whether he wants to stop immediately or is still considering it.
• What happened during previous quit attempts.
• What helped previously.
• What made stopping difficult.
• His current smoking pattern.
• Situations where cravings are strongest.
• Smoking at work, home and socially.
• Previous nicotine replacement or medication use.
• Withdrawal symptoms previously experienced.
• His current motivation and confidence.
• Support from his mother, girlfriend or others.

TThe bulk of marks is in clinical management, so aim to move on from data gathering by around 6–7 minutes.

High-yield questions

Agenda and motivation

• “What were you hoping we could do today?”
• “What made now feel like the right time to talk about stopping?”
• “What would you most like to be different if you stopped?”

Smoking pattern and dependence

• “How many do you smoke a day now?”
• “When do you usually have your first cigarette?”
• “In which situations do you find yourself reaching for a cigarette the most?”

Previous attempts

• “Have you tried to stop before?”
• “What happened then?”
• “What helped?”
• “What made it difficult?”
• “Did you use nicotine replacement or medication before?”

Triggers and barriers

• “Do you smoke more at work, at home or with friends?”
• “Are there particular times when cravings are strongest?”
• “How does stress affect your smoking?”
• “What worries you most about stopping?”

Support and preferences

• “Who knows you’re thinking about stopping?”
• “How do your mother and girlfriend feel about it?”
• “Would you prefer individual support rather than a group?”
• “How would you feel about setting a quit date?”

Functional, psychosocial or contextual assessment

Smoking cessation planning should be grounded in Ilyas’ real life. Explore:

• Work routines and smoking breaks.
• Friends who smoke.
• Smoking at home.
• Stress and mood.
• Financial impact.
• Relationship impact with his mother and girlfriend.
• Fitness and energy.
• Confidence after previous attempts.
• Preference for individual or group-based support.
• Whether he smokes more in particular situations.

Explore ideas, concerns and expectations

Ilyas may believe smoking helps him cope and may expect to become irritable if he stops. Explore this explicitly.

“What do you feel smoking does for you at the moment?”

“You mentioned you get ratty when you try to stop. What worries you about not smoking?”

Also clarify expectations:

• Is he looking for medication?
• Does he want help with cravings?
• Does he want to set a quit date?
• Does he want to reduce first?
• Does he want written information or app-based support?
• Does he want to avoid group support?

Recognise and respond to cues

Important cues include:

• Anxiety about quitting.
• Enjoyment of smoking.
• Fear of irritability.
• Concern about cravings.
• Low confidence after previous attempts.
• Reliance on cigarettes for stress relief.
• Preference against group work.

Respond by validating and exploring:

“It sounds like smoking has been doing a few different jobs for you — helping with stress, fitting into work breaks, and being something you enjoy. If we’re going to make a plan, we need to take those things seriously.”

Avoid responding as though Ilyas is simply unmotivated.

Useful consultation phrases

“Lots of people feel smoking helps them cope, but there are ways of getting through the cravings. I can explain these, if you like?”

“Nicotine patches can really cut down cravings and help your mood while you stop.”

“Previous attempts aren’t failures — they tell us what gets in the way and what we need to plan for.”

“Would working towards a quit date be more likely to help you stick to quitting? How would you feel about that?”

“You’re the expert on when you smoke most. Let’s build the plan around those high-risk times.”

Consultation flow and signposting

1. Confirm the agenda.
2. Explore motivation and readiness.
3. Ask about previous quit attempts.
4. Clarify smoking pattern and dependence.
5. Identify work, social and emotional triggers.
6. Explore impact and personal benefits of stopping.
7. Discuss quit-date options.
8. Explain medication, nicotine replacement and behavioural support.
9. Agree a personalised cessation plan.
10. Arrange follow-up and relapse support.

Use signposting to keep the consultation structured:

“We’ve talked about what makes smoking difficult to stop. Next, I’d like to go through the options that can reduce cravings and make the plan more realistic.”

Summarising and checking understanding

Before moving into management, summarise Ilyas’ situation.

“You’ve tried to stop before, but cravings and feeling irritable made it difficult. You’re now thinking about trying again, particularly because of your cough, the cost and the support you have at home.”

Check confidence and understanding:

“Does this sound like it could work for you?”
“What questions do you have?”
“How confident do you feel about trying this plan?”

Data gathering self-check

Before agreeing a plan, the trainee should know:

• Why Ilyas wants to stop now.
• Whether he is ready to stop or still considering it.
• What happened in previous attempts.
• What helped and what made quitting difficult.
• How much he smokes and when.
• His main triggers at work, home and socially.
• His concerns about cravings, irritability or mood.
• Whether he has used nicotine replacement or medication before.
• What support he has from his mother, girlfriend or others.
• Whether he prefers individual or group support.
• Whether a quit date feels acceptable.

