Over the last 6 months, we have carried out qualitative research with members of the public to explore how they respond to questions asked on the online registration form. We discovered that some users only consider beer, wine or spirits as alcohol – or, at least, they don’t consider other alcoholic drinks worth reporting to their GP.

The National Institute for Health and Care Excellence (NICE) today issued draft quality standards that stress the importance of correctly gathering information on people's alcohol habits.

If registration forms aren't working, GP teams may not be getting accurate information about drinkers of alcopops, cocktails, mulled wine and other spirit-enhanced beverages, in particular. 

As one of the people we talked to said: ”I might have a shot of Baileys in a hot chocolate, but that’s not alcohol, right?”

A nightly drinker of hot chocolate with a single shot of Irish cream liqueur would actually earn a score of 4 on the Alcohol use disorders identification test consumption (AUDIT C). That’s still low risk if that is all that patient is consuming, but if people aren’t registering all types of alcohol, it could make a big difference to the overall picture.

There are other reasons patients can be reluctant to provide honest or accurate answers to questions about drinking and smoking, including religious, cultural, peer or family pressures. Some people are just wary of confronting themselves with how much they drink and smoke.

Our team within NHS Digital was tasked with improving the questions the NHS ask at the point of registration to make it easier to obtain accurate answers.

We’ve made questions more specific to help deal with the problem that some patients don’t think to report drinks containing alcohol or define alcohol as just beer, wine, or spirits.

We now ask, “How often do you drink alcohol or have a drink containing alcohol?”, and we include some examples in the supporting text.

We also found that counting units was a problem. To calculate an AUDIT C, GP teams need the quantity in units. But we know that patients struggle with what constitutes a ‘unit’. They better understand pints, bottles, cans and shots.

So, we presented the name, quantity, alcohol content and unit amount for a range of typical drinks in an easier to understand table. We also included the formula for calculating units, which is ‘quantity x alcohol content = units.

We found the question ‘Have you ever smoked’ improved the capture of current, former and occasional smokers. Some people who have never smoked said they were irritated by having to answer this question. While it needs to be asked of everyone, our improvement meant non-smokers could quickly exit this question set by selecting ‘No’ or ‘Prefer not to say'.

Similarly, the follow up ‘What best describes you?’ enables us to capture current smokers without the need for further questions.

Finally, capturing the date a smoker gave up means a patient can be given the right support early on to reduce the risk of re-starting.

As a result of the changes, GP practices get the information they need to provide better care and advice to patients. They can now calculate an AUDIT C score quickly and more accurately – and that puts them in a better position to help people at the point of registration. In addition, the work we’ve done to amend the smoking questions means data of a higher quality will be fed into the Quality and Outcomes Framework (QOF). The ultimate aim of the QOF is to improve standards of care by assessing and benchmarking the quality-of-care patients receive.

The new-look smoking questions went live earlier this month, with the alcohol questions set to follow in the next few weeks. They are just one example of how we are continually making improvements to Register with a GP surgery based on feedback from both the patients that use our service to submit registration requests and the practices that process them. We are now working with over 500 practices to refine the service and, to date, have received around 100,000 submissions using our new online service.

GP practices can find out more about the service and enrol via our dedicated resource hub.