Transcript Slide 1

Nottingham
Alcohol! Identification, Brief
Advice and Extended Brief Advice
Mark Holmes, Framework
A bit about me
• Psychiatric Nurse (RMN) with a first class degree in
substance misuse. Also a NMC recognised Specialist
practitioner in Substance Misuse.
• Vice chair of Nursing Council on Alcohol
• Have worked in alcohol misuse field for over 13 years
• Set up the QMC Alcohol Liaison Team just over 7 years ago.
Assessed over 2000 patients in this time from ages 16-98
• Seen referrals from the ‘had a bit too much to drink and fell
over’, to the end stage of liver disease
• Now Clinical Nurse Specialist in Brief Advice employed by
Framework working with Nottingham PCT.
• Just set up a sensible drinking service: Last Orders.
• Currently advising the DH on Identification and Brief Advice
• A moderator and sit on the steering group for Alcohol
Learning Centre
Background:How much do we
drink in Nottingham?
Lots!
• 1 in 4 drink too much
• 42,000 drink at ‘increased risk’
• 15,000 drink at ‘higher risk’
• 50,000 binge drink
Alcohol in Nottingham
• 4,700 alcohol-related hospital admissions. Rising –
• One of the highest alcohol-attributable death rates
(64 per 100,000 in Nottingham, 47 per 100,000 in
England)
• Highest rate of alcohol-related recorded crime in the
country£27 million being spent by the criminal justice
system
• 230,000 working days lost from the workforce
• Contributes to 280 sexual assaults
• Affect 14,000 children with drinking/drug using
parents
Why does Nottingham
have a problem?
• Culture - party city?
• Stag and Hen Parties
• Stag Nights and Hen Nights
in Nottingham
• According to Stag and Hen
world
• “Nottingham is one of the top 5
locations in the UK for stag
nights and hen nights. FACT!”
• Football/ other sport
Why does Nottingham
have a problem?
• Deprivation?
• Nottingham ranks 13th out
of the 354 districts
• Better than Liverpool;
Hackney; Tower Hamlets;
Manchester; Knowsley and
Islington
• but just not as good as
Newham; Easington;
Middlesbrough;
Birmingham; Kingston
upon Hull and Blackpool
Why does Nottingham
have a problem?
• Population! Lots of people
drink in a relatively small
area. Claims to have the most
pubs per square mile
• Whilst the City of Nottingham
unitary authority has a
historically tightly drawn
boundary which accounts for
its relatively small population
of 288,700, the wider
Nottingham Urban Area has a
population of 667,000
• It is the seventh-largest
urban area in the United
Kingdom, ranking between
those of Liverpool and
Sheffield
Why does Nottingham
have a problem?
• Lots of young people?
• Estimated 40,000 students
• Karnival is the University of Nottinghams student-run charitable
organisation, and the largest one of its kind in the UK.
• Every Saturday, armed with a collecting tin, a ridiculous outfit and
usually a hangover, Nottingham students hit the streets of cities
across the country.
“7 legged
pubcrawl”!
Why does it matter?
• Many people don’t realise
they are
drinking too much
• Health is at risk
• Harms to society (crime,
antisocial behaviour, family problems)
• Increases inequalities
What is NHS Nottingham City
doing?
• Working with partners - refreshed strategy
• Reviewing current services and
filling the gaps
• Good evidence that identification and brief
advice can reduce consumption - hence Last
Orders and a new ‘locally enhanced service’ for
GPs
Last Orders: Where do
we fit in?
• In 2008, the C.D.P and P.C.T
conducted a review of the alcohol
treatment system in Nottingham
City. The following gaps were
identified:
• No alcohol specific health promotion
• Little I.B.A. in primary care
• No alcohol treatment specifically
targeting those groups suffering
highest rates of alcohol-related harm
What are we doing:
Locally Enhanced Service for
alcohol
• LES is to reward practices for screening patients
aged 16 or over who at likely to be misusing
alcohol and offering brief advice to patients found
to be drinking at ‘increased risk’ or ‘higher risk’
• £10 per patient
• Target Population- Patients scoring 5 or more on
AUDIT-C
• First Stage- (30 secs) AUDIT C
• Second Stage (1-2 mins) If score 5 or over Full
AUDIT to determine level of alcohol misuse
• Third Stage Patients scoring 8-20 are offered
brief advice with Last Orders leaflet.
• Fourth Stage- If motivated offer referral to Last
Orders in alcohol dependancy to APAS or SMS.
Training
• A minimum of one GP and one practice nurse should have
attended the City PCT alcohol session or individual training
by Last Orders .
• Training can be cascaded to other clinicians by the trained
GP and/or practice nurse or can be done electronically
through the Alcohol Learning Centre
www.alcohollearningcentre.org.uk
• But what happens when you open
up the ‘Can of worms”
A new alcohol service for
• Funded by NHS Nottingham
City- provided by Framework
• Launched 1st July 2009
• Recently expanded to 4
nurses, a Health Promotion
Nurse and admin
• Initial clinics in
• Family Medical Practice,
Carlton
• Cripps
• Radford Health Centre
• River Lyn Bulwell
• Wilford Grove, Meadows
• Windmill Practice
• Greenwood
• Top Valley Health point
Who, how, what?
• Self referral via Free phone
number 0800 055 6184
• Referral from primary care
team
• Via fax 9789111/ telephone
• Written via referral form
• Those who score under 20 on
the AUDIT and request
further support for their
alcohol problem
• Sessions will run on a
cognitive behavioural model
of intervention.
• Up to six sessions
• Signposting if clients need
more support
• Rapport building
Drinker typology based on AUDIT scores
Possible
Dependence 20-40
Higher Risk
16-19
Increasing risk
8-15
Lower risk
1-7
Abstainers
0
Diagnose & refer to specialist
service
Brief counselling/follow-up
Simple structured Brief
Advice
Positive reinforcement
? No action
indicated
Support
• We can provide you with:
• Telephone support- clinical
advice
• Materials for Brief Advice i.e.
Patient information leaflets,
booklets, posters, unit
calculators, calling cards
• Training
• Website- www.last-orders.org
• Events- Raising alcohol
awareness, weeks of action.
• Research
• Raising awareness via media
What We have Provided:
• 1098 primary care workers trained in delivering I.B.A or
alcohol awareness in the last 12 months.
• 87 clients seen EBA
• 243 Extended Brief Advice sessions delivered in the last 3
months
• 45 clients successfully completed (significant reduction in
drinking)
36 referred on to other services (SMS, Mimosa, Carers Fed,
counselling services etc)
• 372 Brief Advice sessions completed in the last 3 months,
including Pride, Indian Community Group and Parklife
events.
• Specific Outreach with Travellers, LGBT & South Asian
Community.
Success & how to
measure it.
• We are currently being independently evaluated
by the University of Nottingham.
• Referrals (including self-referrals) are increasing
week on week.
• 11 people have so far successfully completed the
E.B.A treatment.
• We have submitted a bid to ‘Pump Priming’ to
fund a further study into the effectiveness of our
E.B.A. Program.
However it’s not all plain
sailing. We have struggled
• Split into groups
and lets look at the
challenges we face
taking IBA into
Primary Care.
• Introduce
yourselves to
group and then
pick a problem to
discuss:
Workshop: Problem solving
• How do I get into talk to Primary
Care?
• Swine flu!- How do we keep alcohol
on the agenda?
• Skill mix- How do you train primary
care staff from a broad background?
• Should we give incentives to do IBA?
• How do target alcohol health
promotion to your locality?