Assessment domain mapping

Data gathering

• Agenda, motivation and readiness.
• Previous quit attempts and withdrawal symptoms.
• Smoking pattern, dependence and triggers.
• Psychosocial context and support.
• Concerns about cravings, irritability and coping.

Clinical management

• Explaining cessation options.
• Offering medication and behavioural support.
• Supporting an agreed quit date where appropriate.
• Planning for triggers, lapses and follow-up.

Relating to others

• Non-judgemental approach.
• Validating ambivalence.
• Shared decision-making.
• Positive framing of previous attempts.

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Prioritised differential diagnosis or clinical reasoning

This is not primarily a diagnostic case. The main clinical focus is smoking cessation and nicotine dependence.

Consider:

• Nicotine dependence.
• Psychological and behavioural triggers.
• Stress-related smoking.
• Social reinforcement from smoking friends.
• Low confidence after previous unsuccessful attempts.
• Smoking-related symptoms such as cough.
• Other smoking-related disease where clinically relevant.

Do not become distracted from the main agenda by investigating every possible smoking-related illness unless symptoms indicate this is necessary.

Clinical reasoning script

“You’ve tried to quit on your own before, but cravings and irritability made it hard. Using nicotine replacement or medication, plus some support, can make stopping more achievable. We can build the plan around your work triggers, your friends, and the type of support you’d actually use.”

This frames previous attempts as useful learning, not failure.

Red flags and risk assessment

Consider areas that may affect the safety and success of the plan:

• Worries about low mood.
• Irritability when stopping.
• Stress-related smoking.
• Smoking-related symptoms such as cough.
• Previous unsuccessful attempts.
• Strong social and workplace triggers.

Decision points

Key decisions include:

• Is Ilyas ready to stop now, or is he still considering it?
• Would a planned quit date help?
• Does he prefer abrupt stopping or gradual reduction while preparing?
• Which option feels most acceptable: nicotine replacement, medication, behavioural support, or a combination?
• Does he want individual or group support?
• Which work or social triggers need a specific plan?
• Who can support him?
• What will he do if he has a lapse?

Management priority

The management priority is to agree a realistic, personalised smoking cessation plan that addresses:

• Nicotine cravings.
• Irritability and withdrawal symptoms.
• Stress and coping.
• Workplace and social triggers.
• Support from people close to him.
• Follow-up and relapse prevention.

Management options

1. Nicotine replacement therapy

Discuss options including:

• Nicotine patches.
• Nicotine gum.
• Nicotine lozenges.
• Combining longer-acting and short-acting nicotine replacement where appropriate.

Patches may be useful for providing steady nicotine levels and reducing cravings.

2. Medication

Discuss medication options such as:

• Varenicline.
• Bupropion.

Explain the purpose, potential benefits, side effects and any monitoring or prescribing considerations.

3. Exercise and distraction

Suggest practical craving-management strategies:

• Short bouts of exercise.
• Keeping busy.
• Changing routines.
• Distracting himself during high-risk periods.
• Going for a walk.
• Activities that occupy his hands and mind.

4. Set a clear quit date

Encourage a clear quit date where this suits Ilyas.

Discuss:

• The “not a puff” rule.
• Preparing for high-risk situations.
• Removing cigarettes and smoking materials.
• A plan for managing cravings.
• A plan for dealing with lapses.

5. Follow-up

Arrange brief, regular follow-up to:

• Review progress.
• Adjust treatment.
• Address withdrawal symptoms.
• Support motivation.
• Prevent relapse.
• Reinforce achievements.
• Help after any lapse.

6. Written resources

Offer:

• Written smoking cessation information.
• NHS smoking cessation resources.
• The NHS Quit Smoking app.
• Information about nicotine replacement.
• Information about managing cravings.

7. Avoidance of social triggers

Explore ways to reduce exposure to triggers such as:

• Pubs or other smoking environments.
• Friends who smoke.
• Smoking breaks at work.
• Specific routines linked to cigarettes.

Help Ilyas plan what he will say or do if offered a cigarette.

8. Family and friend support

Explore support from:

• His mother.
• His girlfriend.
• Friends who do not smoke.
• Colleagues.

Ask whether he would like family members involved in supporting his quit attempt.

9. Stress management

Consider:

• Stress-management leaflets.
• Apps.
• Relaxation strategies.
• Exercise.
• Talking to supportive people.
• Addressing the underlying situations in which he smokes.

10. Group or specialist support

Mention group or specialist smoking cessation services, while respecting Ilyas’ preferences if he does not want group work.

Explain that support can be adapted to his preferred format.

Abrupt versus gradual reduction

STtopping abruptly may be more effective than gradual reduction according to NICE NG92, while still supporting Ilyas’ preference and readiness.

The trainee should offer evidence-based advice without dismissing Ilyas’ preferred approach.

“The guidance suggests stopping completely from a quit date can work better than gradually cutting down, but the plan still needs to feel realistic for you. Let’s talk about what you’d be willing to try.”

