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Nottingham Alcohol! Identification, Brief Advice and Extended Brief Advice Mark Holmes, Framework.

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Presentation on theme: "Nottingham Alcohol! Identification, Brief Advice and Extended Brief Advice Mark Holmes, Framework."— Presentation transcript:

1 Nottingham Alcohol! Identification, Brief Advice and Extended Brief Advice Mark Holmes, Framework

2 A bit about me Psychiatric Nurse (RMN) with a first class degree in substance misuse. Also a NMC recognised Specialist practitioner in Substance Misuse. Vice chair of Nursing Council on Alcohol Have worked in alcohol misuse field for over 13 years Set up the QMC Alcohol Liaison Team just over 7 years ago. Assessed over 2000 patients in this time from ages 16-98 Seen referrals from the ‘had a bit too much to drink and fell over’, to the end stage of liver disease Now Clinical Nurse Specialist in Brief Advice employed by Framework working with Nottingham PCT. Just set up a sensible drinking service: Last Orders. Currently advising the DH on Identification and Brief Advice A moderator and sit on the steering group for Alcohol Learning Centre

3 Background:How much do we drink in Nottingham? Lots! 1 in 4 drink too much 42,000 drink at ‘increased risk’ 15,000 drink at ‘higher risk’ 50,000 binge drink

4 Alcohol in Nottingham 4,700 alcohol-related hospital admissions. Rising – One of the highest alcohol-attributable death rates (64 per 100,000 in Nottingham, 47 per 100,000 in England) Highest rate of alcohol-related recorded crime in the country£27 million being spent by the criminal justice system 230,000 working days lost from the workforce Contributes to 280 sexual assaults Affect 14,000 children with drinking/drug using parents

5 Why does Nottingham have a problem? Culture - party city? Stag and Hen Parties Stag Nights and Hen Nights in Nottingham According to Stag and Hen world “Nottingham is one of the top 5 locations in the UK for stag nights and hen nights. FACT!” Football/ other sport

6 Why does Nottingham have a problem? Deprivation? Nottingham ranks 13th out of the 354 districts Better than Liverpool; Hackney; Tower Hamlets; Manchester; Knowsley and Islington but just not as good as Newham; Easington; Middlesbrough; Birmingham; Kingston upon Hull and Blackpool

7 Why does Nottingham have a problem? Population! Lots of people drink in a relatively small area. Claims to have the most pubs per square mile Whilst the City of Nottingham unitary authority has a historically tightly drawn boundary which accounts for its relatively small population of 288,700, the wider Nottingham Urban Area has a population of 667,000 It is the seventh-largest urban area in the United Kingdom, ranking between those of Liverpool and Sheffield

8 Why does Nottingham have a problem? Lots of young people? Estimated 40,000 students Karnival is the University of Nottinghams student-run charitable organisation, and the largest one of its kind in the UK. Every Saturday, armed with a collecting tin, a ridiculous outfit and usually a hangover, Nottingham students hit the streets of cities across the country. “7 legged pubcrawl”!

9 Why does it matter? Many people don’t realise they are drinking too much Health is at risk Harms to society (crime, antisocial behaviour, family problems) Increases inequalities

10 What is NHS Nottingham City doing? Working with partners - refreshed strategy Reviewing current services and filling the gaps Good evidence that identification and brief advice can reduce consumption - hence Last Orders and a new ‘locally enhanced service’ for GPs

11 Last Orders: Where do we fit in? In 2008, the C.D.P and P.C.T conducted a review of the alcohol treatment system in Nottingham City. The following gaps were identified: No alcohol specific health promotion Little I.B.A. in primary care No alcohol treatment specifically targeting those groups suffering highest rates of alcohol-related harm

12 What are we doing: Locally Enhanced Service for alcohol LES is to reward practices for screening patients aged 16 or over who at likely to be misusing alcohol and offering brief advice to patients found to be drinking at ‘increased risk’ or ‘higher risk’ £10 per patient Target Population- Patients scoring 5 or more on AUDIT-C First Stage- (30 secs) AUDIT C Second Stage (1-2 mins) If score 5 or over Full AUDIT to determine level of alcohol misuse Third Stage Patients scoring 8-20 are offered brief advice with Last Orders leaflet. Fourth Stage- If motivated offer referral to Last Orders in alcohol dependancy to APAS or SMS.

13 Training A minimum of one GP and one practice nurse should have attended the City PCT alcohol session or individual training by Last Orders. Training can be cascaded to other clinicians by the trained GP and/or practice nurse or can be done electronically through the Alcohol Learning Centre But what happens when you open up the ‘Can of worms”

14 A new alcohol service for Funded by NHS Nottingham City- provided by Framework Launched 1 st July 2009 Recently expanded to 4 nurses, a Health Promotion Nurse and admin Initial clinics in Family Medical Practice, Carlton Cripps Radford Health Centre River Lyn Bulwell Wilford Grove, Meadows Windmill Practice Greenwood Top Valley Health point

15 Who, how, what? Self referral via Free phone number 0800 055 6184 Referral from primary care team Via fax 9789111/ telephone Written via referral form Those who score under 20 on the AUDIT and request further support for their alcohol problem Sessions will run on a cognitive behavioural model of intervention. Up to six sessions Signposting if clients need more support Rapport building

16 Higher Risk 16-19 Increasing risk 8-15 Lower risk 1-7 Abstainers 0 Possible Dependence 20-40 Diagnose & refer to specialist service Brief counselling/follow-up Simple structured Brief Advice Positive reinforcement ? No action indicated Drinker typology based on AUDIT scores

17 Support We can provide you with: Telephone support- clinical advice Materials for Brief Advice i.e. Patient information leaflets, booklets, posters, unit calculators, calling cards Training Website- Events- Raising alcohol awareness, weeks of action. Research Raising awareness via media

18 What We have Provided: 1098 primary care workers trained in delivering I.B.A or alcohol awareness in the last 12 months. 87 clients seen EBA 243 Extended Brief Advice sessions delivered in the last 3 months 45 clients successfully completed (significant reduction in drinking) 36 referred on to other services (SMS, Mimosa, Carers Fed, counselling services etc) 372 Brief Advice sessions completed in the last 3 months, including Pride, Indian Community Group and Parklife events. Specific Outreach with Travellers, LGBT & South Asian Community.

19 Success & how to measure it. We are currently being independently evaluated by the University of Nottingham. Referrals (including self-referrals) are increasing week on week. 11 people have so far successfully completed the E.B.A treatment. We have submitted a bid to ‘Pump Priming’ to fund a further study into the effectiveness of our E.B.A. Program.

20 However it’s not all plain sailing. We have struggled Split into groups and lets look at the challenges we face taking IBA into Primary Care. Introduce yourselves to group and then pick a problem to discuss:

21 Workshop: Problem solving How do I get into talk to Primary Care? Swine flu!- How do we keep alcohol on the agenda? Skill mix- How do you train primary care staff from a broad background? Should we give incentives to do IBA? How do target alcohol health promotion to your locality?

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