Directed Enhanced Service for Alcohol
Date of Issue:
1 April 2013
End Date
31 March 2014
Service Aims
All practices are expected to provide essential, additional and enhanced services they are contracted
to provide to all their patients. This Directed Enhanced Service (DES) specification is designed to:

Encourage practices to screen newly registered patients aged 16 and over for alcohol
consumption.

Deliver a brief intervention to those identified as drinking at hazardous or harmful levels.

Refer dependent drinkers to specialised services.
No part of this Directed Enhanced Service (DES) specification, omission or implication, defines or
redefines essential or additional services.
Background
It is government priority to address the issue of illness associated with increasing alcohol
consumption. This DES is to reward practices for case finding in newly registered patients aged 16
and over.
It also aims to deliver brief intervention to help reduce alcohol-related risk in adults drinking at
hazardous and harmful levels.
Practices that wish to participate in the scheme will be required to sign and return a copy of the
signature sheet section
Criteria
This Directed Enhanced Service Specification details the following criteria.
1. Service Delivery
2. Data Collection and Patient Monitoring
3. Facilities
4. Staff Competence
5. Sterilisation and Infection Control
6. Consent
7. Annual Review
8. Ongoing Measurement and Evaluation
9.
Accreditation
10. Financial Details
11. Agreement Variations and Dispute Resolution Processes
12. Termination of Agreement
Criteria One: Service Delivery
A practice may be accepted for the provision of this DES if it has a partner, employee or
sub-contractor, who has the necessary skills and experience to carry out the contracted procedures.
Clinicians taking part should be competent in clinical practice and have a responsibility for ensuring
that their skills are regularly updated.
The provision of this service will not be prejudicial to those common principles that underpin the
GMS/PMS contract to ensure minimum standards are met and to encourage high quality care. The
range of standards includes:
(i)
(ii)
(iii)
(iv)
minimum legal requirements, eg having effective clinical governance systems in place;
complying with the NHS complaints system;
producing patient leaflets;
adequate facilities including premises and equipment, as are necessary to enable the
proper provision of services, including facilities for cardiopulmonary resuscitation.
Practices will be required to screen newly registered patients aged 16 and over using
either one of two shortened versions of the World Health Organisation (WHO) Alcohol
Use Disorders Identification Test (AUDIT) questionnaire: FAST or AUDIT-C. FAST has four
questions and AUDIT-C has three questions, with each taking approximately one minute to
complete.
If a patient is identified as positive, the remaining questions of the ten question AUDIT
questionnaire are used to determine hazardous, harmful or likely dependant drinking.
Following identification, the practice should deliver a brief intervention to those identified as
drinking at hazardous or harmful levels. Dependent drinkers should be referred to specialist services.
The recommended brief intervention is the basic five minutes of advice used in WHO
clinical trial of brief intervention in primary care, using a programme modified for the UK context
by the University of Newcastle – How Much is Too Much?
Further information regarding the audit tools and brief intervention can be found at :
http://www.ncl.ac.uk/ihs/news/item/?brief-interventions-alcohol-and-healthimprovement
Criteria Two: Data Collection and Patient Monitoring
This directed enhanced service will fund:
(i) The service described above
(ii) History taking, and relevant clinical examination
(iii) Documentation of any procedure carried out under this DES in the patient record
(iv) Maintenance of adequate records of the service provided, incorporating all known
information relating to any significant events e.g. hospital admissions, drug reactions and
premature withdrawal of therapy. (serious incidents reported through normal reporting
mechanism to area team)
(v) Collection of activity related to the provision of these services including: appropriate read
coding, type of activity, number of contacts and who provides the service
(vi) Read Codes to be used
Criteria Three: Facilities
 Practices carrying out this DES should have such facilities as are necessary to enable them to
provide such services properly.
 Adequate and appropriate equipment should be available for the clinician to undertake the
procedures chosen, and should also include appropriate equipment for resuscitation. National
guidance on premises standards has been issued
 All personnel providing the service through the contract have appropriate indemnity cover to meet
in full claims made against them as individuals.
 Comply with any relevant Health and Safety legislation requirements.
Criteria Four: Staff Competence
As with any clinical intervention, it is important that staff carry out sufficient volume of activity to
ensure they are appropriately skilled to provide high quality care and meet appropriate standards.
The practitioners can provide evidence that they have the experience and qualifications to undertake the
