Rapid Access Protocol Bradford and Airedale Drug Services

Transcription

1 Rapid Access Protocol Bradford and Airedale Drug Services Responsible Head Of Service: Name of responsible committee: Name of Author: Contact for further details: Simon Long Professional Advisory Sub Committee Liz Barrett Version:.0 Supersedes: N/A Date Approved: 4/0/20 Review due: 4/0/204 Key words: Document type: Rapid, access, prescribing, drug treatment, prison release Protocol If you are using a printed copy of this document please be aware that it may not be the latest version. To view the latest version visit nww.bradford.nhs.uk/extranet/policies/pages/default.aspx NOTE: All policies remain valid until notification of an amended policy is placed on the intranet.

2 Protocol for Bradford & Airedale Rapid Access Prescribing. Introduction The aim of the rapid access sessions is to provide a rapid planned access system into treatment for those who fall outside the currently set up referral pathways in Bradford & Airedale drug treatment systems. It will be used as an emergency resource only. Referrers will need to have tried existing referral routes wherever possible prior to making a referral. This documentation has been devised utilising guidance from the National Treatment Agency (NTA). The service has been working in pilot form to date and has been widely consulted within BACHS drugs services and partner organisations in the criminal justice, secondary care and third sector. 2. Key Documents Department of Health (England) and the devolved administrations (2007). Drug Misuse and Dependence: UK Guidelines on Clinical Management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive National Treatment Agency (2006a). Models of Care for Treatment of Adult Drug Misusers: Update London: NTA National Treatment Agency (2006) Care Planning Practice Guide, London: NTA National Treatment Agency (2005). Retaining Clients in Drug Treatment. London: NTA 3. Scope 3. This policy only addresses the clinical management of those meeting the referral criteria, and does not supersede current referral procedures into treatment agencies. The process will only work if the pathway is adhered to as shown in appendix. All referrals into this service will be through the Rapid Access worker who will act as the Case Manager for this group of clients, from referral into the rapid access service to on ward transfer to the appropriate prescribing agencies. Good communication with the prescribing practitioner and criminal justice workers/prisons is critical to ensure the process runs smoothly. 3.2 The management of the client aims to provide some flexibility with regards to prison releases, and accepts that clients recently released from prison may have multiple needs that require addressing (e.g. urgent housing/financial needs). Therefore if a client needs to rearrange a rapid access appointment with good reason then attempts should be made to offer an alternative wherever possible. Page 2 of 5

3 4. Definitions Treatment Agencies treatment agencies are recognised as Tier 3 (NTA, 2006a) treatment agencies who are skilled in the holistic care and opiate replacement prescribing services and are commissioned to Tier 3 service provision by NTA commissioners. 5. Roles and Responsibilities Day to day operational mangement of the Policy will be under the remit of the Rapid Access Worker who will be supervised by the Service Team Leader. Prescribing responsibility, accountablity and clinical decision making is part of the General Practitioner with Special Interest (GpwSI) role. Commissioning of the service is part of the function of the NTA commissioners employed by NHS Bradford. 6. Referral criteria: 6. The service is open to clients who have been released at short notice from custody, either directly from prison or via court or the police cells, with no means of continuation of their medication through their usual prescriber. 6.2 Notice has been given that a client may be released from custody following a court appearance on a certain day. Please note that only provisional assessment appointments may be made in this instance, and a doctors appointment should not be booked until it is confirmed that the client will be released from court If a client is due to be released from prison on a planned date and their usual prescriber is unable to provide an appointment, an assessment appointment may be be booked in advance if both following actions are applicable a/ The prison have been approached for a bridging script and have refused b/ The release date is with 3 working days. 6.4 Treatment naïve opiate users- those who have limited/no experience of treatment. This may include referrals from Drug Intervention Programme (DIP) Arrest Referral. 6.5 Sex workers not currently in treatment whose lifestyle requires urgent appointment. 6.6 Referrals where the individual has compromising health issues and normal referral routes are unavailable. This includes clients released from hospital, and pregnant users. 6.7 Individuals who have had to urgently move into a different area, for example either due to fleeing domestic violence or being under witness protection. 7. Exclusion Criteria: 7. The client is deemed suitable by discharge process to fit into DIP treatment plan, i.e. advanced notice of appointment requirement. Page 3 of 5

