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How I...set up an alcohol harm reduction programme

Alcohol misuse is a major challenge for the NHS, says Wirral GP Dr Stefan Janikiewicz, but simple primary care screening can bring about dramatic improvements

Alcohol misuse is a major challenge for the NHS, says Wirral GP Dr Stefan Janikiewicz, but simple primary care screening can bring about dramatic improvements

Excessive drinking and alcohol misuse is, arguably, the biggest national problem currently facing the NHS, and is certainly behind a great deal of GPs' workload. We have been running routine screening at my own practice, Moreton Health Clinic, for the past few months and have already seen some dramatic results.

Alcohol screening is extremely easy to implement and just requires patients to fill in a form that records the frequency and nature of their alcohol consumption. This can be done by practice nurses as part of the registering process for all new patients, as part of a routine health check or when taking a patient history. This basic information highlights if a patient falls into the ‘hazardous drinker' or ‘harmful drinker' category, as well as ‘dependence' cases. It enables the relevant information and help to be channelled to the patient.

In my opinion, alcohol screening can and should take place as part of routine primary care provision. There are so many immediate tangible benefits as well as reducing the risks of patients getting major health problems later in life. There is also the bigger picture to consider. This issue is costing the NHS over £20m each year and if we fail to address it, we are failing at what we do.

The problem with alcohol treatment is that the issue is cultural. In the UK, alcohol misuse is still socially acceptable and our responsibility is to challenge these cultural norms and re-educate individuals in how they think about their alcohol consumption. Brief intervention is simply about pointing out the potential health risks and issues to someone who may not have been aware of them previously, and motivating them to modify their behaviour. As in the screening and diagnosis of any chronic illness, patients have to be willing to be honest and ready to accept advice. But we find that in primary care, people tend to present because they do want help, and from there a whole range of advice can be offered.

The initial feedback from our practice nurses and staff has also been very positive. Some patients are surprised to fall into these categories, but most people are aware that they are drinking a little too much or too often and usually people want help and want to take our advice. We have found that the key to success in helping patients to change their attitude towards alcohol is to deliver the advice in a motivational and non-judgmental manner.

I think this is one of the most rewarding aspects of our job, because you can see a dramatic change in a person quite quickly if the patient is motivated to change. For example, we have seen a number of young people in the practice, especially young women over the past couple of months who are in danger of long-term liver damage through excessive drinking. We have been able to support them in forming new patterns of drinking, and several of these patients have given up alcohol altogether.

If general practice doesn't address this issue, who will? In Merseyside for example, 50% of men are known to be drinking too much. If we fail to address this in primary care, we are failing at what we do. Ultimately, I'd love to see QOF points brought in for alcohol so that all primary care physicians get involved in this kind of treatment, and unless we do, I suspect things will get much worse before they get better.

I believe that alcohol screening and brief intervention should be a normal part of everyday consulting with every patient, and I would encourage every practice to start engaging with the issue.

Dr Stefan Janikiewicz is a GP in Wirral and Clinical Director of the Wirral and Chester Drug and Alcohol Service, Cheshire and Wirral Partnership NHS Trust

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