Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service

Transcription

1 08/09 Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service Reference: LES24 Contents: 1. Finance Details 2. Service Aims 3. Service Criteria 4. Ongoing Measurement & Evaluation 5. Signature Sheet

2 1. Financial Detail The agreement is to cover the 12 months commencing 1 April Practices that wish to participate in providing this service will have undertaken the initial development of a patient register using the agreed patient assessment tools. A baseline rate of 60 per patient would then apply for 2008/09. Further discussions about a payment by results for patients who successfully complete a programme of detoxification (possibly based on that described in the national enhanced specification) will be considered as will a more detailed tariff that reflects the more qualitative aspects of the service provided (see Read Codes in section 4). 2. Service Aims All practices are expected to provide essential and those additional services they are contracted to provide to all their patients. This specification is designed to cover the enhanced aspects of clinical care of the patient all of which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services. There is evidence that: 1 in 25 adults in the UK are dependent on alcohol. Problem drinkers consult their GPs twice as often as other patients and alcohol misuse is associated with a range of physical health problems. - In1997therewere4907deaHeavy drinking is closely linked with psychiatric morbidity, including clinical depression. Up to 65% of all suicide attempts are linked with excessive drinking, and alcohol is responsible for approximately 22,000 premature deaths per annum. 180,000 hospital admissions annually are for alcohol related illness or injury. Around 95 million is spent annually on alcohol treatment. 20 per cent of general hospital beds are occupied by people with alcoholrelated problems. It is estimated that between 780,000 and 1.3 million children are affected by parental alcohol problems Brief interventions can reduce alcohol consumption by over 20 per cent and so reduce the number of patients who become dependent on alcohol and the need for more intensive treatment in the future.

3 The major aim, therefore, is to improve the quality of care provided by practices to patients who misuse alcohol. The service will achieve this by incentivising and training GPs to advise and treat alcohol misuse patients and, where possible and over time, to undertake more specialised treatment of alcohol dependent patients. Practice Eligibility to Provide LES Practices eligible to provide services under this LES will have already completed the setting up of a patient register and participating GPs will need to adhere to the Models of Care for alcohol misusers (MoCAM) NTA 2006 and the Review of the Effectiveness of treatment for alcohol problems NTA Identifying Eligible Patients Where practices are signed up to provide the service, patients eligible for the service will be identified by: A positive commitment and/or proactive request to participate in a programme Explicitly informing, or confirming with, the GP that they regularly exceed the prescribed maximum number of units per week and categorising whether patients fall within Hazardous/ Harmful/ Dependant drinkers A subjective assessment that their unit intake has increased over time Refer to examples of their drinking causing problems in their home or working lives Of these criteria, the first two are the most important and where a patient satisfies these then they should be admitted to the programme. It should also be noted that patients who do not exceed the prescribed unit limits may be accepted to the programme if, in their self-assessment, their drinking is problematic or a cause for concern. This may be established by using simple assessment tools like the CAGE questionnaire, where two or more positive answers indicate some form of alcohol dependence. Patients are asked whether they have ever: Thought they should Cut down on drinking? Felt Annoyed by others criticising their drinking? Felt bad or Guilty about their drinking? Had a drink first thing in the morning to steady the nerves or get rid of a hangover? (Eye-opener). 1 Practices should be able to apply the appropriate Read Code and, de facto, maintain an at-risk register. Further work may be needed around patient 1

4 confidentiality, particular in regard to the development of the Electronic Patient Record. Patient Pathway and Description of Service Following the identification of the patient as an individual requiring treatment, the GP should then initially assess whether the practice-based programme is the best option. This is likely to be based on the clinician s judgement of the seriousness of the individual s alcohol dependency, but could involve direct referral to local specialist alcohol services (CAT) and/or urgent and possible short-term pharmaceutical interventions. Where the patient is accessing services based in the practice and does not require more specialist interventions, the GP will agree a treatment programme over a specified time period for the individual. This could involve some or all of the following: Initiating brief drug intervention where necessary Discussion with patient s family and onward referral for support where possible. Provision of more frequent and longer consultations for patients with an explicit focus on their alcohol use Monitoring of biochemical parameters Where the patient requires a detoxification programme, the GP may be able to make a direct referral (though it may be the case that detox referrals have to be made via more specialist services). It is expected that participation in detox will generate more work for the GP, specifically in addition to the points shown above: Liaison with Detoxification services Providing drug therapy to patients undergoing detoxification and liaison with detox agency 3. Service Criteria This enhanced service will fund: (i) practices to be able to undertake brief interventions and offer support to carry out behavioural change (ii) follow-up treatment. A range of treatments may be prescribed including a set number of counselling sessions which may be done in conjunction with or by referral to local alcohol services or through the patient s attendance at a day programme or residential rehabilitation centre, both of which would require referral (iii) detoxification regime. For those where a detoxification regime is required, this may be provided by the primary care team (and could be undertaken in partnership with alcohol support services) in the community or home setting (iv) routine use of assessment tools (v) liaison with local specialist alcohol treatment services

5 (vi) appropriate training. This must be available to the primary care team to enable team members to understand the problems experienced by people who misuse alcohol and their families, and to communicate effectively with them. Training should include detecting problem drinkers, carrying out brief interventions, and managing follow-up treatment, including counselling (vii) review. All practices involved in the scheme should perform an annual review which could include an audit of: those identified and recorded as alcohol misuse patients the advice and/or treatment offered to patients who, following screening, have been shown to misuse alcohol the number of patients who have reduced their alcohol consumption feedback from patients who misuse alcohol and their families/carers. Accreditation Those doctors who have previously provided services similar to the proposed enhanced service and who satisfy at appraisal and revalidation that they have such continuing medical experience, training and competence as is necessary to enable them to contract for the enhanced service shall be deemed professionally qualified to do so. 4. Ongoing Measurement & Evaluation Practices will be required to use standardised Read Codes to monitor both the quantitative and qualitative aspects of providing this service for individual patients. These are: Item Read Code Alcohol Consumption Counselling 9k11. Alcohol Counselling by Other Agencies 9k12. Referred to community alcohol service 8H7p Alcohol Disorder monitoring 66e These items refer to activities undertaken with the individual patient identified as requiring such interventions to address their problems with alcohol consumption.

6 5. Signature Sheet This document constitutes the agreement between the practice and the PCT in regards to this nationally directed enhanced service. Practice Stamp Signature on behalf of the Practice: Signature Name Date Signature on behalf of the PCT: Signature Name Date