NHS Manchester Alcohol IBA Pilot Scheme in Primary Care

1. NHS Manchester Alcohol IBA Pilot Scheme in Primary Care Clare McCann Public Health Manager

2. Manchester: The Local Context • Population growth (451,136) since the beginning of the decade and predicted to rise • Key economic driver for city region and regional economy • Significant employment and household growth forecast over the next 10 years

3. Manchester: The Challenge • Concentration of deprivation and worklessness • Skills gaps in many communities • Low educational attainment • Poor neighbourhoods in the core of the city that cannot retain or attract income earning households • High levels of crime/ fear of crime • Poor environment • Poor health

4. Manchester: The Challenge • Manchester is now ranked as the 4th most deprived local authority in England overall • 228,235 residents in worst 10% most deprived neighbourhoods nationally – 51,155 within worst 1% • Position improved but remains consistently high across all measures of deprivation

5. National and Local Targets • PSA 25 (Public Service Agreement) • To reduce the rate of increase in hospital admissions for alcohol related harm by an additional 1% each year, compared to the projected trend for 2010/2011 • Reducing public perceptions of drunk and rowdy behaviour • Local Area Agreement • Commissioning Strategic Plan

6. Baseline data and recent trends

7. Historic trends and target trajectory 2002-03 to 2010/11

8. Distribution of multiple admissions for alcohol specific conditions, 2008/09

9. Primary Care • 101 GP Practices working across the city • 76 signed up for the Alcohol DES • An Alcohol Capacity and Needs Analysis conducted in 2007 • The national Review of the Effectiveness of Treatment for Alcohol Problems (NTA 2007) • Improving Health in Manchester

10. Improving Health in Manchester Bid 20 GP Practices Opportunistically screen: • Patients who are hypertensive • Patients who present with mild to moderate mental health conditions such as depression, anxiety, panic, stress, insomnia • Patients who are signed off work due to work related stress/issues for a period of longer than 4 weeks • Patients with a BMI of 25 – 30 (overweight)

11. Process • Letter to all Practices: Service Specification, including criteria for selection Signed off by DPH Expressions of interest • DES! • Timescale: Letter drafted in October 2008, sent in March 2009!

12. Service Requirements • Nominate a lead clinician to take responsibility for coordinating the pilot • 2 hour IBA training session • Target any patient in the 4 identified categories, who present at the Practice and seek consent to follow up with the patient. • Undertake AUDIT-C/AUDIT as part of the consultation

13. Financial Incentive… • £1,000 for each practice upon completion of IBA training session with relevant staff, delivered by the Alcohol Primary Care Trainer • Per patient payment of £3 for each patient screened in the identified groups, up to a maximum of £3,500 • £500 payment on completion of final review (evaluation) • Payment: • Retrospectively/Quarterly basis/Submission of monitoring data

14. Response • Initial interest from 15 practices, 2 arrived after the deadline • 17 practices participating initially • 1 practice withdrew due to data demands • Geographical spread of practices across the city

15. Response….. • North: 3 practices • Central : 8 practices • South: 3 practices • 2 – 9 GPs • Smallest Population Practice size: 3, 314 • Largest Population Practice size: 14,250

16. The 16 Practices in the Pilot represent 22.7% of the total GP registered population in Manchester • Screened 2.3% of the patients within the Pilot group, equivalent of 0.5% total GP registered population • Tiny amount of the GP registered population! • Using IMD, Pilot Practices less deprived, than NHS Manchester Practices, as a whole. • Slightly older population

17. Monitoring & Evaluation • How many appointments undertaken with patients who fall into the above named categories? • The number of patients who have been screened using Audit-C • The number of patients with a positive Audit-C score and full AUDIT score recorded in the appropriate AUDIT category • The number of patients given brief advice • The number of patients with a full AUDIT score of 20 or more who have been referred to the Community Alcohol Team • Demographics: Age, Gender, Ethnicity, Post code

18. Audit Scores

19. Gender • 54% Women • 46% Men

20. Health Warning!(Data Limitations) • Small sample • 3 months data • Total number of appointments! • Inputting/human error!

21. Manchester: The Challenge

22. NHS Manager Clare McCann Public Health Manager clare.mccann@manchester.nhs.uk