GP-led services for alcohol misuse: the Fresh Start Clinic

Background A growing number of patients are presenting to health services with alcohol misuse disorders. The challenge to the NHS is to deliver the most cost-effective treatment solutions for all forms of alcohol misuse disorders. Setting NHS Wandsworth undertook a 12-month pilot to identify the most effective model for delivering treatment for alcohol dependency within the primary care setting. Question What are the most effective models to treat patients with alcohol dependency in primary care? Methods Model A: This was a locally enhanced services agreement (LES) agreement for screening, brief interventions and treatment. Practices were required to attend training in the management of alcohol withdrawal and had access to specialist nurse support. Model B: A GP-led clinic supported by a full-time specialist nurse prescriber. The clinic was promoted as the Fresh Start Clinic. It offers planned alcohol withdrawal within a pre-agreed structured treatment plan, and sign posts to after care. Results There were 76 treatment episodes in the fresh start clinic compared with 6 recorded treatment episodes under the LES. Fresh Start ClinicWaiting time to treatment is 7 days.We achieved a 100% completion rate.Patient satisfaction questionnaires confirmed positive patient experience.Twenty percent of patients completed questionnaires.Fifty seven percent abstinence at 3-6 months follow-up.Fifty percent improvement in mental well being as measured by Beck's Depression Inventory.Improvement in markers of dependency (GGT and MCV).The cost per treatment episode in the Fresh Start Clinic was significantly less. Conclusions The Fresh Start Clinic offers clinically safe and cost-effective treatment to patients suffering from mild to moderate alcohol dependency in a primary care setting and offers choice to both GP's and patients.