Personalised plan

A bespoke plan might include:

• A mutually agreed quit date.
• Nicotine patches, with additional short-acting treatment if appropriate.
• A plan for work and social triggers.
• Support from his mother and girlfriend.
• Individual rather than group support if preferred.
• Written information and the NHS Quit Smoking app.
• Follow-up within a week.
• An agreed approach to lapses or relapse.

Example personalised plan:

“You’re most comfortable with patches and not group work, and you feel ready to set a quit date. Shall we prescribe patches, give you some information and arrange to touch base in a week?”

Shared decision-making

Discuss which options Ilyas feels are most acceptable and realistic.

Explore:

• Whether he prefers patches, gum, lozenges or medication.
• Whether he wants a quit date.
• Whether he wants individual or group support.
• Which situations are most difficult.
• Who can support him.
• How confident he feels about stopping.
• What he would do if he smoked a cigarette after the quit date.

Use a positive frame:

“You’ve already made good progress thinking about this, and you’ve got support at home — which gives you a much better chance of success.”

Safety-netting and relapse planning

Explain that difficulty or relapse does not mean future attempts will fail.

Encourage Ilyas to:

• Contact the practice if cravings are difficult to manage.
• Return if side effects occur.
• Seek further support if mood worsens.
• Review the plan if he is unable to maintain the quit attempt.
• Use a lapse as an opportunity to identify triggers and modify the plan.

Example phrase:

“If you have a cigarette after the quit date, it doesn’t mean the attempt has failed. Let’s use it to work out what triggered it and adjust the plan.”

Documentation points

Document:

• Ilyas’ agenda and motivation.
• Smoking pattern and triggers.
• Previous quit attempts and what helped or hindered.
• Concerns about cravings, irritability or mood.
• Options discussed.
• Chosen cessation plan.
• Quit date if agreed.
• Resources offered.
• Follow-up arrangements.
• Relapse plan.

Common unsafe or weak management plans

Avoid:

• Giving only brief advice without exploring Ilyas’ readiness or barriers.
• Assuming he wants group support.
• Ignoring irritability, low mood or cravings.
• Focusing only on health risks rather than practical support.
• Prescribing without discussing behavioural triggers.
• Not arranging follow-up.
• Treating relapse as failure.

Follow-up and coordination with other professionals

Arrange brief, regular follow-up to monitor progress, reinforce motivation and adjust the plan if needed.

Where acceptable to Ilyas, consider:

• Local smoking cessation services.
• Group or specialist support.
• Involvement of his mother, girlfriend or other supportive people.

Learner checkpoint

Have I agreed a plan that Ilyas feels able to follow when cravings, stress and social triggers appear?

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Relevant guidance areas

This includes guidance and resources on:

• Stop smoking interventions and services.
• Smoking cessation.
• Patient resources for quitting.
• Consultation communication and relating to others.

NICE guidance

• NICE NG92: Stop smoking interventions and services.
• NICE CKS: Smoking cessation.

RCGP and SCA resources

• RCGP SCA Toolkit: Relating to Others.

Patient information websites

This includes:

• NHS Quit Smoking app.
• NHS smoking cessation information.
• Written information about nicotine replacement and other treatments.
• Local smoking cessation services.
• Group or specialist support services, where acceptable to Ilyas.

Key principles to remember

• Confirm the patient’s real agenda rather than relying on the booking note.
• Begin with an open question about motivation.
• Explore previous attempts without judgement.
• Recognise ambivalence and nicotine dependence.
• Ask about cravings, irritability, enjoyment and coping.
• Identify work, social and emotional triggers.
• Explain treatment options in simple language.
• Offer medication and behavioural support.
• Support an agreed quit date where appropriate.
• Respect preferences about individual or group support.
• Arrange regular follow-up.
• Maintain a positive approach and support future attempts after lapses or relapse.

Transferable learning for future cases

In behaviour change consultations, the task is not simply to give advice. A strong GP trainee should:

• Clarify what the patient wants from the consultation.
• Explore ambivalence without judgement.
• Understand what the behaviour does for the patient.
• Identify previous attempts as learning opportunities.
• Offer practical options, not just warnings.
• Personalise the plan around the patient’s routines and support network.
• Arrange follow-up so the patient is not left to manage alone.

Supervisor or examiner lens

A supervisor or examiner is likely to look for:

• Agenda setting and patient-centred opening.
• Exploration of motivation, confidence and previous attempts.
• Recognition of triggers and barriers.
• Clear explanation of cessation options.
• Shared decision-making around quit date, treatment and support.
• Respect for Ilyas’ preferences.
• Positive relapse planning and follow-up.

Final learner takeaway

Smoking cessation consultations work best when you explore ambivalence, personalise support, and turn previous attempts into a practical plan for the next quit attempt.

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