4 7.2 No paperwork to confirm medications currently taking in prison or a risk assessment highhlighting any risk to the client, staff, clinic population or the general public. 7.3 Clients who have not attended (DNA) for two previous appointment through their own choosing. 8. Prescribing Requirements 8. Continuation of prescribing for unexpected prison releases will only be possible if there is accurate documentation from the prison service evidencing the medication prescribed. This must include the dose and date of the last dose of medication received by the patient. This must be sent by the prison healthcare team before the client attends the rapid access clinic. The doctor will not be able to continue a prescription if the only information available is given by the patient/via telephone. If there is no paperwork from the prison available the appointment will have to be deferred until such time as this becomes available 9. Training and Competency 9. The Rapid Access Worker will be a band 5 or 6 Substance Misuse Practitioner who has the competencies to assess, evaluate and record the assessment procedure accurately, and must be fully conversant with the Rapid Access Policy. 9.2 The prescriber must be a GPwSI / clinician who has undertaken the accreditation process as a substance misuse practitioner at level 2 (RCGP) or a medical practitioner working at this level. 0. Monitoring 0. The Rapid Access Drugs Worker will provide monitoring data regarding the process, and highlight any issues in the provision of the service (appendix2).. Data Collection City SMS. Data collection (NDTMS) for those who are seen in City Substance Misuse Service (SMS) will be registered to the service in the normal manner and will then be transferred to the appropriate agency as a transfer in modality (this will be logged as a successful outcome). 2. Data Collection via the Fountains Hall Medical Practice 2. If the client is to be seen by Fountains Hall Medical Practice GP s and they are not already registered as a patient at that practice, they will need to be registered as an immediately necessary for care patient within the practice to facilitate safer prescribing and contemporaneous record of actions on Systmone. This will be shared with the client s surgery and consecutive treatment agency. It will be the Rapid Access Worker s Page 4 of 5

5 role to facilitate registration with the GP practice, initial assessment and arrange onward transfer into and from the practice. 3. Time Scales 3. The service will aim to provide an assessment appointment time within 2 hours of an appropriate referral being accepted. The appointment will follow at a time that is convenient for service user and service provider. Where referrals are made before 3pm, every effort should be made to provide an assessment that day, failing which the assessment should take place before 2pm the following day. In all cases, if treatment is deemed appropriate, this should be started at the point of assessment. Wherever possible, a follow-on appointment for the client s transfer to their appropriate service should be available at assessment. 3.2 Appointments will take place during the normal working hours of the host service- City Substance Misuse Services. The service will be contactable 9am- 5pm Monday-Friday. 3.3 There is a requirement that referrals to this service will be monitored closely to ensure that the referral requirement is genuine, and that the referral agency has used the locally agreed referral pathways without success prior to referring to the Rapid Access Service. 3.4 As soon as a referrer is aware that a prescription may be required for a court/prison release they should advise rapid access as soon as possible- if possible days in advance. If contact is made any later than 3pm this will reduce the availability of a prescription on that day. Protocol Additional Information 4. Rapid access clinic / worker guidance 4. Rapid access IS NOT intended to overlap any current service provision. It is not intended to cover gaps in GP/worker provision at other services. Rapid access referrals should be assessed only by the appointed rapid access worker or SMS staff standing in for them. 4.2 If staff at partner agencies is unsure whether a referral qualifies as rapid access then they should contact the named rapid access worker, or City SMS team leader to discuss. 5. Taking referrals Rapid Access Worker Responsibility 5.. Referrals should be made by via the rapid access mobile phone number. If a referral query is made through SMS reception then reception staff should advise they contact the rapid access mobile number The rapid access mobile no is: Page 5 of 5

