The Tayside Experience The Long Road To Implementation Peter Rice, Consultant Psychiatrist, NHS Tayside Alcohol Problems Service

Minimal Intervention at the early stages of an alcohol problem can be effective. A Primary Care culture which encourages the identification of alcohol problems and early intervention should be encouraged TAYSIDE ALCOHOL STRATEGY1994

Alcohol Enhanced Service in Primary Care Identified as highest priority by local GPs Investment of £500k of Primary Care funding 89% of Tayside practices offering Screening for specific presentations Brief interventions for hazardous/harmful drinkers

Scottish Alcohol Related Death Trends ISD Scotland 2005

SCOTTISH LIVER ADMISSIONS

SCOTTISH ALCOHOL HARM or INTOXICATION ADMISSIONS

First steps Established Primary Care Liaison post end Networking Health Improvement facilitators Public Health Practitioners Senior Managers and Clinicians Ad hoc training/education with Primary Care and other groups Promotion of alcohol care pathway Range of severity Role of Primary Care Role of specialist agencies

Locating SBI in an integrated care pathway (informed by NES for alcohol misuse)

PREVENTION 2010 / KEEP WELL March Anticipatory Care Project. Part of Delivering for Health 5 pilot CHPs. High deprivation measures. (incl Dundee) “Hard to reach” populations Initially broad focus, then narrowed down to Heart Disease Alcohol acknowledged as important contributor Opportunity to include Alcohol Screening and Brief Intervention

2006/08: Keep Well - Dundee Practice-nurse delivery Systematic FAST screening Simple Brief Intervention for hazardous/ harmful drinkers Referral for harmful/dependent drinkers Allowed links with regional Long Term Conditions agenda / Health Behaviour Change Counselling training

ENHANCED SERVICES PROGRAMME FOR PRIMARY CARE – June 2007 LOCAL AND ACCESSIBLE HEALTHCARE Services for Adults with Learning Disabilities Care for Adults with Diabetes COPD Flexible GP Appointment systems IMPROVING PUBLIC HEALTH Alcohol Screening and Brief Interventions Falls Prevention and Bone Health Cancer and Urgent Referral Audit Services for Carers Childhood Obesity

TAYSIDE ENHANCED ALCOHOL SERVICE SPECIFICATION Prepare staff – At least one team member trained Opportunistically screen patients Using FAST Develop a register of patients with a +ve fast screen Deliver brief interventions on behaviour change. Provide patient information on support services. Refer to specialist services where appropriate. Use standardised health promotion material. Record all related information using agreed Read codes Participate in audit

EXPECTED WORKLOAD FOR 5000 PTS 1000 patients be targeted for screening / year % might be expected to screen positive and be offered a brief intervention brief interventions a year.

PAYMENT STRUCTURE £500 per practice on signing up On achieving 70% of target, £1 per pt registered Above that, payment to be agreed Review overall activity at 6 months.

SCOTTISH GOVERNMENT HEALTH IMPROVEMENT TARGETS Coronary Heart Disease - Children’s Dental Care - Childhood Obesity - Suicide Prevention - Smoking Cessation - Breastfeeding and……. Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11

First call on the additional funding should be to enable NHS Boards to meet these (HEAT) targets, and for brief interventions to become part of the standard services offered by NHS Scotland. We anticipate that considerable work will be required in 2008/09 to establish delivery arrangements and build capacity across the priority settings of - Primary Care, - A&E - Ante natal and - Acute Care, SCOTTISH GOVERNMENT PUBLIC HEALTH ALLOCATIONS 08/09

Increased screening for alcohol misuse will have a knock-on effect on the volume of downstream services required. As a consequence the overall package delivers a considerable uplift in funding for early intervention and treatment (including support for newly identified dependent drinkers), and for prevention activities. Where appropriate, services should comply with guidance contained in the Health Technology Assessment Report 3 on Prevention and Relapse in Alcohol Dependence. SCOTTISH GOVERNMENT PUBLIC HEALTH ALLOCATIONS 08/09

Incentivising the implementation of brief interventions in primary care; Alcohol liaison nurses in Accident and Emergency, ante- natal care and acute care Ongoing treatment for existing and newly identified dependent drinkers Increased treatment and prevention/education services Appropriate and auditable recording systems. SCOTTISH GOVERNMENT PUBLIC HEALTH ALLOCATIONS 08/09