Tackling smoking where it’s needed most
In areas where smoking is deeply embedded in communities, change isn’t just about willpower — it’s about understanding communities, providing support, and building trust. These are things that the Breathe project has put at the heart of their service to help our local communities.
Since July last year, Bradford District and Craven Health and Care Partnership has been working closely with primary care services to deliver personalised stop smoking support for:
- pregnant women who smoke
- people living with chronic obstructive pulmonary disease (COPD)
- people living with asthma
to improve their respiratory health. Breathe is designed for people in South Bradford — particularly those living in the BD4+ Health population.
Backed by funding through the Core20PLUS5 programme, the Breathe project focuses on the people and communities most affected by smoking-related harm, offering tailored behavioural support, therapies, and signposting to services that can make a real difference.
Why this area of Bradford?
Smoking rates within the Bradford 4 primary care network (PCN) and Community partnership area are significantly higher than the national average — with 22.2% of the population classed as smokers, compared to 13.8% across the UK. Smoking is a key driver of chronic illness in the area, including cancer, heart disease, diabetes, and respiratory conditions such as COPD and asthma.
For many people in these communities, smoking isn’t just a habit — it’s often linked to trauma, mental health challenges, poverty, and long-standing social inequalities. That’s why Breathe takes a trauma-informed approach, treating smoking as a long-term condition rather than a lifestyle choice.
Personalised support at the heart of the community
The innovation through the Breathe project comes from its strong partnership with general practice, allowing for smoking patients to be targeted and offered a personalised approach to stopping smoking.
At the centre of the project is the Breathe Co-ordinator, a dedicated member of the team based within the primary care network (PCN). They provide one-to-one support, behaviour change conversations, and help patients navigate the services that can support their health and wellbeing.
Working closely with GPs and other healthcare staff, the Co-ordinator:
- Uses SystmOne to identify people who smoke and have respiratory conditions, mental illness, learning disabilities, or are pregnant
- Runs weekly clinics in GP surgeries to provide convenient access in a trusted setting
- Offers a single point of contact for stop smoking support, lifestyle advice, health checks and onward referrals
- Leads peer support groups to reduce loneliness and isolation by patients joining a community that is supportive towards good health and wellbeing
- Signposts to services such as social prescribers and the Swap2Stop nicotine replacement scheme
This integrated approach makes it easier for patients to access joined-up care, without needing to chase multiple services. The Breathe Co-ordinator alongside a public health approach to quitting smoking has allowed for a hyper local co-produced model to evolve.
Designed with the community, for the community
Breathe is built on strong partnerships. It brings together key partners:
- GP practices and PCNs
- Bradford Council’s smoking cessation service (Living Well Stop Smoking)
- VCSE organisations
- Social prescribers
- Clinicians including the West Yorkshire Integrated Care Board’s Respiratory Lead
- From the beginning, partners have worked together through regular co-design sessions and a shared steering group to ensure the project reflects the community’s needs and builds on existing strengths.
Impact
The project has been running for 12 months, and is already having an impact:
- 900 people engaged through clinics, outreach, and referrals
- Over 500 appointments offered to provide behavioural support and clinical checks
- Over 100 referrals to the council’s Living Well Stop Smoking service
- 39 people signed up to nicotine replacement support through the Swap2Stop scheme
A patient who has used the Breathe service said: “I would recommend it, I found it a lot easier speaking to somebody rather than just trying by myself. I would recommend the service to my cousin to stop smoking, she had help previously but started smoking again. I’ve also got my daughter to ring too. I don’t feel like you could improve the service. Everything was very helpful, and I really enjoyed taking part.”
Aligned to wider health transformation
Breathe supports the local ambition to move more care into communities, reducing reliance on hospitals by offering early, preventative support close to home. It also directly contributes to the aims of the Core20PLUS5 national framework, which focuses on reducing health inequalities among the most vulnerable populations.
About CORE20PLUS5
The Core20PLUS5 approach, led locally by the Reducing Inequalities Alliance, is part of NHS England’s national plan to close the health gap in areas of high deprivation. In Bradford District and Craven, the programme supports innovative, small-scale projects that make a big difference for people who need it most.
View more inequalities stories below or on our Reducing Inequalities Alliance webpage. To write a blog about inequalities work you’re involved in, please email ria@bradford.nhs.uk
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