Hippo Labs uses the official NHS England QOF Business Rules to help practices manage and record smoking status, advice, and referrals systematically — across the general population and patients with long-term conditions.
💬 Just a reminder: these indicators aren’t clinical guidelines — they define which patients appear for recall, how achievement is calculated, and where gaps may occur.
📋 The Smoking Registers
There are two main registers that underpin the smoking indicators:
Register | Includes | Purpose |
SMOK1_REG | Patients with CHD, PAD, stroke/TIA, hypertension, diabetes, COPD, asthma, CKD, schizophrenia, bipolar disorder, or psychosis | Used for indicators SMOK002 and SMOK005 (chronic condition population) |
SMOK2_REG | Patients aged 15 and over | Used for SMOK004 (general population) |
✅ In short: SMOK1 covers long-term condition patients, while SMOK2 covers everyone aged 15+.
🩺 The Indicators
💬 SMOK002 — Smoking Status Recording
Measures:
% of patients with a long-term condition (CHD, PAD, stroke/TIA, hypertension, diabetes, COPD, asthma, CKD, or SMI) whose smoking status is recorded within the last 12 months.
Counts as complete if:
Latest smoking status recorded within the past 12 months, and
Recorded as smoker, ex-smoker, or never smoked.
Exclusions (Personalised Care Adjustments):
Smoking care unsuitable.
Patient declined to disclose smoking status.
Patient declined smoking care.
Two smoking review invitations ≥7 days apart with no attendance (for payment only).
New diagnosis or new registration within last 3 months.
⚠️ Common pitfalls:
Smoking status older than 12 months.
Recording text notes instead of a valid SNOMED code.
Missing both systolic and diastolic BP when recording opportunistically.
Forgetting to re-record ex-smokers who relapse or reclassify as current smokers.
✅ In short: every patient with a long-term condition should have an up-to-date smoking status recorded every 12 months.
💨 SMOK004 — Smoking Advice (General Population, 15+)
Measures:
% of patients aged 15 or over who are current smokers and have been offered advice, support, or treatment within the past 24 months.
Counts as complete if:
Referral to a stop smoking service/advisor, or
Record of smoking cessation pharmacotherapy (e.g. nicotine replacement, varenicline, bupropion)
— both within 24 months of the achievement date.
Exclusions (PCAs):
Smoking care unsuitable or declined.
Two smoking invitations ≥7 days apart with no attendance.
Newly registered within last 3 months.
⚠️ Common pitfalls:
Offer recorded verbally but not coded.
Using free-text entries instead of referral codes.
Recording referral >24 months ago.
✅ In short: every current smoker aged 15+ should have a coded offer of smoking cessation advice or treatment within the past 2 years.
💊 SMOK005 — Smoking Advice (Long-Term Conditions)
Measures:
% of patients with long-term conditions (as defined in SMOK1_REG) who are current smokers and have been offered smoking cessation support or treatment within the past 12 months.
Counts as complete if:
Referral to stop smoking services/advisor, or
Pharmacotherapy for smoking cessation recorded in the last 12 months.
Exclusions (PCAs):
Smoking care unsuitable or declined.
Two invitations ≥7 days apart with no attendance (for payment purposes only).
Newly diagnosed or registered within last 3 months.
⚠️ Common pitfalls:
Referral or medication older than 12 months.
Missing referral code (free-text advice not counted).
Forgetting to code “declined” or “unsuitable” for excluded patients.
✅ In short: every smoker with a chronic condition should be offered smoking cessation advice or treatment each year.
🧩 Putting It All Together
Indicator | Focus | Who It Applies To | What It Measures | Timeframe |
SMOK002 | Smoking status recording | Patients with LTCs (CHD, COPD, etc.) | Smoking status recorded | 12 months |
SMOK004 | Smoking advice — general | All patients aged 15+ | Offer of cessation support/treatment | 24 months |
SMOK005 | Smoking advice — LTCs | LTC patients who smoke | Offer of cessation support/treatment | 12 months |
🌟 Why This Matters
Following these indicators helps practices:
Keep smoking status up to date across all patient groups.
Ensure smokers are consistently offered advice and support.
Improve public health outcomes and reduce risk of chronic disease complications.
Demonstrate QOF compliance and proactive prevention work.
✅ In short: the Smoking Indicators ensure that smoking status is consistently recorded — and that every smoker, especially those with long-term conditions, is supported to quit.
📚 Sources
NHS England QOF Business Rules v50.0 (Smoking, April 2025)
Primary Care Domain Reference Sets (TRUD Portal)