SMMGP
is increasingly concerned about reports of the
decommissioning of primary care based drug and alcohol treatment. Some seem to
be suggesting that treatment in primary care is incompatible with the 2010 Drug
Strategy’s aim for recovery. Following on from Steve Brinksman’s
Soapbox
article
(
DDN
, February, page 23) here are four important reasons why localities are putting
drug users, their families and their communities at risk if they do not involve
primary care based services in their treatment systems.
1. Primary care based drug treatment offers choice
The average day for a primary care clinician involves balancing risks and complexities,
which is why providing drug and alcohol treatment can seem like second nature,
given the right support. It has long been established that primary care provides
effective treatment, and many patients would rather visit their local medical practice
than the local drug team. Stigma, distance to travel, and familiarity all play a part.
That is not to say we do not need specialist services; for some patients the level
of expertise offered by secondary care is essential. The 2010 Drug Strategy
suggests that a ‘one size fits all’ model will not meet the needs of individuals, and
SMMGP agrees. The best system for patients is that of primary and secondary care
working together to provide a range of services from a range of settings, as it does
across other health problems.
Primary care based treatment has been characterised by some as a place where
people are ‘parked on methadone’ and as being ‘anti recovery’. This is not our
experience and over the next few months SMMGP will publish evidence of the
phenomenal success primary care based drug and alcohol services have in
supporting people to become free of all drugs, including methadone. However,
medically assisted recovery and stabilisation – recognised by the 2010 Drug
Strategy and the Professor John Strang’s interim report on recovery orientated drug
treatment as essential parts of the treatment system – remain important options
for patients, and primary care can offer this full range of treatment.
We find that when things don’t work as they should, it is because the right
structures and supports – needed for any multi-agency team – are not in place,
rather than some inherent problem with primary care treatment. These can usually
be fixed pretty easily.
‘Primary care based treatment has
been characterised by some as a place
where people are “parked on metha-
done” and as being “anti recovery”.
This is not our experience...’
Ignore primary care based drug and alcohol treatment
at your peril, says Kate Halliday
20 |
drinkanddrugsnews
| April 2012
Treatment|
Primary care
www.drinkanddrugsnews.com
Treatment hub
2. Primary care based drug and alcohol treatment will
help localities meet public health outcomes
People with drug and alcohol problems often experience poor health that goes
untreated. Drug and alcohol users who receive their treatment in primary care have
the advantage of also getting their general health needs met. The 2012 Public
Health Outcomes Framework includes the following domains: improving the wider
determinants of health; health improvement; health protection; and preventing
premature mortality. While all the indicators have yet to be defined, improvement
in the health of drug and alcohol users are included in the domains, and localities
will be monitored on their progress by Public Health England and given financial
incentives where they are achieving these indicators.
3. Primary care is the perfect setting for recovery
In his recent article (
DDN
, February, page 20) David Best suggested that a crucial
role of specialist services in providing a recovery oriented service was ‘that the
specialist service and its link to partner agencies such as housing and primary care
enable the person to grow well and safe enough to make recovery choices’. There is
no better way of achieving this than by placing services within primary care.
Primary care does not simply offer health interventions; it offers a multi-agency
service in people’s communities. The primary care team has often known the
person using drugs and/or alcohol for years, and also their families. GP surgeries
offer a range of services, from mental health to health visitor support – SMMGP is
aware of interpreter services, Citizens Advice Bureaux and a mobile dental van
being available from GP surgeries!
4. Involvement and commitment from primary care underpins
the future stability of drug and alcohol services
The commissioning landscape is changing, and public health and wellbeing boards
will be responsible for commissioning drug and alcohol services as of April 2013.
Clinical commissioning groups consisting of primary and secondary care doctors
will feed in to this process, and will become a powerful local force. As the
landscape changes, the need to address the burgeoning health problems related to
alcohol increases. The more primary care is involved in delivering drug and alcohol
treatment, the greater its understanding and commitment to the future of these
services will be.
Primary care can also feed important information into the commissioning process;
patients often do go to their GPs about drug problems. With the changing patterns of
drug use, including growing concerns about legal highs and addiction to medicines,
primary care involvement in commissioning will provide an understanding of,
together with solutions to, what is happening in local communities.
If commissioners feel that their primary care based drug and alcohol services are not
performing as well as they could, SMMGP can offer advice. Our experience is that it is
more effective to make changes to improve quality, rather than to go through the
upheaval of decommissioning services. Contact us at www.smmgp.org.uk
Kate Halliday is SMMGP policy and development manager