Alcohol Policy UK

Funding opportunities for GP alcohol inteventions?

Ministers have put forward plans for  £50 million of clinical funding that would be partly used to pay for Screening and Brief Interventions (SBIs) by GPs. The funding would see the development of a number of Locally Enhanced Services for GPs, a framework by which GPs are paid to screen and offer appropriate interventions to patients.

The clinical funding, if approved, would also pay for enhanced services for GPs to address osteoporosis, heart failure, improved collection of ethnicity data and annual health checks for those with learning disabilities.

However a number of obstacles are likely to affect the implementation of any such clinical programmes within the development of GP services. These include the pay dispute involving the British Medical Association (BMA) and concerns over the position of such proposals in relation to the development of the Quality Outcomes Framework (QOF). Dr Ahmat Fuat, a GP in Darlington and deputy chairman of Primary Care cardio-vascular society, candidly rasied his concerns relating to alcohol treatment in primary care, stating: "You’d probably need £50m to tackle alcohol alone."

The Health Secretary Alan Johnson nonetheless highlighted the opportunities being made available within the new agendas, saying:

"‘This is about developing high-quality services with a strong focus on prevention. It’s a great opportunity for entrepreneurial GPs as well as social enterprises, voluntary organisations and the independent sector to develop innovative services."

Increasing numbers of PCTs are already commissioning alcohol enhanced services either through Choosing Health or other local funding streams such as in Lewisham.

For more information follow the Pulse medical journal for GPs.

Wirral sets up screeening and brief interventions in 56 pharmacies

Wirral PCT has launched Screening and Brief Interventions (SBIs) in 56 of the district's pharmacies, aiming to have all 86 covered as part of the 2007-2010 local alcohol strategy. The developments follow SBIs being set up across GP surgeries in Wirral last year, a setting well suited for SBIs and supported by national guidance. In pharmacy settings, people will be screened by being asked to fill in a short questionnaire and being provided with advice, information or onward referral as appropriate. Follow-up telephone calls will also be made to assess how clients may have responded to the intervention or to deliver any further support.

Wirral has amongst the highest rates for alcohol misuse in the country, with over half of men in Merseyside regualrly drinking more than the reccomended guidelines. According to the Liverpool Daily Post, Andy Mills, head of partnership and engagement at Wirral PCT, said:

“Wirral is leading the way nationally, and many pharmacists have already started running routine alcohol screenings. Wirral PCT is now looking to get all pharmacies involved in providing this service.”

Trusts across the country are increasingly commisisoning SBIs as part of local approaches to reducing alcohol misuse, particularly in primary care, A&E and criminal justice settings. Recently a guidance framework for commissioners was relesaed by the NHS, the Alcohol Primary Care Service Framework.

Alcohol Primary Care Service Framework released

The NHS have released Primary Care Service Framework: Alcohol Services in Primary Care, designed to support commissioners, practitioners and providers in setting up alcohol interventions in primary care.

The document is likely to be welcomed across the country as increasing numbers of PCTs and local authorities are setting up Screening and Brief Intervention programmes within primary care settings, particularly with General Practitioners and in cases other settings such as pharmacies.

Previously there had been no specific frameworks to help local commissioners and practitioners set up such programmes, despite national guidance such as Models of Care for Alcohol Misusers (MoCAM) and Alcohol Misuse Interventions: Guidance on developing a local programme of improvement. The Alcohol Services in Primary Care Framework may be particularly useful in helping commissioners and practitioners:

• Scope and define suitable services
• Identify key agendas and frameworks
• Identify suitable evidence bases and local need
• Identify service objectives and intended health outcomes
• Set up suitable governance, monitoring and evaluation arrangements
• Identify suitable contract management
• Identify suitable review, variation and recommissioning process
• Find supporting documents, guidance, definitions and Read codes

Where commissioners may still be stuck is around pricing of services with no recommended or nationally agreed prices.

The new framework comes as part of 6 new Primary Care Service Frameworks falling within objectives of providing enhanced, localised service provision within the Practice Based Commissioning agenda.

Alcohol hospital admissions hit squad announced

A specialist squad is to be set up to help towns with the most drink-related hospital admissions fight their alcohol problems.  Health Secretary Alan Johnson announced the formation of the National Alcohol Support Team during a speech on tackling health inequalities.

The 10 worst-affected towns or local authority areas across England will get targeted support by March next year. The Alcohol Support Team will be made up of civil servants who will advise primary care trusts about how they can tackle alcohol misuse in their areas.

Measures could include introducing specialist alcohol nurses into A&E to offer support to patients for drinking-related problems, or offering safe drinking advice in settings such as sexual health clinics. The Department of Health highlighted evidence to show that for every eight people who received brief advice, one cut down on the amount of alcohol they drank. In addition to the 10 visits in this financial year, there will be around 18 visits in 2009-10, and at least 20 the following year.  BBC News

For more information, see this previous post.

Alcohol Liaison Seminar, Wednesday 11th June, updated programme

The upcoming Alcohol Liaison Seminar for nurses and drugs or alcohol workers with an interest in alcohol liaison in hospital or healthcare settings, has a slightly revised programme, though will still be taking place on the 11th June in Leicestershire.

The updated programme and to book your place here

The previous event and audio presentations here

Alcohol Liaison Seminar, Wednesday 11th June

An Alcohol Liaison Seminar will take place on Wednesday 11th June 2008 in Leicestershire, following the success of forums in 2006 and 2007. The event is expected to be attended mainly by nurses and alcohol/drug workers in hospital or healthcare settings, although commissioners or service managers may wish to enquire about availability.

