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Draft guidance stresses GP role in identifying and managing alcohol use disorder

Draft guidance stresses GP role in identifying and managing alcohol use disorder

The Government has launched a consultation on new guidance aimed at improving alcohol treatment services across the UK, with implications for GPs.

The draft guidance stresses that primary and community services should routinely identify people with alcohol use disorders using a validated screening tool and providing brief interventions at an early stage; and refer patients who are probably dependent, and those with alcohol related health conditions to specialist alcohol treatment services.

It also says GPs and their teams can help support a patient’s recovery from alcohol dependence ‘working with alcohol treatment services and sharing information with the patient’s consent’.

Highlighting that some patients fall through the gaps due to having both a mental health diagnosis and AUD, the guidance says GPs should be ‘identifying, managing and arranging’ secondary healthcare for patients with alcohol-related physical and mental health conditions’.

GPs should also offer ‘harm reduction advice and interventions’ to patients who continue to drink at harmful or dependent levels and help family members access support if needed.

GPs are also tasked with ‘reducing barriers to accessing primary healthcare for all people with alcohol problems, including socially excluded people and communities experiencing the worst health outcomes’.

‘Some primary care teams include GPs or nurses with appropriate competencies to provide specialist alcohol treatment interventions (for example, medically assisted withdrawal), and they may be commissioned to offer these,’ the guidance added.

Meanwhile, ‘after a patient is referred to specialist alcohol treatment, there should be ongoing information sharing between services, with the patient’s consent’, including about health changes, medication and the patient’s progress.

But it also stressed primary care needs to be supported in improving support for patients with AUD.

The document said: ‘There should be strong strategic leadership and senior level commitment to support primary care and community health services to carry out their role in preventing and managing alcohol-related harm in their patients. An appointed alcohol lead can help to prioritise effective interventions and pathways for the full range of alcohol use disorders.’

And, in England, it suggested PCNs could take a greater role in addressing alcohol harm.

‘Organisational structures for reducing alcohol harm vary across the UK. In England, primary care networks and integrated care systems provide important opportunities to address alcohol harm at a whole system level and to reduce the health inequalities,’ the guidance said.

GP-specific guidance in new draft guidelines

15.6 The role of GPs and their teams

Interventions and support offered by GPs and their teams to people with alcohol use disorders varies depending on local commissioning arrangements, clinical competencies within the wider primary care team and local partnership arrangements. However, all GPs and their teams will provide some interventions to:

  • prevent and manage health harms in their patients with alcohol use disorders
  • work with specialist alcohol services to support patients in their treatment and recovery

15.6.1 Expectations of GPs and their teams

All GPs and their teams could:

  • routinely identify patients with alcohol use disorders and offer brief interventions
  • with patients’ consent, refer them to specialist community alcohol treatment services
  • work with alcohol treatment services (where patients are in specialist alcohol treatment) to support patients to achieve their recovery goals and share information appropriately
  • contribute to a multidisciplinary and multi-agency care plan to support recovery and manage risks where patients have complex needs in addition to alcohol problems
  • identify possible alcohol-related health conditions and (with patient consent) arrange for further investigations
  • refer to relevant specialist secondary healthcare care services where indicated and keep alcohol treatment services informed
  • encourage people with alcohol use disorders to take up the routine screening and vaccinations that are offered to the general population
  • provide advice on alcohol use and pregnancy
  • refer women who are pregnant and drinking harmfully to specialist antenatal care and specialist alcohol treatment services
  • offer alcohol harm reduction advice and interventions based on the MECC approach
  • identify and act on risks to the person and to others such as child safeguarding and adult safeguarding (see annex 1 on relevant legislation and statutory guidance for more information)
  • ask about social circumstances and offer social prescribing for people who need social support and care
  • consider the needs of people from inclusion health groups (see section 15.6.10 below for more information)

Some GPs and their teams who have appropriate competences can also offer specialist alcohol treatment interventions, for example, medically assisted withdrawal.

GPs and their teams are in a position to identify probable alcohol-related health conditions and to refer the patient for investigations. Depending on the condition and the severity, they can then manage this in primary care or refer to the relevant specialist secondary healthcare service.

When a clinician in specialist alcohol treatment services identifies a probable alcohol related health condition, in most healthcare systems the pathway to access specialist care for other health conditions is through the GP.

People who drink at harmful and dependent levels often have poor health and may also have poor self-care. So, the GP has a vital role in identifying health conditions and helping the patient to manage alcohol related health conditions.

Source: DHSC

The term alcohol use disorder (AUD) is defined as ‘a pattern of alcohol use that involves regularly drinking above 14 units per week’. It is estimated that just over 21% of the adult population are drinking above recommended levels in England.

The Government noted that ‘most people’ with an AUD ‘do not need specialist alcohol treatment but may benefit from alcohol brief interventions’, which could be provided by the patient’s GP.

Deputy CMO Dr Jeanelle de Gruchy said: ‘These UK-wide guidelines will provide a clear consensus for health and care services on best practice for alcohol treatment, resulting in better outcomes for those who need treatment and care.”

‘I encourage anyone who works in alcohol treatment services, and anyone with experience using them, to contribute your views to the eight-week consultation to ensure that the guidelines are as robust and person-centred as possible.’

Public health minister Neil O’Brien said: ‘This consultation will help us develop guidance to ensure alcohol treatment services are of consistently high quality, providing stronger pathways to recovery for those in need of treatment for alcohol dependence.’

The failure of the Government to tackle harm from alcohol dependency over the past decade has led to a serious public health crisis, according to a Public Accounts Committee report published earlier this year.

The committee heard that more could be done by health services to identify people with alcohol dependency and direct them to treatment and that GPs and outreach could be used more to deliver services.

Meanwhile, a new NICE quality standard asked GPs to formalise recording of patients’ alcohol use so they they do not miss out on interventions.


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Please note, only GPs are permitted to add comments to articles

Dr N 16 October, 2023 4:49 pm

In my experience alcohol dependent patients rarely attend if referred. They need to be motivated hence self referral routes waste less resources.

John Graham Munro 16 October, 2023 6:17 pm

Point them all in the direction of A.A.

Sujoy Biswas 16 October, 2023 8:38 pm

Dr N — spot on.
Its a public health issue — they should be leading on this

fareed bhatti 17 October, 2023 8:36 am

Looking through the expectations list, its what we do already -dont we?
And while we are here, lets ask about your gambling habits, drugs, safeguarding issues, contraceptions, sexual health, housing, heating, bed bugs etc etc.
so what did you come in with anyway….! Fitness to skydive letter. Of course , here is my pen and my stamp -you might as well do it yourself, pls bring in your parachute for the mandatory check by a GP too.

Bonglim Bong 17 October, 2023 9:34 am

Every one of these guidelines, should come with a workload impact assessment for primary care:
– this process will require xGP appointments throughout the UK. That is the equivalent to 1500 FTE GPs (or whatever) so it should remain in draft form until:
– the number of GPs has increased to meet the current deficit
– and then increased by a further 1500 (or whatever)

Otherwise the result, as we have seen, is that it:
– never gets done correctly
– increases expectation inappropriately
– or perhaps most importantly has unintended consequences such as reducing the availability of other service. There is no point in improving care for one illness and patting yourself on the back, if your change has resulted in a much larger increase in incurable cancer because other undifferentiated patients have not been able to get an appointment for their new presentation.