6 5.3. When responsible for the rapid access mobile phone staff should: Have the phone switched on from 9am -5pm Aim to answer any missed calls within hr 5.4. When the Rapid Access Worker is unavailable to respond to calls through the rapid access phone then the phone should be passed to another member of staff at City SMS. It is the City SMS team leader responsibility to ensure holiday and sickness cover is provided. 6 Procedure from taking referral 6.. When a rapid access referral is taken, an appointment as agreed in the SLA (see time scales) Practitioners with Special Interest who have clinics at City SMS should only be consulted about prescribing for rapid access clients if all avenues have been explored, and where possible this should be discussed with the team leader beforehand Appointments offered should consist of hr with a drugs worker and 0.5 hr with a GP. The referrer should be asked to inform the client of how long the appointments will take. The named rapid access worker will need to arrange both appointments. Appointments will usually be either at SMS or in Fountains Hall Medical Practice It is a requirement that the criminal justice worker attends with the client Details taken from referrer at point of referral should include: Full name, D.O.B., address, GP, who their usual prescriber is and when they can offer an appointment. DIP or Drug Rehabilitation Requirement (DRR) should forward copies of any information they have, including confirmation of last medication given in prison. Details should also be provide if the client has any special requirements. Mobility Problems Language difficulties if English not first language Other disablity (visual, deafness) Arrangements to address any of the above issuse must be in place to allow equal access to this service. Note: A prescription will not be able to be given to the clients unless written confirmation of their medication. 7. Assessment: 7.. Telephone contact with client s GP should be made prior to appointment to advise them of the requirement for treatment, and check whether they are currently prescribing any medication to avoid any duplicate prescribing. If the client is to be seen Page 6 of 5

7 at Fountains Medical Practice and they are not already registered there, then they will need to register there as an immediately necessary patient prior to their assessment. It is an expectation that the clinical justice worker will attend with the client at all appointments. 7.2 At assessment a urine sample will be taken, and the drugs worker will complete a Triage form (including risk assessment) a Treatment Outcome Profle and collect any data that is required Nation Drug Treatment Monitoring System (NDTMS) with the client. Information should be entered onto SystmOne as usual in a new assessment. Appropriate consent forms should completed The follow-up appointment with the clients usual prescriber should be confirmed, and details given to the criminal justice worker and the client Assessment and referral details are to be provided to the clinician prior to seeing the client. If the client is to be seen by a GP at Fountains Hall Medical Practice, then the rapid access worker will provide blue prescriptions for methadone/buprenorphine scripts to the service. Any prescriptions used should have the prescription numbers noted on the rapid access database. 8. Following assessment: 8.. Triage, TOPs and NDTMS data to be faxed to usual prescriber to facilitate transfer of care if the clients is not to remain in treatment at City SMS. Confirmation of safe receipt should be by phone Update Rapid Access database with monitoring information and ensure SystmOne reecord keeping is complete. 8.3 If applicable, once transfer of care has been completed client should be closed as City SMS client if moving to another service. 9. Review of Protocol This is a working document which should be reviewed at the demand of service change or yearly review at clinical governance meeting. Reference: National Treatment Agency (2006a). Models of Care for Treatment of Adult Drug Misusers: Update London: NTA Page 7 of 5

8 Appendix Referral pathway Referrer made aware of prison release/potential release (if potential release appointment will not be made until release is confirmed) Call to Integrated Drugs Worker City SMS ( ) Relevant paperwork sent (including confirmation of medication) Appointment Given for Triage and Clinical Assessment (To include urine test) If necessary client to register as immediately necessary patient with Fountains Hall Medical Practice Assessment -outcome of clinical assessment to inform potential prescription Case management of individual needs (housing etc) Referral to GP if has primary care needs/mental health problems Consultation and actions on Systmone case notes Consultation with GP-if appropriate prescription provided. Referral onto appropriate agency and discharge complete data collection. Page 8 of 5

