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Tuesday, November 04, 2008

Comments

The alcohol DES certainly isnt worthwhile if GPs are planning to perform screening and brief intervention to the quality level needed to obtain the outcomes seen in clinical trials.

We train large numbers of doctors and other clinical staff in brief intervnetions using the Newcaslte version of the WHO Strucutured Brief Intervention sheet.

In our opinion, you need 4 minutes to do a full AUDIT (this will be done by Health Care Assistants in most practices). You need to allocate 3 minutes per brief intervention, needed in 30% of adult patients. Probably more if the doctor doing the intervention did not run the initial questionnaire.

And you should budget for 10 mins of GP time per brief intervention if there is a new appointment just for this.

So my guess is the practices who DO sign up for the DES can only make this work by cutting corners to keep it as a worthwile rate of pay.

Most LES agreements that we have seen have been in the £5-£7 per patient screened category - and these use a shortened version of AUDIT (normally FAST)

If asked, I recommend that GPs do not take up the DES because they will have to choose either to do it well (hence unprofitably) or do it poorly (hence unprofessionally)

MT

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