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What the RCP thinks about tobacco

The Royal College of Physicians (RCP) has a long history of campaigning on issues relating to tobacco use and control. We want the delivery of smoking cessation support to all smokers to be a core function of all healthcare activity.

Key recommendations

In 2016 the RCP’s Tobacco Advisory Group published Nicotine without smoke: Tobacco harm reduction. It provides an update on the use of harm reduction in tobacco smoking in relation to all non-tobacco nicotine products, but particularly e-cigarettes. The report recommends:

  1. Cessation services should be adequately funded, and in clinical settings integrated systematically into routine health service delivery.
  2. All existing and new policies with the potential to promote smoking cessation, particularly among disadvantaged groups, should be applied to their fullest extent.
  3. E-cigarettes should be regulated but it should be proportionate. A regulatory strategy should take a balanced approach in seeking to ensure product safety, encourage smokers to use e-cigarettes instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy.

Smoking is the biggest avoidable cause of death and disability, and social inequality in health, in the UK. In 2016 it was estimated that 15.5% of adults in England smoke and smoking causes 79,000 preventable deaths every year.

Smoking is estimated to cost the NHS £2.5 billion a year as smokers are more likely to see their GP or be admitted to hospital. The cost to the wider economy is estimated to be £9.4 billion a year, including the cost of absence and illness from work and lost earnings.


The use of e-cigarettes is increasing. In 2016, 5.6% of people in Great Britain said they used e-cigarettes, up from around 4% in 2015. Some 12.1% of users were ex-smokers, and 13.7% were current smokers. While they are probably more hazardous than nicotine replacement therapy, the harm is unlikely to exceed 5% of that from smoking tobacco.