1. Kristin Rothert Head of Clinical Standards & Quality Bridge Project kristin.rothert@bradford.nhs.uk Dr Beverley Bray PhD Head of Performance Bridge Project beverley.bray@bradford.nhs.uk Setting up and delivering a Specialist Benzodiazepine Withdrawal Service in a Primary Care Setting

2. Implementing the service within a primary care setting – who does what and how does it all hang together? Lessons learnt Demonstrating outcomes The four decisions that need to be made before getting started Background What is achievable What next? 4. The Bridge B.W. Service 1. Setting up a service 2. Making it happen 3. Things to think about

3. 1.Consider:. What is the need within your own practice area? 2. Consider:. What are the barriers to delivering this service from both your own and the patient's perspective?

4. First decision: Funding the service........

5. Second decision: What does success look like?

9. Third decision: Making it happen – who needs to be around the table?

10. Fourth decision: Making it happen – what needs agreeing prior to launch? Clinical standards? What documents? Who?. Where?. What model? Cost / funding sources?

11. Implementation – getting stuck in! 1. Identify practices / areas with sufficient need 2. Identify target cohort and set up administrative processes Liaise with GPs to inform future prescribing practices 3. Contact target cohort and invite for a medication review 4. Assess and work with cohort identified

12. 1.Identify practices / areas with sufficient need for the service and 2.Identifying the target cohort

13. 3. Contact target cohort and invite for a medication review Letter to all target cohort sent by GP administration team Non-responders followed up by reminder letter after a given period Appointment booked with specialist worker for review

14. 4. Assess and work with cohort identified In depth assessment Looks at social situation Looks at prescription history and relevant information Agreement for patient to participate Agree reduction regime in principle – can be amended at a later stage Regular face to face contact Review of reduction and progress made so far – flexible reduction programme to take into account changes in circumstances Use of recognised psychosocial therapies, including CBT and MI based interventions Frequent top up phone contacts Allows flexibility of contact to suit patient Top up contacts to help with anxiety associated with medication reduction

15. Delivering the service – lessons learnt

16. Delivering the service – demonstrating outcomes....

18. Background Bridge Benzodiazepine Withdrawal Service Operating since mid 2008 Re-designed in January 2010 Lone worker employed and supervised by Bridge Located within GP practices Initially funded by Voluntary Sector grant funding A Brave New World – reporting to NDTMS

19. The story so far 223 individuals helped since January 2010 75 individuals helped since April 2012

20. The story so far 50% helped to stop their medication completely 50% reduced by between 25-80% (average 52.5%)

21. The story so far Average 24 weeks receiving support Between 9 – 47 weeks for a medication free outcome

22. Where to from here? What ideas / thoughts will you be taking back to your area / practice?