Intelligent Commissioning in 

Alcohol Services

Bradford Airedale Craven & Wharfedale 

Alcohol Project – BACWAP

The story so far...

‘Development of Community Alcohol Services in Bradford & Airedale‐ Findings & Recommendations Bradford District 2012’( Andrew O’Shaunnessy  & Hilary McMullen)

November 2012 –appointment of District  wide Clinical Speciality Lead in Alcohol & Substance Misuse

Graham SandersonLead Partner Bradford Student Health ServiceGPwSI SMS & Alcohol

CCG Priority –

reduction in 

Alcohol related 

admissions

Local Annual Costs & 

Potential Savings  

‘£5 saved for £1 invested’Extrapolation of national data suggests:NHSBA costs £27 m (probably higher)Societal costs £200 mEach dependent drinker costs the NHS £2 300 pa24% increase in moderate to severely dependent drinkers between 2000 –200717 000 drinking at Harmful Levels

Financial Commitment to 

the 2012/13

& 2013/14

pilot.Existing

Alcohol Care Teams AGH &BRI         £148 KCommunity Alcohol Support Staff CAST  BRI  & AGH                                                  £120 KAlcohol Health Worker A&E AGH                            

£35 KCEE Tier 2&3 supporter                       £90 KAlcohol Assessment HUB Bradford & Keighley HUB                                                      £155 KProject Mx, evaluation & setup costs £180 K

Coming online Provider LifeLine Piccadilly Project with Project 

6‘Lifeline Community Alcohol Service’

6 Primary Care Alcohol Workers (AHW)                   £210 K

Community Alcohol Detox & Relapse prevention service                               £259 K

TOTAL £1,197,527 pa

Switch off...  CCGs haven’t committed  £1.2m to do more work themselves...My key commissioning principles for effective patient ‘capture’ in Primary Care include :

‐Use existing clinical systems & data‐Recognise that even the most motivated 

Clinician is enormously time‐pressured‐

Appropriate delegation

• SHA stated objective was 

‘Industrialising’

Alcohol Screening in 

Primary Care.• An ad hoc approach in the context of a 

routine consultation is a cottage 

industry.

Assessment HUB – Rapid access comprehensive assessment of up to 6 weeks duration. During the assessment period refer to any of the following services.

Hospital admissionsIdentification via AUDIT score 5 or more, refer to ACT. Comprehensive assessment BA and where appropriate refer on to HUB or Tier 2Identified frequent admission refer to CAST for intensive support for up to 6 weeks post discharge

Primary Care SettingIBA score 5 or more refer to PCW

Primary Care Worker undertakes full AUDIT. Score 5-15 undertake BA. Up to 6 sessions, follow up through primary care. If appropriate, refer on to HUB or Tier 2 service. Score over 15 refer to HUB

CAST to refer to HUB whilst offering 6 weeks intensive support. If alcohol free at the end of intensive support refer to abstinence services

Upon completion of assessment period at HUB refer to Tier 3 psycho -social interventions services or where applicable Tier 2 or Abstinence and Recovery Service

A&E attendanceIBA score 5 or more offer appointment with AHW at A&E. Score over 15 refer to HUB

Tier 4 IPD or RRFollow pathway. Upon completion refer to Abstinence & Recovery Service

Tier 2 triage and instant access and support services.AUDIT score at triage over 15 refer to HUB

Community detoxification Refer to Abstinence & Recovery Service

Abstinence and Recovery ServiceAbstinence and recovery service SHARE, to access Structured Day Care, SMART, AA, CARM

services plus recovery staff and peer support.

RecoveryExit from services. Offer mutual Aid groups and on-going support at the Abstinence Service on a drop in

basis

HUB assessment complete

Ex it

fro m tre at m en t

sy st e m -

ca n re -

en ter at va rio us po int s

Green arrow entry in to systemBlue arrow exit from systemBlack arrow referral pathway

Tier 3 psycho- social interventions and care planning

Switching back on...AUDIT‐C  is key to the PathwayFlow of patients into & through the pathway is determined by AUDIT (C/PC/full) scores.

Practices will use the BACWAP Alcohol template .

BACWAP ALCOHOL 

TEMPLATE:   

Self‐calculating AUDIT‐C & Full AUDITAn e‐referral facility to the Community Alcohol Service for Brief Advice/further evaluation/assessment for Community DetoxFull local & National Guidance & references A referrer feedback facility  via SystmOne or email 

Really Intelligent 

Commissioning in Alcohol 

Services 

Integrated Care monitoring/Service delivery  via the 

Alcohol Hub to include: Alcohol associated (causal & non causal ) morbidities(restricting to causal &  100 % alcohol attribution  misses

opportunities)Dual Diagnosis  (Alcohol is the most commonly misused drug in patients with SMI)Safeguarding Coordination with SMS to pick up co‐dependency and transfer of dependency from opiates to alcohol

It’s not just about cutting 

down the units...

Thank You!gsanderson@bradford.nhs.uk

District Speciality  CCGCommissioningLead Drugs & AlcoholLead Partner Bradford Student Health 

ServiceGPwSI

Drugs & Alcohol