Provision of Alcohol identification and Brief Advice Support and

Guidance Pilot

Service Level Agreement

Parties to the Agreement

/

Provider:

Purchaser: NHS Blackpool

1. Background

Blackpool has a thriving and vibrant night-time economy, and like many UK towns and cities, that economy centres around entertainment premises licensed to sell alcohol. Blackpool has 130 on-licensed premises in a compact town centre, an area of approximately 1 square mile. A total of 1900 licensed premises exist in the entire town: approximately 1 for every 72 residents.

Alcohol misuse in the northwest region of England is the worst in England and Wales, and Blackpool has high levels of alcohol related harm (health, disorder, violence) for the size of the population. The health and well being of the community and local services are strained. The alcohol industry brings some economic prosperity through employment, yet paradoxically 105,000 working days a year are lost in Blackpool due to alcohol misuse, at an estimated cost upwards of £10,500,000 per year.

Blackpool has widespread deprivation within the central wards of the town, and it is here that alcohol related early death and illness are the highest. A combination of poor quality housing, lack of appealing employment, and low aspiration within the resident population makes alcohol a convenient pastime. Alcohol related domestic abuse is concentrated in these central wards.

Alcohol misuse is not a new phenomenon to Blackpool. According to local historians, Blackpool in the Victorian era hosted destination drinking. The challenges facing us today are a powerful alcohol industry, an above average prevalence of harmful attitudes towards alcohol, and an environment and culture that support excess alcohol consumption. This strategy and its interventions aim to engage all stakeholders, including residents, to work together to reduce alcohol related harm in Blackpool.

Recent North West Public Health Observatory data has demonstrated that Blackpool continues to have the highest number of months of life lost attributable to alcohol in England. However, the number of recorded alcohol related hospital admissions are lower than would be expected to correspond with the mortality data.

There is evidence of the effectiveness of community pharmacy-based public health interventions such as smoking cessation and methadone maintenance for addictions, and in the management of osteoporosis, diabetes and raised cholesterol. Service users report positive experiences of using community pharmacy-based public health services, suggesting these services are acceptable as well as effective. Choosing Health Through Pharmacy identified opportunistic advice, brief interventions and offering floor space to other health professionals as areas where community pharmacy could make a contribution.

Several screening tools exist which are relevant for use in primary care settings including community pharmacy. Brief interventions for alcohol misuse are of four main types:

  • alcohol education
  • simple advice
  • simple advice plus brief counselling and continued monitoring
  • Referral to specialist services for diagnostic evaluation and treatment.

Brief interventions by GPs or A & E departments have achieved statistically significant reductions in alcohol consumption of about six units per week in primary care populations, showing greater benefits for men than women.

2. The service

The Pharmacy will be contracted to deliver coordinated alcohol identification and

brief advice pilot as part of NHS BlackpoolAlcohol Harm Reduction Strategy.

The service will be provided in the pharmacy consultation room.

This is an evaluated pilot for 12 months starting from 01st March 2010.

3. Aims and intended service outcomes

3.1 To support the reduction in the level of alcohol related harm within the

community.

3.2 To provide advice to customers drinking at increasing risk levels.

3.3 To signpost those customers that have been identified as being at risk from their

alcohol use to the single point of contact treatment services.

3.4 To support the TRUST to increase awareness within the local population to the

associated health risks linked to alcohol use.

4. Service Description

4.1 To provide an Identification and Brief Advice (IBA) service through community

pharmacies that has the following 6 elements:.

4.1.1 Identification

Using defined criteria (below), customers ‘walking in’ to a participating Pharmacy

will be offered screening using the AUDIT alcohol assessment tool (Alcohol

Usage Disorder Identification Test, WHO 1982, Appendix IV)

Defined Criteria for Screening:

Any customer that the Pharmacist / trained staff member identifies as needing

advice/support around alcohol use

Any customer that has not completed AUDIT in the last 12 months

Vulnerable groups:

Females and Males aged 18 – 30 years

Black and Racial Minorities Groups (BRM) all age groups

65+ males and females

Homeless

Diabetics

Customers presenting frequently with symptoms which may be associated

with alcohol misuse e.g.:

- Gastric problems – e.g. peptic & duodenal ulcers

- Falls and associated injuries

- High blood pressure

- Depression

- Anxiety / stress

- Identified during a Medication Use Review (MUR) or a Smoking Cessation

Consultation

4.1.2 Screening

The Pharmacist / trained staff member will undertake the AUDIT (see appendix 2) questionnaire

with the customer. AUDIT scores will be recorded as hard copy.

EACH customer undertaking the AUDITquestionnaire regardless of score should be recorded.

