Clinical & Policy Updates:
SMMGP Policy Update September-October 2013
|Download the PDF version of this Update here! (PDF*, 64K)|
The Alcohol Learning Centre website was transferred to PHE as part of the transition to the new organisation. The site has been renamed PHE Alcohol Leaning Resources but website address and content remains and continues to be updated.
14 pilot areas were tested during 2012-13 as a precursor to the Alcohol Stock Take Self Assessment Tool and feedback from the then NTA regions and partnerships was that it was a highly successful way to organise a constructive review of local integrated response to alcohol harm.
The stocktake is designed to provide a structure for local areas to take a systematic view of their response to alcohol-related harm and it covers the full range of activity across all levels of prevention. The tool provides areas with a way of benchmarking against evidence-based practice in order to support improvement and identify effective practice.
More information and access to the tool, is available on the PHE web site.
Admission episodes for alcohol-attributable conditions (previously NI39) - Quarterly data (Q3) 2012/13 are now available; annual data will be available in December 2013. Please see the LAPE web site for more information.
National Confidential Enquiry on Patient Outcome and Deaths (NCEPOD) report "Alcohol Related Liver Disease: Measuring the Units", June 2013.
The recent report "Measuring the Units" from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) June 2013 offers a number of recommendations to improve practice in alcohol treatment. Whilst there is no formal monitoring process arising from this report, its recommendations are considered by Hospital Trust services and commissioners.
The recommendations cover a wide range of areas of practice from information recording and sharing to specialist clinical interventions, including good practice guidance for hospital alcohol liaison teams.
The exploration of "missed opportunities" in the NCEPOD report is particularly interesting in highlighting that patients who had presented on a number of occasions to health services were not routinely asked about their alcohol use. The recommendation for primary care and hospital staff is for routine screening, identification of alcohol problems, the delivery of brief interventions and referral on to appropriate specialist alcohol treatment at the earliest opportunity.
The NHS Health Check - commissioned by local authorities from April 2013 - includes an alcohol risk assessment. Everyone having an NHS Health Check will have a risk assessment which will look at the level of risk associated with their alcohol consumption as well as their risk of having, or developing, vascular disease in the next 10 years. Local authorities can decide where these take place and, as long as the staff are appropriately trained and qualified, who carries them out. For example, they may choose to use a combination of pharmacies and other community settings as well as GP practices. Where the risk assessment is conducted outside the person's GP practice, there is also a legal duty for information to be forwarded to the person's GP. When fully implemented, the NHS Health Check is expected to be taken up by over 2.2m patients per year.
Draft Best Practice Guidance (PDF, May 2013) on the implementation of this assessment, is available on the NHS Health Check website.
Discussions have begun between PHE alcohol programme leads and NHS England about the future of DES contracts. The alcohol DES which has been in place since 2008 pays GPs to offer Identification and Brief Advice IBA to new patient registrations and has been continued as a responsibility of NHS England through 2013/14, with no decision yet having been made about continuation beyond March next year.
IBA typically involves:
- Identification: using a validated screening tool to identify "risky" drinking, such as AUDIT;
- Brief advice: the delivery of short, structured "brief advice" aimed at encouraging a risky drinker to reduce their consumption to lower risk levels.
Currently, less than 50% of the funds set aside for the alcohol DES are claimed by GPs, and one ambition in 2013-14 would be to increase the take up of the DES - and claims - in order to substantiate the programme as worthy of continuing.
The NICE QOF Committee is considering alcohol screening to be included in existing QOF indicators such as hypertension. They are looking closely at the SIPS findings to identify the most appropriate conditions. They are not proposing a separate QOF indicator for alcohol screening.
NICE's indicator development team will report back in October 2013 with suggestions for new potential inclusion of alcohol elements in other indicators. If approved, these would then be piloted among GP practices and the new indicator would become a part of QOF from 2015/16.
The drug nalmefene has been licensed in Scotland related to the reduction of alcohol consumption in adult patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms and who do not require immediate detoxification. Nalmefene should only be prescribed in conjunction with continuous psychosocial support focused on treatment adherence and reducing alcohol consumption.
Read further comments in the blog post from Euan Lawson on our website. Comments from our readers are welcome.
This document has been produced by DrugScope as part of the support provided by Making Every Adult Matter (MEAM) and Revolving Doors to the Big Lottery "Fulfilling Lives" partnerships. The development of services for people with multiple needs in the 12 Fulfilling Lives (FL) areas in England will require the partnerships to navigate new policy structures, managing risks and taking advantage of opportunities. The purpose of the briefing is to equip the FL partnerships to navigate this emerging terrain effectively by providing:
- An overview of relevant policy themes and initiatives;
- Mapping of the new local (and regional) policy environment;
- Consideration of the financial context and new approaches to purchasing and commissioning of services;
- An overview of independent initiatives on multiple needs and sector specific information and resources.
This comprehensive briefing by Drugscope's Director of Policy and Membership (Marcus Roberts) outlines policy and other changes that have taken place this year in one handy document, including mapping new policy structures and bodies, and links to resource documents. A really useful report.