Calls to extend programme which supports people with alcohol problems in Glasgow’s Deep End Practices

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A new study has shown specialist addictions nurses in general practices in the most disadvantaged areas of Glasgow have been effective in treating alcohol problems.

The research, conducted by researchers at the University of Dundee and University of Stirling, explored healthcare professionals’ and patients’ experiences and perceptions of the management of alcohol problems in Deep End general practices in Scotland.

In 2020, 1190 people in Scotland died directly because of alcohol and alcohol-related deaths were 4.3 times higher in the most disadvantage areas of Scotland compared to the least. Deep End practices are general practices serving the 100 most disadvantaged populations of Scotland, where alcohol problems are often the most prevalent.

In 2015, a new model to address alcohol dependence in primary care was piloted in Deep End practices in Scotland, which combined specialist skills with a primary care setting. The pilot was successful and was extended for a further three years. The service was renamed ‘Primary Care Alcohol Nurse Outreach Service’ or PCANOS, and had an Addictions Nurse located within GP practices. The primary aim of this service was to engage patients with alcohol problems who have either not engaged with or have low engagement with specialist community alcohol services, and to refer them on to mainstream alcohol services upon discharge.

This unique Addictions Nurse service focuses on individuals who haven’t otherwise engaged with alcohol treatment services. The research showed that the service was viewed positively by both practice staff and patients due to its ‘person-centred approach’, flexible nature, and ability to be tailored to support specific individuals. The study also found that the model enabled collaborative working between practice staff because of the Addictions Nurse being situated within the practice, leading to faster referrals and coordinated care between services and with wider community services after discharge by the Addictions Nurse.

Call for funding

Researchers are calling for long-term funding to be provided for PCANOS to enable the continued support of people with alcohol problems who have complex needs and for further research to be conducted into unique services such as PCANOS, in supporting people with moderate to severe alcohol problems who do not engage with alcohol services.

Dr Andrea Mohan, the principal researcher on the project, from the University of Dundee, said: "People from deprived backgrounds in Scotland continue to experience serious harms such as illness and early death due to alcohol. Supporting this group can be challenging as they often have complex health and social needs, and find it difficult to access appropriate services. This research study found that benefits can be achieved when a specialist alcohol service such as the Primary Care Alcohol Nurse Outreach Service (PCANOS), works closely with general practices. PCANOS uses a person-centred and coordinated care approach to engage and support patients with moderate to severe alcohol problems who are referred by general practices serving some of the most deprived populations in Glasgow. It is crucial that a service like PCANOS continues to be funded as our study has shown that it is filling an important gap in alcohol service provision in Glasgow.”

Dr Clare Sharp of the University of Stirling, another of the report’s key researchers, said: “Individuals with moderate to severe alcohol problems often have complex health and social care needs, and we know that for many, it is challenging to engage with current alcohol treatment services for various reasons. This is where PCANOS comes in. This study provides evidence that PCANOS can help address this gap in service provision by providing a more personalised care and support service to this group of patients, offering them flexibility and enabling them to engage in treatment for their alcohol problems. It is also important to highlight that although PCANOS is a specialist service, its strong connection to GP practices has provided a vital link between primary care and specialist addiction services resulting in a more coordinated care package for patients.  Findings from this study strongly support the need for investment in alcohol services like PCANOS.” 

Dr Andrea Williamson, Deep End and Inclusion Health GP Glasgow, said: “This research describes some of the key ingredients of high-quality care for Deep End patients - relational care, collaboration between GP practice teams and the specialist nurse, and 'no wrong door' when it comes to patients accessing appropriate specialist care and treatment. This is important to increase engagement for patients struggling with problem alcohol use and of relevance for other conditions too.”

Elinor Jayne, Director of Scottish Health Action on Alcohol Problems (SHAAP), said: “Alcohol harm disproportionately affects people living in Scotland’s most disadvantaged communities, so targeted, innovative services such as this Addictions Nurse model in Deep End practices in Glasgow are to be celebrated. It’s really important that not only is this service continued, but is expanded to all Deep End practices so that we can begin to reduce the harm caused by alcohol in all of Scotland’s most disadvantaged communities. Investment in this type of person-centred, holistic care is not only the right thing to do but will ultimately reduce the burden placed on other overstretched NHS services, so I would encourage all health boards in Scotland to take this model forward.”

The study was developed by Dr Andrea Mohan of University of Dundee and Dr Clare Sharp of University of Stirling, alongside colleagues Dr Danielle Mitchell, Mr. Douglas Eaddie, and Professor Niahm Fitzgerald, all of University of Stirling in the report ‘Exploring the management of alcohol problems in Deep End practices in Scotland’.