Mid Highland Community Health Partnership
Alcohol Brief Interventions
Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11.
1 / CURRENT POSITION1) Delivery of ABI’s (cumulative totals):
Based on revised trajectory (Jan)
Mid CHP / Sep / Oct / Nov / Dec / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / TOTAL by March 2011
Actual Brief Interventions / 79 / 92 / 96 / 110 / 124 / 136
Trajectory / 75 / 87 / 91 / 100 / 110 / 125 / 145 / 170 / 210 / 290 / 420 / 600 / 830 / 2307
Actual screening / 218 / 229 / 249 / 283 / 308 / 338
Screening trajectory / 3096 / 3612 / 4128 / 4644 / 5160 / 5677
Delivery by practice
The data shows that only 11 of the practices who have signed up to the LES have delivered any ABI’s. Of these, 47% of the ABI’s are delivered by Dingwall, and 23% by Fortrose GP practices. Numbers of brief interventions being recorded are still very low, and Mid CHP will have increasing difficulty in meeting the trajectory unless GP’s both deliver and record ABI’s.
2) Signup to the LES
26 practices are signed up to the LES, and 7 practices are not signed up. This includes a number of practices who initially signed up and have since withdrawn. Practices not signed up are Fort Augustus; Strathpeffer; Alness/ Invergordon; Tain & Fearn; Aird, Beauly; Lochcarron, and Munlochy. This situation has been consistent for some time, although the Primary Care Manager is currently in talks with Alness/ Invergordon.
All practices which are not signed up have been visited by the Mid CHP Primary Care Manager and most have had additional visits from the Highland ABI Training Coordinator.
Reasons given include:
· The intervention is likely to take too long
· Reluctance to complete more ESCRO screens
· The data to be collected is too complex
Good practice points have been sought from Dingwall and other NHS Highland practices with a view to cascading learning points for delivery to under performing practices. Feedback thus far suggests opinion and experience are varied. Some useful initial points are as follows:
· Screening tool useful and works well in consulting
· Screening provides an objective
· Need option of calculating units from fractions of a bottle
· Motivational Interviewing useful intervention
· Some GP’s experiencing difficulty with limited time and competing demands
3) Amendments to the LES
Note has been taken of the feedback from GP’s, and the LES algorithm for screening has now been revised to make it simpler (using FAST tool only). This change started in January 2009. Figures from March onward should begin to indicate the likely impact of the revised trajectory. Some initial feedback suggests reporting screens, although more straightforward are still a bit cumbersome.
4) Training for GP’s and other staff
A full calendar of training has been available to all staff since February 2009. A majority of GP’s have been trained, although a significant minority have still to attend.
In recent times training has been targeted at A&E staff and midwives, and a MID CHP midwife is trained to deliver the training. Training has also been offered to community staff. Uptake by midwives and community staff continues to be small because of the difficulties of releasing staff. It appears ABI training has been prioritised as ‘Essential’ for antenatal staff. Work is currently underway to encourage ABI training to be prioritised as ‘Essential’ for community nursing staff as a means of encouraging managers to prioritise releasing appropriate staff for training so they can deliver ABI’s.
Please note discrepancies from previous figures can be explained by lack of specific information on those attending sessions prior to May 2010. Where data exists ONLY on numbers trained without names of participants, this information has now been excluded from the overall numbers trained in Mid.
Mid Numbers Trained 25/02/10: (Please view appendix 1 for full breakdown)
96 out of 127 GPs are signed up to the LES
(Includes 7 Portree GPs. Unclear if practice will follow through on LES).
Of that 96, 56 have been trained = 58%.
(5 GPs who are not signed to the LES have also attended training. They are not included in the 56 trained)
Locality Breakdown:
Lochaber 13 out of 27 GPs (Includes Retainer from Isle of Eigg) = 48%
Skye 13 out of 26 GPs = 50%
Ross, Cromarty and West Ness 30 out of 43 GPs = 70%
Staff Trained 25/02/10: (Please view appendix 2 for full breakdown)
Lochaber = 19
Skye = 40
Ross = 28
Total = 87
2 / ACTION PLANS TO ADDRESS
Actions
Extend delivery and recording of ABI’s to community staff and others in order to provide an addition or alternative to delivery through GP’s
· A data collection system for community staff has been developed and is available from 1st March.
· Encourage ABI planning by local teams (Team Leaders)
· Develop an ABI planning tool for teams.
· Ensure support for attendance at training by relevant community and acute staff.
Continue to enable access to training for all relevant staff
· A full training calendar is available from the Highland Alcohol Brief Interventions Training Coordinator, as well as bespoke and inhouse training. There will be more courses offered in Mid CHP until June 2010.
· The ABI Training Coordinator is targeting practices in Mid CHP where few GP’s have received training.
· Teams should be informed of the importance of training for midwives and community nurses and should encourage and approve uptake.
Support all practices to deliver ABI’s
· Relaunch the ABI programme to primary care and community services in the light of the simplified algorithm and of the potential for recording ABI’s delivered by community nursing and others.
· Plan to approach practices which are signed up to the LES but are not delivering ABI’s, to discuss barriers, and offer support. Approaches will be by the Primary Care Manager, the local Public Health Practitioners, and the ABI Training Coordinator.
· Continue to approach and support practices which are not signed up to the LES.
· Continue to encourage GP attendance at training and GP delivery of ABI’s
3 / EXPECTED IMPACT OF ACTIONS ON PERFORMANCE
· It is expected that a relaunch of the programme in Mid CHP in the light of the redesign of the data collection process will encourage more delivery of ABI’s.
· It is expected that extending the ABI programme to community staff and others will lead to increased delivery of ABI’s.
· It is expected that targeting those practices which are not delivering will lead to increased delivery.
· It is expected that continuing to provide support to GP’s will lead to increased delivery of ABI’s by GP’s.
4 / FORECAST OF RETURN TO PLANNED PERFORMANCE (ie Trajectory)
The trajectory for Mid Highland CHP has now been revised to more accurately reflect existing activity delivering the Enhanced Service for Alcohol Brief Intervention, however in the longer term Mid CHP has little chance of meeting this trajectory unless Primary Care services make the commitment to deliver brief interventions.
Jane Groves
Mid CHP Health Improvement Specialist
Deborah Stewart
Alcohol Brief Interventions Trainer