procedure/s and all personnel providing the service are competent to provide those aspects of the
service for which they are responsible and will keep their skills up to date.
Each practice must ensure that any personnel involved in providing any aspect of care under this
scheme has the necessary training and skills to do so.
Any practitioner involved in the provision of this DES will satisfy at appraisal (and revalidation if
necessary) that s/he has such continuing clinical experience, training and competence as is necessary to
enable her/him to contract for the enhanced service and shall be deemed professionally qualified to do
so.
Criteria Five: Sterilisation and Infection Control
General practitioners are responsible for the effective operation and maintenance of sterilizing
equipment in their practices. Practices must have infection control policies that are compliant with
national guidelines including inter alia the handling of used instruments, blood, excised specimens and
the disposal of clinical waste.
Criteria Six Consent
In each case the patient should be fully informed of the treatment options and the treatment proposed.
Criteria Seven: Annual Review
The service delivered by this Directed Enhanced Service will be subject to clinical audit monitoring. This
will be carried out as part of the annual review of the contract based on evidence of activity and quality
of record-keeping.
 Full records of all procedures should be maintained in such a way that aggregated data and details of
individual patients are readily accessible.
 Clinical audit must be undertaken within the Practice and be accessible by the Area Team.
The Practice must comply with NHS complaints procedure.
Criteria Eight: Ongoing Measurement & Evaluation
The ongoing measurement is outlined below.
Criteria
Scrutiny
Qualifications &
The practice can demonstrate that any clinician providing this DES is
Training
appropriately qualified with a nationally recognised qualification, and
receives regular and appropriate supervision and training updates
Patient records
The practice can provide a random sample of patient records for
examination by the Area Team. This sample will be anonymised, in line
with confidentiality guidelines. The sample will be drawn from the
register held by the practice.
Referrals and inquiries The practice will be able to provide an analysis of referrals,
demonstrating that full records are being kept
Feedback
The practice will demonstrate that they have undertaken a survey of
patients included in the enhanced service, and where appropriate,
changes implemented
Review and payment
See criteria 10 this DES.
criteria
Criteria Nine: Accreditation
Those doctors who have previously provided services similar to this enhanced service and who satisfy at
appraisal and revalidation that they have such continuing medical experience, training and competence
as is necessary to enable them to contract for the enhanced service shall be deemed professionally
qualified to do so.
Criteria Ten: Financial Details
The practice will be paid £2.38 for each patient that has been screened under the Terms of this DES.
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Criteria Eleven: Agreement Variation and Dispute Resolution Process
In the event of contractual issues failure outside of the formal notification by either partner this will be
covered by the Area Team disputes procedure as per nGMS. In the event of failure to deliver against
the agreed standards both parties can instigate procedures for a breach. There will be no variation to the
increase in the agreement value in year.
Criteria Twelve: Termination of Agreement
In the event of the practice wishing to terminate the agreement with the Area Team to provide the
service, three months notice should be given in writing to the Area Team. Three months notice in
writing will also be given to the practice should the Area Team wish to terminate the agreement.
Signature Sheet - Direct Enhanced Service for Alcohol 1st April 2013 to 31st March 2014
NHS England
Participation Agreement.
This document constitutes an agreement between the NHS Commissioning Board (the commissioner)
and a GMS/PMS or APMS contractor (the contractor) in respect of delivering the agreed enhanced
service.
By entering into this agreement the contractor enters into an arrangement to deliver enhanced primary
medical services:
(i)
in line with the requirements of the service specification published by the commissioner
which is deemed to be a part of this agreement (and which may be attached for reference);
and,
(ii)
for the duration specified below.
Duration of agreement: From 1 April 2013 to 31 March 2014
The contractor reserves the right to withdraw from the enhanced service by giving 3 months notice to the commissioner. The
commissioner reserves the right to terminate this agreement should the contractors GMS/PMS/APMS contract be
terminated or be subject to such conditions that in the reasonable opinion of the commissioner warrant early termination.
Signed on behalf of the commissioner
Date
Signed on behalf of the contractor
Date
Please note for GMS practices, one partner may sign, for PMS and APMS contractors, all signatories to
the PMS or APMS agreement must sign
Practice stamp:
Please return two signed copies of this agreement by 30th June 2013 to:
england.gp-contracting@nhs.net.