Local pharmacy staff on the Wirral tactfully help people think about how much alcohol they drink, reports Lynne Greenwood

Trained staff in pharmacies on the Wirral are now pretty astute at engaging their customers in a chat about alcohol. If people are waiting for a prescription for medication which interacts with alcohol, the way in is easy.

But even if shoppers are browsing or buying anything from over-the-counter remedies to cosmetics, experienced staff have learned non-intrusive ways to introduce the subject of drinking.

Wirral primary care trust in Merseyside - one of the areas with the highest rates of adult binge drinking in the UK - has become the first NHS organisation to offer an alcohol screening and brief intervention programme through its 86 pharmacies.

Excessive drinking is a major concern in a geographical area which includes both affluent villages and deprived suburbs and has the fourth highest number of alcohol related hospital admissions in the UK.

“I was happy to complete the questionnaire and I preferred it in the pharmacy than if I had been asked by a doctor or nurse”

Initially the PCT introduced the screening programme into GP surgeries but decided to extend the service to cover the region’s 86 pharmacies, which are more likely to capture people who rarely visit a doctor.

The service was introduced slowly as pharmacy staff were trained and in the first 12 months it conducted 2,163 screenings.

A spokesperson for the Department of Health, which distributed educational tools and resources on alcohol reduction to all pharmacies in 2007, says: “We are aware that PCTs are following Wirral’s example and making use of pharmacies to provide alcohol reduction services where there is an identified local need.”

Dave Astbury, pharmacist at one of Wirral’s three 100-hour pharmacies, was among the first to sign up to deliver the service, arranging for his counter staff to do one of the half-day study courses organised by the PCT.

“Demographically we are in a good position to deliver this service,” says Mr Astbury, manager of the Claughton Pharmacy, Birkenhead, whose opening hours of 7am to 10.30pm six days a week and from 9am to 4pm on Sundays result in “a good footfall of people from a real mix of backgrounds”.

Friendly questions about alcohol

Mr Astbury wanted to build on a poster campaign highlighting levels of alcohol consumption in units.

“It was very clear to us that many people did not understand what constitutes one unit - for example that one large glass of wine may be the equivalent of 3.5 units,” he says.

“We do not target specific age groups or sexes, although we do have a lot of young males among our customers,” says Mr Astbury. “The staff may use certain triggers in conversation - if someone mentions they have had a good weekend, that may be a way in to asking if they have thought seriously about how much they drink. If not, staff are trained to ask in a friendly way whether customers would be willing to complete a short questionnaire on alcohol.”

Those willing are invited into a private consultation room to complete a 10-question audit, from which a points total indicates whether they are at low risk, hazardous, harmful or dependent levels of drinking.

Questions include: “How often during the last year have you failed to do what was normally expected of you because of your drinking and have you had a feeling of guilt or remorse after drinking?” and “Have you or someone else been injured as a result of your drinking?”

Initially the questionnaires displayed the scores and what level of drinking the totals represented.

“But as we suspected, if people caught sight of those, it may have prompted them to adjust their answers accordingly,” admits Mr Astbury.

Now most audits do not reveal the meaning of the different totals.

Everyone is given a booklet with more information and asked whether they are willing to receive a telephone follow-up after eight and 52 weeks to determine whether people have acted on the advice and changed their drinking habits.

Those who reach a “harmful” or “dependent” score are asked whether they want to be referred to the appropriate team within Wirral PCT’s alcohol service.

Pharmacy setting

Although some people have refused to be referred, Mr Astbury says many have admitted they did not realise their drinking levels could be damaging their health. Builder Ray Allinson, 48, who uses Claughton Pharmacy regularly, felt at ease filling in the questionnaire.

“I was happy to complete the questionnaire and I preferred it in the pharmacy than if I had been asked by a doctor or nurse,” he says.

“I used to drink quite heavily a few years ago but now I hardly drink at all - although at Christmas and on special occasions I can still enjoy a few. I have spoken to a few people who have taken part and they all think it is a good idea. It just makes you think, realise what drinking can do to you.”

One important piece of advice, particularly to young drinkers, is that storing up the recommended number of units per week for a one-night “binge” can be particularly harmful.

Wirral PCT pharmaceutical adviser Tee Weinronk says: “Anecdotally, we know that many people get a bit of a shock when they learn how many units they drink regularly, but they do not feel ready to be referred.

“We know of one man whose score [indicated] a dependent drinker who refused a referral but later returned to the pharmacy and admitted he needed help.

“We are trying to target people who would probably not come into contact with other health services by using the unique link between people and pharmacy staff. They have a good rapport with patients, which enables them to get the message across.”

A spokesperson for current DH research into the most effective methods of alcohol screening and intervention says the Wirral initiative “is a positive step which has our backing”.

It is also in line with the changing role of pharmacies, from purely dispensing prescriptions to offering public health advice. Under the new community pharmacy contract they are required to run six health promotions each year, agreed by local PCTs.