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

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

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

Manchester: The Challenge

• Manchester is now ranked as the 4 th 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

IMD 2007 - Manchester

Higher Blackley Charlestow n Crumpsall Moston Harpurhey Cheetham Miles Platting and New ton Heath Ancoats and Clayton City Centre Bradford Hulme Ardw ick Gorton North Chorlton Moss Side Whalley Range Fallow field Longsight Rusholme Levenshulme Old Moat Withington Gorton South Chorlton Park Burnage Didsbury West Didsbury East Northenden Brooklands Baguley Sharston Woodhouse Park Lower level SOA by IMD 2007 rank where 1 = most depriv ed and 32,482 = least depriv ed in England (top 75%) 19,490 to 23,679 (5) (top 60%) 16,242 to 19,489 (9) (top 50%) 12,994 to 16,241 (14) (top 40% 9,746 to 12,993 (29) (top 30%) 6,497 to 9,745 (29) (top 20%) 3,249 to 6,496 (top 10%) 1,625 to 3,248 (top 5%) 326 to 1,624 (top 1%) 1 to 325 (38) (56) (49) (30) Source: CLG Of these 259 LSOAs in Manchester, the w orst LSOA is ranked 2 (the second most deprived) in England. The best LSOA is ranked 23,678 out of 32,482 in England.

Crow n Copyright. All rights reserved. Manchester City Council. 100019568 (2007).

Policy Analysis, Chief Executive's Department. December 2007.

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

Baseline data and recent trends

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 Number of admissions 4,938 6,321 7,710 8,797 8,979 9,418 10,511 Directly Standardised Rate (per 100,000) Annual change in rate (%) 1,247.9

1,577.4

1,894.5

2,160.6

2,199.7

2,296.2

2,569.5

26.3% 20.6% 14.0% 1.8% 4.4% 11.9%

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

3500.0

3000.0

2500.0

2000.0

1500.0

1000.0

500.0

0.0

2002/03 2003/04 2004/05 2005/06 Projected trend 2006/07

Year

Actual 2007/08 LAA target 2008/09 2009/10 2010/11

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

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

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)

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!

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

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

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

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

• 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

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

Lower Risk (0 – 7)

Audit Scores

85.1% Increasing/Higher Risk (7 – 19) Possible Dependence/Referral to CAT (20+) Patients declined screening Patients declined Brief Advice Totals 12.6% 1.4% 0.6% 0.3% 100% 2343 346 38 17 09 2753

Age 16 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+ Total % 09 14 14 16 17 30 100% Gender • 54% Women • 46% Men

Health Warning!

(Data Limitations)

• Small sample • 3 months data • Total number of appointments!

• Inputting/human error!

Manchester: The Challenge

NHS Manager Clare McCann Public Health Manager [email protected]