NHS England have updated the national Commissioning for Quality and Innovation (CQUIN) for 2019–2020, which incentivises hospitals and other settings to deliver alcohol 'Identification & Brief Advice' (IBA). See here for the updated Public Health England (PHE) Health Matters guidance.
CQUINs allocate a percentage of the total value of an NHS contract with a provider for sufficient delivery of specified activity. The national CQUIN covers activities including alcohol and tobacco interventions under a prevention of ill health theme.
The updated guidance broadly follows on from the previous CQUIN theme applying a simple IBA approach to brief intervention. For 2019-20, eighty per cent of patients admitted as a hospital inpatient for one night or more are expected to be 'screened' for alcohol and tobacco use. Alcohol screening for the CQUIN is based the three AUDIT-C questions where a score of 5 or more indicates an alcohol use disorder for which brief advice or referral is required. Ninety per cent of those scoring 5 or more are expected to be given brief advice or referal where dependence is likely, which the guidance suggests equates to AUDIT-C scores of 11 or 12.
To support delivery, PHE previously produced resources including the basic AUDIT-C pathway (pictured above) and 'scratch card' version, a short e-learning course, and a set of infographics which demonstrate the case for implementing alcohol IBA including a potential Return on Investment (ROI) of £27 per patient over four years.
Brief interventions: ongoing questions?
IBA has been a central component of alcohol prevention strategies in the UK over recent years, with many local areas seeking to implement IBA across a range of settings, including via previous locally commissioned CQUINs.
However whilst there may be good evidence from research trials, the extent of effective implementation remains questionable, particularly in key primary care settings. In 2015 the 'DES' Primary Care IBA scheme came to an end but was integrated into the main GP contract and it was stated monitoring would continue, though no outcomes appear to have been reported by PHE as yet. Meanwhile IBA remains part of the 'NHS Health Checks' programme offered to all adults aged 40-74 and forms part of primary care QOF initiatives for depression and hypertension.
As such, debates over whether the benefits of brief interventions seen in research trials can be translated to busy front-line settings may be regarded as ongoing. Many will be hoping for evaluation findings to come out of the CQUIN, particularly that may attend to ongoing questions about fidelity and whether more simplified 'advice' approaches are effective. A rumoured forthcoming national alcohol strategy may also set out future brief intervention plans, should it materialise.
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