The Alcohol DES for England is a means of case finding followed by structured alcohol advice. It is by no means a data collection exercise but an attempt to identify people and provide support to make a positive change in their physical, mental, social and psychological wellbeing.
Early detection and early intervention can prevent mortality from alcohol cirrhosis and reduce the morbidity associated with vascular disease.
The DES pays practices to undertake alcohol screening in patients aged 16 years or over using FAST (the fast alcohol screening test) or AUDIT-c (Alcohol Use Disorders Identification Test Consumption) tool to newly registered patients. The payment is worth £2.38 for each patient screened with an alcohol risk assessment tool.
Reviewing what we were doing
In 2005, I conducted an audit to see how my practice was performing regarding identification, brief advice, intervention, coding and referral. The percentage of newly registered patient screened was 25%. Some 20% of patients were AUDIT positive and we provided no intervention to these patients.
I was lucky to get the help of an alcohol counsellor fully-funded by the PCT. She provided a structure to our service provision. We introduced a practice protocol covering screening questionnaires, referrals to the counsellor and treatment, including detoxification at home.
The practice uses the AUDITc tool, which takes less very little time. For pregnant women TWEAK (tolerance, weakness, eye opener, amnesia ‘kut down’) and TACE (tolerance, annoyance, cut down, eye opener) are more appropriate.
I have added these questionnaires to all of the chronic disease register including the family planning and postnatal template.
The healthcare assistants, family planning nurse and practice nurses are aware of the tool and record it directly on the template.
To satisfy our QOF assessor we scan the form into patients’ notes.
This is initially done by the GP face to face. In my personal view a softly, softly approach does not work.
I spend at least 20 minutes at the first consultation, arranging blood tests and another 20 minutes for a follow-up appointment a week or two later, where I show patients the results of the tests, which I find works in the vast majority of case.
Where brief advice is not successful I refer the patient to alcohol counsellor. The patient is advised on motivational techniques such as having a few alcohol free days each week, never to drink on an empty stomach and encouraging them to think about the impact alcohol could be having on their body and their family.
This works well in some patients and my practice is able to provide this service because we have an exceptionally good alcohol counsellor who is willing to visit or telephone the patient daily and give a positive encouragement and support not only to the patient but also the family.
Read coding is clearly very important and a computer search is done by the practice manager annually to make sure that the practice is rewarded for the work done.
- Dr Anita Sharma is a GP in Oldham