‘Mystery shopping’ for IBA in Primary Care?

14 Aug

Chances are that if you sign up to a new GP practice any time soon you’ll be given the chance to answer some questions about your alcohol use. If you’re reading this, chances are you’ll also probably know more about IBA than the person asking you the questions, or following them up. This presents a unique opportunity to unofficially ‘mystery shop’ and see what’s really happening out there in practice. If it’s bad, coming clean and providing some feedback could make all the difference, as I’ve found out.

Primary Care is the key setting for IBA but there is evidently still a long way to go. At present, the updated national ‘DES’ scheme offers practices a £2.38 payment to deliver IBA to new registrations. However, there are undoubtedly a significant number of practices that are not fulfilling their duty to deliver at least feedback and relevant advice or information. In 2011 the excellent HAGA alcohol service produced DES guidance after identifing that in the local area 75% of practices were using incorrect screening questions, and only 50% of practices were offering face-to-face Brief Advice.

Although some responsibility for ensuring proper IBA delivery falls to both local commissioners and national policy makers to try to improve on the DES itself, surely the clearest responsibility is down to the practices themselves. Since partaking in the scheme is optional, practices should not sign up if they don’t feel they are able to properly deliver IBA.

At local commissioning level, I know it can be hard to engage many practices on issues that are a lower priority (or payment value). We also know amongst GPs attitudes, lack of training or concern about availability of treatment services can also be barriers. And nationally alcohol has to compete with many other areas if the DES is going to be superseded by a stronger system. Mystery shopping though presents a unique opportunity to bypass many such barriers to directly test IBA and improve delivery in the real world – albeit on a small scale.

A quick guide to IBA ‘mystery shopping’:

  1. If registering for a new GP and asked alcohol questions, score as ‘risky’ drinking
  2. If IBA is given well, either thank them for their time, or come clean and congratulate them on good IBA!
  3. If IBA is not given, ask to speak to the practice manager or equivalent and ask why this did not happen. Advise the practice of PHC alcohol framework, or that the local commissioner should also be able to arrange support/information around IBA delivery
  4. If IBA given poorly or inadequately, come clean and offer some brief pointers or suggestions for improvement or seeking further help or information, e.g. IBA e-learning or this blog!

The downside… as I understand, such information would be likely to go on your medical record which could affect say the price of private medical insurance. Perhaps best to come clean and ask they discount your answers!

Ethical practice?

Whilst I’ve certainly pondered the ethics of ‘mystery shopping’, pragmatically this is really about improving what may often be unacceptable IBA, or lack of. I personally find it extremely concerning if a practice is receiving payments to ‘identify’ risky drinkers and doing nothing when they do. And this does happen based on my own experience, and what local DES data often indicates.

I’ll soon post on my experiences of ‘IBA mystery shopping’ to demonstrate why I think this approach can be so valuable. Meanwhile I’ll be thinking further about whether it could be implemented by commissioners as effective quality assurance, and listening closely to any comments!

See here for the follow up post on IBA ‘mystery shopping’ experiences: the good, the bad and the…

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