Around 1.5 million may have missed out on alcohol screening after scheme axed

Around 1.5 million adults may have missed out on being screened for signs of potentially harmful drinking habits, researchers believe, after a scheme offering GPs financial incentives to discuss the issue was stopped.

Small increases in screening and alcohol advice were observed after the Direct Enhanced Service (DES) scheme was introduced by the Department of Health and Social Care (DHSC) in April 2008.

Participating practices in England were paid £2.38 for each newly-registered adult patient they screened for higher-risk drinking using a questionnaire.

In April 2015, the scheme was discontinued, with an “immediate and significant” drop in rates of screening and advice, which have continued falling, according to a UK study.

By the end of 2016, some 27,439 fewer patients received advice on how to manage their risky drinking as a consequence of the scheme ending, researchers from Newcastle, Sheffield and London estimate.

At that point, they also believe 603,719 fewer adults had been screened for higher-risk drinking.

Assuming screening rates have not fallen since the period covered by the study, and that other factors have remained stable, they estimate a further 900,000 people may have not been screened.

Lead author Dr Amy O’Donnell, from the Institute of Health and Society at Newcastle University, told the PA news agency: “Since April 2015, even if there hasn’t been any further decline in the screening rate, we estimate that around 1.5 million fewer primary care patients have been asked about their drinking since the alcohol incentive scheme was terminated.”

The authors believe the paper, published in the scientific journal Addiction, is the first large-scale assessment of the impact of the programme.

They analysed records from a database of 4 million newly registered patients from more than 500 general practices.

Modelling from a sample suggests that 36,223 fewer patients were screened, and 1,646 fewer patients received advice, between April 2015 and December 2016.

Dr O’Donnell added: “Scaling-up our findings to the English population, we estimate that by the end of 2016 alone, 27,000 fewer patients received brief advice as a result of terminating the alcohol incentive scheme.

“This is despite the fact that GPs are still legally obliged to identify and support higher-risk drinkers.

“As well as drawing attention to the disappointing rates of alcohol advice giving in England since GP payments were withdrawn, our findings also highlight the real risks of using short-term financial incentives to boost delivery of public health measures in healthcare.”

Before the scheme, 92 out of every 1,000 eligible patients were screened for higher-risk drinking each month.

Of every 1,000 who screened positively, fewer than 15 received brief advice.

Advice rates increased when the scheme was introduced, with just over 20 more higher-risk drinkers receiving advice per month per every 1,000, the study found.

Since it was discontinued, screening rates are believed to have fallen by almost three patients per month.

As of December 2016, 31 fewer patients were estimated to be receiving advice, per every 1,000 higher-risk drinkers, compared to March 2015.

The authors concluded: “Removing a financial incentive for alcohol prevention in English primary care was associated with an immediate and sustained reduction in the rate of screening for alcohol use and brief advice provision.

“This contrasts with no, or limited, increase in screening and brief advice delivery rates following the introduction of the scheme.”

The study is funded by the National Institute for Health Research (NIHR).

A Department of Health and Social Care spokesman said: “We are committed to supporting the most vulnerable at risk from alcohol misuse and it is encouraging to see an overall decrease in the amount of people drinking, especially from the younger population.

“As part of the detection and prevention commitment in the NHS Long Term Plan, GPs continue to routinely check patients’ alcohol consumption levels and, where appropriate, offer advice and guidance.”

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