During 2009 – 2010, Haringey practices participating in the alcohol Direct Enhanced Service (DES) identified just 2% of new patients as AUDIT positive
An estimated 26% of Haringey residents drink above recommended limits.
So why were so few being identified? Supported by the Department of Health, HAGA’s investigation gave rise to new guidelines and best practice on delivering DES.
The numbers just didn’t add up
Alcohol Direct Enhanced Services were provided by twenty-nine Haringey practices in 2010 – 2011. Across these, the percentage of new registrations screened varied considerably from 24% to 100%. Of those new registrations screened locally, only 2% screened positive, a number that was far too low. In addition, over half of the practices didn’t identify any of their patients as AUDIT positive, whereas some practices identified all of their patients as AUDIT positive.
Time for some detective work
Haringey Drug and Alcohol Action Team (DAAT) decided to review local alcohol DES delivery to find out what was going on. Working with HAGA and an external consultant, a full review was undertaken and the results used to develop best practice guidance on how to deliver the alcohol DES.
The review found, to give just two examples, that 75% of practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice. Crucially for practices, it was also discovered that some were actually losing money due to DES returns that did not reflect the work that they had done. Clearly GP practices across Haringey needed clear guidelines on this essential service.
A new set of guidelines
Taking the results of this review, and supported by the Department of Health, HAGA produced and released step by step guidance for primary care on the delivery of the alcohol DES. The resulting document: ‘Improving Delivery of the Alcohol Direct Enhanced Service’ is a valuable source of best practice for those delivering primary care and for commissioners reviewing local DES delivery.