4.1.3 Brief Intervention

If the score determines that the customer scores between 8 -15 (increasing risk

category), a brief intervention will be carried out, which consists of:

• Explanation of recommended daily amounts

• What a unit of alcohol is

• Explanation of category of drinker

• Explanation of the content of the supporting leaflet

4.1.4 Referral

If a customer scores above 16 (high risk drinking category) then referrals should be made to the specialist treatment.

4.1.5 Follow up

Those customers having scored 8-15 (increasing risk drinking category), should

be contacted using three follow up questions after 4 weeks. Telephone follow

up’s are acceptable. Outcomes must be recorded.

4.1.6 Monitoring of the service

Pharmacies will be expected to:

• Agree to use screening and data collection tools (AUDIT and MonitoringForm)

• Agree to record details about all brief interventions and referral processes

• Provide regular monthly data on customers who have been screened.

This data must be sent toSteve Morton, NHS Blackpool, Blackpool Stadium, Seasiders Way, Blackpool, FY1 6JX by the 7th day of the month. All records should be submitted by Special Delivery mail.

• Pharmacies must be able to provide the monthly records within the required timescales to the TRUST. Payments are only available on receipt of this information. Failure to submit data in a timely fashion may result in late payment.

4.2 The Pharmacy contractor has a duty to ensure that all staff involved in the

provision of the service have relevant knowledge and are appropriately trained in

the operation of the service.

4.3 The Pharmacy contractor has a duty to ensure that all staff involved in the

provision of the service are aware of and operate within local protocols.

4.4 The Pharmacy should maintain appropriate records to ensure effective on going

service delivery and audit.

4.5 The TRUST will provide a framework for the recording of relevant service information

for the purposes of audit and the claiming of payment.

4.6All pharmacy staff delivering the service must:

  • Undertake the TRUST alcohol IBA course and be accredited to deliver the service.
  • Be a qualified pharmacist or pharmacy technician.

Counter staff should be trained to deliver the service in terms of their roles such as patient signposting or bringing patients to the pharmacist’s attention. The responsibility for the service including training and managing staff according to the approved protocol is with the provider.

5. Suggested Quality Indicators

5.1 A training event will be provided by the TRUST and attendance is MANDATORY to

deliver the service.

5.2 The Pharmacy must have a standard operating procedure for this service.

5.3 The Pharmacy must participate in a TRUST organised audit of service provision.

5.4 The Pharmacy must co-operate with any locally agreed TRUST-led assessment of

service user experience.

6. Duties of the Pharmacy

6.1 To ensure all staff employed by the Pharmacy who will be providing the service have

undertaken training relevant to this service.

6.2 To keep records of customer consultations and advice given by means of the

monitoring paperwork provided by the TRUST for this purpose.

6.3 To return monitoring paperwork by the 7th day of the month.

7. Duties of the TRUST

7.1 To provide annual training for pharmacists / staff for the service.

7.2 To provide information on how to access resources and all service documentation including:

Monitoring form

AUDIT questionnaire

Posters

Electronic resources

7.3 To pay the Pharmacy monthly on submission of correctly completed documentation.

8.Complaints

The provider must record any significant events or patient complaints according to the NHS requirements. Any event relating to this service must be reported to the NHSB lead within 2 working days.

9. Terms and Fees

9.1 Terms

9.1.1 The Pharmacy will be paid a fee for each customer that takes part in the service.

9.1.2 Payments will be made by BACS from the TRUST direct into the bank account of

the pharmacy

9.1.3 This service is subject to the usual Post Payment Verification (PPV) Procedures.

9.1.4 Payment will only apply to those customers where the documentation has been

correctly completed and has been accepted for inclusion in service audit.

9.2 Fees

Payments to pharmacies will be based on a fee per patient. The fee has been set at £10.00 per patient which must as a minimum include:

  • Completing the screening process with the patient
  • Providing information leaflets to all patients with an AUDIT score of 15 or less
  • And completing an 4 week follow up

It is also part of the programme that the following be delivered

  • Providing a brief intervention by a trained pharmacist or pharmacy technician to all patients scoring between 8-15
  • Providing details of the 4 week follow up.

10. Activity Levels

10.1 The total number of customers receiving an IBA on a monthly basis will be

dependant on the number of pharmacies providing the service, and the activity

required to achieve the total TRUST target.

10.2 Target levels will be reviewed on a regular basis by the TRUST and the TRUST

reserves the right to limit Pharmacies to a maximum number of IBAs that will be

subject to the agreed fee, as defined in section 2.5.

