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drugs+alcoholDUMFRIES AND GALLOWAY

Dumfries & GallowayDumfries & Galloway

Lorrain Hyland - Lorrain Hyland - Project Officer Project Officer

Integrated Alcohol ServiceIntegrated Alcohol Service

Regional RolloutRegional Rollout

• 5 Localities across region5 Localities across region

• 35 Practices35 Practices

• 23 on board23 on board

• 12 to challenge12 to challenge

• Alcohol liaison nurse in each localityAlcohol liaison nurse in each locality

• Alcohol counsellor in each localityAlcohol counsellor in each locality

• Expanding pilot locality serviceExpanding pilot locality service

Staff TrainingStaff Training

• Fully trained service staffFully trained service staff

• Nurse & counsellor designed bookletNurse & counsellor designed booklet

• GPs and PN offered trainingGPs and PN offered training

• GPs and PN resourcesGPs and PN resources

• Primary Care staff trainingPrimary Care staff training

Screening and RecordingScreening and Recording

• 24 GPASS24 GPASS

• 5 Emis5 Emis

• All screening recordingAll screening recording

• Follow up approx. 3 monthsFollow up approx. 3 months

• Claim quarterly with invoice & reportClaim quarterly with invoice & report

• Enhancement direct to practice from ADATEnhancement direct to practice from ADAT

• HEAT targets – 4500 interventions over 3yearsHEAT targets – 4500 interventions over 3years

Data TemplateData Template

• Numbers screened Numbers screened

• Fast scoreFast score

• Unit ConsumptionUnit Consumption

• Alcohol consumptionAlcohol consumption

• LFT ResultsLFT Results

• LFT ImprovementLFT Improvement

• MedicationMedication

• SPICE shareSPICE share

• Diagnosis drinkerDiagnosis drinker

• Offered BI LeafletOffered BI Leaflet

• Offered BI AdviceOffered BI Advice

• Call backCall back

• Referrals into serviceReferrals into service

ChallengesChallenges

•Template for all systemsTemplate for all systems

•Lack guidance for SG data collectionLack guidance for SG data collection

•Consistent and reliable data collectionConsistent and reliable data collection

•Practice access for sessionsPractice access for sessions

•Wrap around servicesWrap around services

PathwaysPathways

• GP First point of contactGP First point of contact

• Screening identifies 50% patients out Screening identifies 50% patients out

• Clients seen in under 8 weeksClients seen in under 8 weeks

• Tier 2 & 3 work in synergy Tier 2 & 3 work in synergy • Multi agency working Multi agency working - Alcohol support- Alcohol support

- Specialist - Specialist servicesservices

- Community - Community projectsprojects

- Leisure & sport- Leisure & sport

- Walking groups- Walking groups

- Volunteering- Volunteering

Community self-help, AA groups etc

Community prevention initiatives

Opportunistic screening for potential alcohol problems in

primary care, using FAST

If FAST +ve, estimate no. of units per week and LFTs

HAZARDOUS DRINKING (15 – 35u/week for females 22 – 50u/week for males)

PRIMARY CARE

Brief advice intervention

Review in 3 months, with repeat FAST, no. of units/week and

LFTs

If FAST –ve, reinforce positive drinking message

and review

DEPENDENT DRINKING

SPECIALIST SERVICE

Community/home detox

Relapse prevention –disulfiram, acamprosate

HARMFUL DRINKING (>35u/week for females >50u/week for males)

SUPPORT SERVICE

1:1 practice-based counselling

Improved, no further action

No improvement, consider referral for counselling

Relapse prevention - counselling

If unsuitable for home/community detox consider in-patient detox

If counselling and relapse prevention fail, consider referral for residential

rehabilitation

75% of population visit their GP each year

Tier 1 services

Tier 2 services

Tier 3 services

Tier 4 services

Under DevelopmentUnder Development

• BlueBay GP systemBlueBay GP system• Tier 1 wrap around servicesTier 1 wrap around services• Relapse Prevention ServiceRelapse Prevention Service• Moving onMoving on• Additional support servicesAdditional support services• Local resourcesLocal resources

Finally..Finally..•Success in D&G accountable to staff Success in D&G accountable to staff enthusiasm and commitmententhusiasm and commitment

•Continuing GP support with processContinuing GP support with process

•Ability to grow and extend service as Ability to grow and extend service as capacity demands increasecapacity demands increase