NHS ManchesterAlcohol IBA Pilot Scheme in Primary Care

Clare McCannPublic 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 4th 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

Didsbury East

Ancoats and Clayton

Old Moat

BrooklandsNorthenden

Chorlton Park

Gorton North

Woodhouse Park

Baguley

Sharston

Higher Blackley

Didsbury West

Burnage

Chorlton

Whalley Range

Fallow f ield

Levenshulme

Gorton SouthMoss Side

Hulme Ardw ick

City Centre

Longsight

Bradford

CheethamMiles Platting and New ton Heath

Crumpsall

Harpurhey

Moston

Charlestow n

Withington

Rusholme

Lower level SOA by IMD 2007 rankwhere 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 (38)(top 10%) 1,625 to 3,248 (56)(top 5%) 326 to 1,624 (49)(top 1%) 1 to 325 (30)

IMD 2007 - Manchester

Source: CLG

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

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

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.

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

Number of admissions

Directly Standardised Rate

(per 100,000)

Annual change in rate (%)

2002/03 4,938 1,247.9 -

2003/04 6,321 1,577.4 26.3%

2004/05 7,710 1,894.5 20.6%

2005/06 8,797 2,160.6 14.0%

2006/07 8,979 2,199.7 1.8%

2007/08 9,418 2,296.2 4.4%

2008/09 10,511 2,569.5 11.9%

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

0.0

500.0

1000.0

1500.0

2000.0

2500.0

3000.0

3500.0

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Year

EA

SR

pe

r 1

00

,00

0

Projected trend Actual LAA target

• 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 Bid20 GP PracticesOpportunistically 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

Audit Scores

Lower Risk (0 – 7) 85.1% 2343

Increasing/Higher Risk

(7 – 19)

12.6% 346

Possible Dependence/Referral to CAT

(20+)

1.4% 38

Patients declined screening 0.6% 17

Patients declined Brief Advice 0.3% 09

Totals 100% 2753

Age %

16 - 24 09

25 - 34 14

35 - 44 14

45 - 54 16

55 - 64 17

65+ 30

Total 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

clare.mccann@manchester.nhs.uk