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Specification for a Directed Enhanced Service

Alcohol 1 April 2011 to 31 March 2012 1. Introduction It is a government priority to address the issue of illness associated with increasing alcohol consumption. The DES is to reward practices for case finding in newly registered patients aged 16 or over. It also aims to deliver a simple brief intervention to help reduce alcohol- related risk in adults drinking at hazardous and harmful levels.

This one-year DES does not include a requirement to set up a register of hazardous or harmful drinkers.

2. Scope i. Practices will be required to screen newly registered patients aged 16 and over using either one of two shortened versions of the World Health Organisation (WHO) Alcohol Use Disorders Identification Test (AUDIT) questionnaire: FAST or AUDIT-C. FAST has four questions and AUDIT-C has three questions, with each taking approximately one minute to complete. ii. This DES applies to all patients registered between 1st April 2011 and 31st March 2012, who are aged 16 and over at the time the short case finding test is applied. The test must be applied within the financial year in which the patient registered. iii. Patients with a positive score should be given the full screening test and offered brief advice for a score between eight and 19, or be considered for referral to specialist services for a score of 20 or more. iv. The recommended brief intervention is the basic five minutes of advice used in WHO clinical trial of brief intervention in primary care, using a programme modified for the UK context by the University of Newcastle – How Much is Too Much? v. Further information regarding the audit tools and brief intervention can be found at: http://www.alcohollearningcentre.org.uk/topics/browse/briefadvice/

3. Audit Requirements

Initial Screening

The practice should use the following Read Codes R Readv2 Read CTV3 FAST alcohol screening test 388u. XaNO9 AUDIT C Alcohol screening test 38D4. XaORP

Directed Enhanced Service 2011/2012 Page 1 of 4 Alcohol Specification There are currently no codes available which indicate a positive FAST or AUDIT-C test result so it will be necessary to add a value to a field associated with the code (please consult your computer system supplier for details). A value of 3+ is regarded as positive for FAST and a value of 5+ is regarded as positive for AUDIT-C.

Full screening If a patient is identified as positive, the remaining questions in the ten-question AUDIT questionnaire should be used to determine increasing, higher risk or likely dependent drinking. The following codes are recommended:

Readv2 Read CTV3 AUDIT Alcohol screening test 38D3. XM0aD

Again, a value should be added to a field associated with the code to record the score:  0–7 indicates sensible or lower risk drinking  8–15 indicates increasing risk drinking  16 -19 indicates higher risk drinking  20 and over indicates possible alcohol dependence.

Brief intervention Those patients identified as drinking at increasing or higher risk levels (scores 8 -19) should be offered brief advice. The recommended brief advice is the basic five minutes of advice used in the WHO clinical trial of brief intervention in primary care, using a programme modified for the UK context by the University of Newcastle ”How Much is Too Much? The tools3 from this programme have been further refined. The following codes are recommended for recording the intervention offered:

Readv2 Read CTV3 Brief intervention for excessive alcohol 9k1A. XaPPv consumption completed

Brief lifestyle counselling In some areas patients drinking at higher risk levels (scores 16-19) may receive brief advice or brief lifestyle counselling (20 - 30 minutes) within the practice, or be referred to, for example, a community-based counselling service for this advice, but this distinction is not recognised for the purposes of this DES. Practices may find the following codes helpful:

Referral for specialist advice

Readv2 Read CTV3 Extended intervention for excessive 9k1B. XaPPy alcohol consumption completed

Directed Enhanced Service 2011/2012 Page 2 of 4 Alcohol Specification Patients identified as possibly alcohol dependent (scores of 20 or more) should be considered for referral for specialist services. Although providing brief alcohol advice is still recommended, on its own, brief advice has not been shown to be effective for this group of patients. The following codes are recommended for recording specialist referral:

Readv2 Read CTV3 Referral to specialist alcohol treatment 8HkG. XaORR service

3. Validation and payment

i. Within 28 days of the end of the financial year (31 March 2012) practices will be required to complete an audit of:

 the number of newly-registered patients aged 16 and over within the financial year who have had the short standard case finding test (FAST or AUDIT-C)

 the number of newly-registered patients aged 16 and over who have screened positive using a short case-finding test (as above) during the financial year, who then undergo a fuller assessment using a validated tool (AUDIT) to determine increasing risk, higher risk or possible dependent drinking

 the number of increasing or higher risk drinkers who have received brief advice to help them reduce their alcohol-related risk

 the number of patients scoring 20 or more on AUDIT who have been referred for specialist advice for dependent drinking.

ii. Practices are required to provide the above data via the template attached (Appendix 1) at year end to [email protected]

ii. In 2011/12 practices will receive £2.38 for each newly registered patient aged 16 and over who have received screening using either FAST or AUDIT-C.

Practices should ensure that not only the screening is conducted but that the full protocol described above is followed; i.e. that those individuals who screened positive on the initial screening tool are then administered the remaining questions of AUDIT and that a full AUDIT score is determined and that appropriate action followed, such as the delivery of brief advice or referral to specialist services if needed.

iii. Payment will be made within 28 days of the end of the financial year following receipt by the PCT of the audit.

iv. The PCT reserves the right to audit activity under the specification and to make any necessary financial adjustments for under or over activity.

4. Protecting Patient Confidentiality Directed Enhanced Service 2011/2012 Page 3 of 4 Alcohol Specification

Caldecott Guardianship is based upon being thoughtful about the way in which patient information is handled, protecting data, using it appropriately and minimising or eliminating the risk of inappropriate disclosure.

5. Termination of Agreement

Both the practice and the PCT may terminate this agreement by giving not less than three months notice in writing to the other party.

6. Variation of Agreement

The PCT may vary this agreement by giving not less than three months notice in writing to the provider, unless required to do so under national policy.

7. Clinical Governance

The Contractor shall comply with the Department of Health publication “Standard for Better Health” published on 21 July 2004 and updated on 3 April 2006 (a copy of which can be obtained from the DH website)

8. Information Governance:

The Contractor shall comply with the standards of Connecting for Health's General Practice Information Governance Toolkit a copy of which is available on Connecting for Health's website. Data will be transferred from the practice in a secure manner as per the PCT policy (i.e. via nhs.net to nhs.net or the N3 connection) to a secure folder on the PCT server. Access to this folder will be limited to authorised personnel only. The reporting requirements of this DES are designed to enable centralised collection of data and establish accurate information for payment.

Signed on behalf of NHS Great. Yarmouth & Name of Surgery: Waveney Primary Care Trust:

Signature of Senior Partner/ Practice Manager: Chief Executive Date: Date:

Please sign the relevant section of the Enhanced Services Agreement Sheet 2011-2012 to confirm acceptance of this specification.

Directed Enhanced Service 2011/2012 Page 4 of 4 Alcohol Specification