10.3 Variation to terms will be subject to a 30 day notice period as per section 11

11. Variations to Terms

A request for variation may come from the TRUST or the Pharmacy and should be

made in writing 30 days in advance of the date from which it is proposed the

variation will become effective.

12. Confidentiality and Data Protection

12.1 Information that can identify individual customers must not be disclosed without

the explicit consent of the customer.

12.2 The Pharmacy must protect personal data in accordance with provisions and

principles of the Data Protection Act 1998 and must ensure the reliability of their

staff that have access to the data.

13. Indemnity

The Pharmacy should ensure that it is adequately covered with indemnityinsurance for the activities undertaken in this service.

14. Tax Liabilities

The TRUST declare that it is the intention of the parties that the Pharmacy shall

have the status of a self-employed person and shall be responsible for all VAT,

Income Tax liabilities and National Insurance or similar contributions in respect of

fees.

15. Termination

15.1This agreement may be terminated if either the Pharmacy or TRUST give the other

party one months notice in writing during the duration of the pilot.

15.2 If the Pharmacy or the TRUST is in breach of the agreement, the agreement can be

terminated with one month notice in writing or with immediate effect for a serious

breach.

16. Audit

The Pharmacy must allow the TRUST’s internal and other nominated auditors

access to all or any records relating to this agreement for the purposes of audit.

Appendix 1: Alcohol Triage Service

Single Point of Contact

Addiction Dependency Solutions

49-55 Cookson Street

Blackpool

FY1 3DR

Tel: 01253 752100

Fax: 01253 296522

Email:

Appendix 2: AUDIT Tool Questionnaire

Clients Name: / DOB / Date: / (0) / (1) / (2) / (3) / (4)
1 / How often do you have a drink containing alcohol? / Never
(0) / Monthly or less
(1) / 2 to 4 times a month
(2) / 2 to 3 times a week
(3) / 4 or more times a week
(4)
2 / How many standard drinks containing alcohol do you have on a typical day when you are drinking? / 1 or 2
(0) / 3 or 4
(1) / 5 or 6
(2) / 7 to 9
(3) / 10 or more
(4)
3 / How often do you have 6 or more standard drinks on one occasion? / Never
(0) / Less than monthly
(1) / Monthly
(2) / Weekly
(3) / Daily or almost daily
(4)
4 / How often during the last year have you found that you were not able to stop drinking once you had started? / Never
(0) / Less than monthly
(1) / Monthly
(2) / Weekly
(3) / Daily or almost daily
(4)
5 / How often during the last year have you failed to do what was normally expected from you because of your drinking? / Never
(0) / Less than monthly
(1) / Monthly
(2) / Weekly
(3) / Daily or almost daily
(4)
6 / How often during the last
year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? / Never
(0) / Less than monthly
(1) / Monthly
(2) / Weekly
(3) / Daily or almost daily
(4)
7 / How often during the last year have you had a feeling of guilt or remorse after drinking? / Never
(0) / Less than monthly
(1) / Monthly
(2) / Weekly
(3) / Daily or almost daily
(4)
8 / How often during the last year have you been unable to remember what happened the night before because you had been drinking? / Never
(0) / Less than monthly
(1) / Monthly
(2) / Weekly
(3) / Daily or almost daily
(4)
9 / Have you or someone else been injured as a result of your drinking? / Never
(0) / Yes, but not in the last year
(2) / Yes, during the last year
(4)
10 / Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down? / Never
(0) / Yes, but not in the last year
(2) / Yes, during the last year
(4)
Scoring The scores for each question are shown under each response.
The minimum score: (for non-drinkers) is 0 and the maximum possible score is 40.
AUDIT TOTAL SCORE …………
0 – 7 8 – 15 16 –19 20+
No Risk  Hazardous  Harmful  Dependent 
Refer to HR Team Refer to Dependent Team

Appendix 3:Categorisation of alcohol misusers and pathway (Source: MoCAM 2005 & Ready Reckoner 2009)

Category / Description / Total registered Blackpool Population
(aged 16 or over)
116,400
Abstainers and low risk drinkers / Those who either do not drink any alcohol or drink within the recommended DH guidelines / 55,477
Increasing Risk Drinkers / Those with no apparent problems but taking risks with their longer term health through regular excessive drinking or intermittent sessions of heavy drinking / 21,996
Risky Drinkers / Those who are already experiencing physical. psychological ill effects from their drinking but are not severely dependent / 6,625
Very High Risk Drinkers / Those who have a wide range of alcohol related problems. Some are drinkers with complex problems such as co existing physical or mental health needs, polydrug dependence and social problems / 3,664
Binge Drinkers / Those who consume over double the maximum Dept of Health recommended daily maximum number of alcohol units in one session. / 28,638