Further details on the event and how to book your place here

We reported on the previous event, with audio and presentations here.

New report: Binge Drinking and Europe

The Institute of Alcohol Studies have released a new report, Binge Drinking in Europe. The comprehensive document considers the picture of binge drinking in Europe, its impact, and recommendations on how it should be addressed. The report is particularly pertinent when considering regulation on marketing and availability, which the Prime Minister Gordon Brown is set to make further announcements on this year. The report also examines the role of education, health care interventions and the cost effectiveness of various approaches to addressing binge drinking.

Alcohol Liaison Forum: screening and early interventions in A&E - audio from the presentations

The Alcohol Liaison Forum took place on Wednesday 28th March at the Soho Centre for Health and Care in Central London. The focus of the event  was alcohol liaison work in hospitals and health care settings.  It was attended by nurses, alcohol and/or drugs workers with an interest in alcohol liaison at hospitals or other settings, and other interested parties such as commissioners and service managers.

The first Substance Misuse Liaison Nurses Conference was held in Birmingham in October 2006. Attendees wanted to keep in touch to discuss the issues of such work, especially with increasing developments in alcohol liaison in hospitals.  Download the programme here.

The speakers include leading experts and practitioners in alcohol liaison work and Wernicke's Encephalopathy.

1. Robin Touquet: Introduction slides (1-13)

Right click to download mp3

2. Allan Thomson: Wernicke’s encephalopathy - clinical aspects from diagnosis to treatment and prevention slides 14-20 

Video used in the presentation

Irene Guerrini: Alocal related thiamine deficiency: what can we do in the community? slides 21-35

Right click to download mp3

3. Moya Forsythe, Rachel Cloudesley, Ruth Cooke, Paramabandhu Groves: Development of alcohol screening and liaison slides

Right click to download mp3

4. Bob Patton: Alcohol problems in A&E: researching the interventions slides

Right click to download mp3

5. Adrian Brown: Alcohol withdrawal management slides

Right click to download mp3

The speakers (left to right): Moya Forsythe, Robin Touquet, Rachel Cloudesley, Bob Patton, Ruth Cooke, Allan Thomson, Adrian Brown, Irene Guerrini, Paramabandhu Groves

View all photos from the Forum here.

Alcohol jobs: Northants, Wigan, SIPS

Alcohol Strategy Co-ordinator, Northamptonshire County Council
£27,492 - £29,859
Details here

Alcohol Strategy Officer, Wigan Council
£25,437 - £28,211
Closing date 21/9/07
Details here

Senior Alcohol Health Worker, St George's, London
Alcohol Screening & Brief Intervention Pilots: DH Trailblazer Research Programme (SIPS)
£27,622 - £36,416 Band 7, 1 year fixed term.
Closing date 14/9/07
Details here

Alcohol Health Worker, St George's London
Alcohol Screening & Brief Intervention Pilots: DH Trailblazer Research Programme (SIPS)
£21,985 — £ 31,004, Band 6, 1 year fixed term
Closing date 14/9/07
Details here

Evaluation of Lewisham's Locally Enhanced Service for alcohol

The new General Medical Services contract for GPs (nGMS), introduced in 2004, gives PCTs a contracting mechanism to provide and promote alcohol screening and brief intervention in GP practices through Locally Enhanced Services (LES).  An alcohol LES was commissioned by Lewisham PCT in early 2006 (see earlier post), and the pilot stage has now been evaluated by the PCT's Jessica Mookherjee (Download full report).

31 out of 50 practices in the PCT participated, receiving a £1000 retainer for which each practice was required to train at least 2 staff in delivering screening and brief interventions (SBI’s) and record their interventions & return their data &  GP evaluation questionnaire (every 6months)  to Lewisham Primary Care Trust (PCT). 

Many patients were identified with an AUDIT (Alcohol Use Disorders Identification Test) score of >8 (indicating hazardous/harmful drinking levels).Screening was offered to:

• All new registrations to the practice
• All Ante/Post natal patients
• All patients with chronic diseases such as Diabetes, Chronic Heart Disease, Depression, Hypertension & Epilepsy
• All those identified with alcohol related conditions (Gastro-Intestinal complaints, trauma or assault)

The most popular time to intervene was when initially presenting with symptoms.

Aims of the Alcohol LES

• To introduce opportunistic screening for alcohol misuse in primary care
• To increase referrals to alcohol services
• To increase awareness among primary care staff of alcohol services
• To motivate and empower staff to use brief interventions

Outcomes

• 18 of 31 (56%) practices referred to local agencies
• 167 patients were referred on for support/treatment
• ALL GP’s recorded some awareness of the local alcohol treatment services
• 100% of participating GP’s gave some form of advice after identifying alcohol misuse, most commonly information on units and harm reduction advice on safely reducing consumption
• Half used the  AUDIT tool, half used other less formal means
• Only 40% practices (13/31) offered community detox

Problems identified

• Poor data quality
• No quality check that GP’s interpreted their data in a uniform way
• The pilot was hard to evaluate as there was no baseline
• Practices frustrated by alcohol services and the delay in detox admission

Recommendations

• The Alcohol LES is a good opportunity to screen in primary care and should continue
• More systematic training and follow up support is needed for practices, preferably one to one support
• The recording process needs to be simplified and clearer

Further information from Hannah Lindsell, Lewisham Alcohol Strategy Co-ordinator on 020 8314 6487 or hannah.lindsell AT lewisham.gov.uk

See also evaluation of alcohol screening and brief interventions in Community Pharmacy