July/August 2015 |
drinkanddrugsnews
| 13
Read the full conference reports online:
From the Floor…
‘We’ve lost a really good shared care service – it’s
been taken away from us. We’ve lost everything
we’ve worked so bloody hard for…. Panel, you
need to listen to what we have to say as we’re
pissed off.’
GP, Sheffield
‘The commissioning process puts GPs at a
disadvantage. There are professional people doing
bids. GPs need to put together a spec that covers
all the points, including recovery.’
GP, Derbyshire
‘All this talk about an integrated future… GPs
don’t have a voice – how can they influence
decisions?’
GP, Hackney
‘Use your CCGs to raise this points. They have to
be raised at the top.’
Nuzhat Anjum
‘I wonder when people are going to stand up and
say the focus on completions is totally
unacceptable. It’s about time we stood up
together and said there are a lot better things to
concentrate on.’
Joss Bray, ‘ex-GP and troublemaker’
‘I’m a service user, I don’t give a shit who pays
your wages. I’ve been in shared care for ten years
– I wouldn’t be here if it wasn’t for shared care.’
Lee Collingham, Nottingham
‘The quality of commissioning is really patchy.
Responsibility is being devolved locally.’
GP, Suffolk
‘In the last five years things have gone into
reverse; 100 per cent of people with drug and
alcohol problems should be treated in primary
care with the right support… management of
drug users in primary care is rotting away.’
Dr Chris Ford, IDHDP
‘SMMGP is looking more at integration. We need
closer integration with addiction psychiatry and
are looking at building links with third sector
organisations. We’ve not integrated as well as we
could have done.’
Kate Halliday, SMMGP
T
he theme of this year’s RCGP conference on drugs and alcohol – now in
its 20th year – was ‘the integrated future of primary care’. But what does
this mean against a backdrop of widespread cuts and recommissioning,
that in some areas means a reduction in shared care?
Dr Stephen Willott chaired a panel that aimed to bring different
perspectives and open a debate with the audience, many of whom were GPs
with a special interest in drugs and alcohol.
Opening discussion, Willott set the scene, describing a political situation
where ‘tackling things for people who use drugs seems even less important.’
Welfare reforms were ‘one of the most worrying negatives’, he said, adding
‘A number of my patients are on sanctions, their benefits on ice.’
Jim Barnard of Inclusion Drug and Alcohol Services had worked for many
years in shared care. He worried that the focus on completions threatened
the capacity for building recovery capital, and lost perspective of the family.
‘Primary care has such involvement with families and service users –
there are so many opportunities to get better outcomes,’ he said. ‘We’re
facing a non-unified and disjointed system.’
Professor Oscar D’Agnone, medical director of CRI, said that in every
country he had worked, drug treatment was political, but emphasised that
‘the focus should be the individual person’. This was a challenge, with shared
care models differing according to local areas and commissioners’ views, but
he said that most patients should be treated in general practice with
services supporting GPs in dealing with the many complex issues around
alcohol and drug use and mental health.
Nuzhat Anjum, head of strategic commissioning at Waltham Forest
Clinical Commissioning Group (CCG) also acknowledged that these were
difficult times, ‘and going to become harder’. But she brought a strong
message on the need to work together to break barriers.
‘The worst thing a commissioner can do is ignore primary care,’ she said,
while urging clinical colleagues to use their voice as ‘part of decision-
making’. CCGs had a £63.4bn budget, she pointed out, with wellbeing boards
having a senior position for a GP. ‘How do we use that?’ she asked the
audience, adding ‘It is our responsibility to support each other, bringing
together GPs, practice managers, helping each other. It’s not just about
targets being met but about service users being happy. It’s an opportunity.’
Pharmacy services were another ‘really positive story’, giving scope for
much wider services.
Acknowledging that money was tight, she highlighted a ‘real opportunity’
for joint bids with the third sector, and asked ‘are we exploring those areas?’
‘My suggestion is that primary care, GPs, commissioners and public
health need to work much more closely together, minimising exclusions,’ she
said. ‘If we do it together we can break it together.’
Sunny Dhadley brought a perspective from Wolverhampton Service User
Involvement Team (SUIT), saying ‘It is our responsibility to help those that
are vulnerable in our midst… there’s a lot more that can be done in terms of
a joint approach.’
Targets didn’t necessarily make sense for every individual, with a holistic
approach needed. But each service user had the capacity to unlock potential
that could be ‘really cost effective’.
Dhadley reminded the audience that individuals had many complex
needs – ‘we can’t expect people to be job-ready if there are other areas of
their lives they need to address’ and asked, ‘are we providing things that’ll
help people to be fulfilled?’
‘We hear the word holistic all the time,’ he added. ‘But if there are GPs
who find this area of work challenging they shouldn’t be working with drug
and alcohol users at all.’
After taking comments from the floor (one of which was a suggestion to
produce a conference ‘mission statement’) Willott summed up the key
themes, acknowledging the many concerns around erosion of shared care in
many areas of the country and emphasising the need to reintegrate care
properly.
‘We all have a responsibility to attack commissioning that’s going on and
make sure it represents the most vulnerable,’ he said. ‘The message from
this conference is that we can’t do it alone, but we can achieve it together.’
