BackgroundGiven, smoking results in poor physical and mental health, reducing tobacco harm is of high importance. Recommendations published by National Institute for Health and Care Excellence to reduce smoking harms included provision of support, use of nicotine containing products and commissioning of smoking cessation services. AimsThis report explores the difficulties in obtaining such support, as observed in a recently conducted randomised controlled trial in patients with severe mental ill health, and outlines suggestions to improve facilitation of provision.MethodsData collected during the Smoking Cessation Intervention for severe Mental Ill Health Trial (SCIMITAR+) trial, was reviewed to identify the difficulties experienced, across the trial, with regards to access and provision of NRT. Actions taken to facilitate access and provision of NRT were collated to outline how provision could be better facilitated.ResultsAccess to nicotine replacements therapy (NRT) varied across study settings and in some instances proved impossible for patients to access. Difficulty in access was irrespective of a diagnosis of severe mental ill health. Where NRT was provided, this was not always provided in accordance with NICE guidelines.ConclusionsAvailability of smoking cessation support, and NRT provision would benefit from being made clearer, simpler and more easily accessible so as to enhance smoking cessation rates.