9 DATA COLLECTION APPENDIX 2 Criminal Justice Time from request to acceptance on rapid access < 2 hours 2 4 hours Next day Rapid Access Drugs Worker Time from prison release to request for appointment Inappropriate Referral Required Prescription Advanced warning Same day Next Day State circumstance es No es No Length of Time into Treatment Agency working days Refusal to access referral es No Non compliance from client es No Criminal Justice Worker Attended es/ No reason Page 9 of 5

10 EQUALIT IMPACT ASSESSMENT APPENDIX 3 Stage One: Screening of a policy, procedure, tender or strategy. Name of policy, procedure, tender or strategy. Is it a policy, strategy, procedure or practice? Protocol for Rapid Prescribing for Bradford and Airedale Drugs Services Protocol 2. Who has been consulted? Governance Planning Group Clinical Governance Steering Group Workforce Commissioners 3. Main aims The aim of the protocol is to provide a framework for a shared working agreement between the criminal justice system and drug treatment agencies to provide rapid assess into prescribing on release from a custodial sentence or bail. It is also to allow for more vulnerable clients i.e. pregnant women, hospital discharges to gain access to treatment in a proactive, prompt and recordable manner. 4. How has the policy been explained to those most likely to be affected? The system will be explained to the service users on a required to know basis, However once the protocol has been ratified it will be taken to the Service User Forum for information. In the pilot phase the rapid access requirement was discussed at groups where there is service user representation. Page 0 of 5

11 Collecting and collating existing information and data Age Disability Gender Race Equality target group Older people oung people Children Early years Sensory disabilities Physical disabilities Learning disabilities Mental health Men Women Transgender Minority ethnic communities Gypsies and Please indicate in the table below whether the policy, strategy, procedure or tender has the potential to impact adversely on the equality target groups. Is the policy likely to have a potential differential impact with regards to the equality target group listed? 0 = no = little 2 = medium 3 = high 0 Not appropriate Page of 5 2. How have you arrived at the conclusions in box? i. Who have you consulted? (appropriate individuals/groups internally and externally) ii. What have they said? iii. What information/data have you interrogated? (library search, complaints data, PALS, research reports, local studies, advice from internal and external specialists) iv. Where are the gaps in your analysis? v. How will your paper promote the equality duties if they apply? Statistics show that people with sensory and physical disability make up a very small proportion of the drug using population; this is also reflected in the referral to the service to date from the prison population. Plans need to be in place to address needs and this fundamental in the protocol. In clients with learning disabilities and mental health issues the early assessment will allow for identification of need for early referral onto specialist services. Men are the highest gender group accessing this service and are most at risk of drug overdose and risky behaviour, early assessment and prescription will reduce risk. City SMS already has in place a robust clinical system which recognises requirements dependent on race or ethnic origin. However early interventions should aid resettlement in their

12 Religion or belief Sexual orientation travellers Christian Muslim Hindu Buddhist Sikh Jew Other Lesbian Gay men Bisexual communities if that is the client choice. 0 Whilst the service recognises the spiritual requirements of all clients it is ran on a non denominational ethos, however becoming more involved with religious bodies may be part of the resettlement process so early treatment will aid this. A specific need around sexual orientation is part of the assessment process and will become of the holistic assessment of any needs the client may have. Summary Is a more full equality impact assessment required? The service has undertaken a full equality impact assessment Please describe the main points arising from the initial screening here that support your decision Policy lead conducting impact assessment: Liz Barrett Approved by (member of the equality and diversity team): Lynne Carter Date: Page 2 of 5

13 PROCEDURAL DOCUMENT CHECKLIST APPENDIX 4 To be completed by the document sponsor prior to submission to the relevant committee for approval. Title of document: Rapid Access Prescribing Bradford and Airedale Drug Services To be submitted to which committee? Professional Advisory Sub committee Title es/no Is the title clear and unambiguous? Is it clear whether the document is a guideline, policy, protocol or care pathway? Introduction Is the purpose of the document clearly stated? Is sufficient information given to place the document in context? Scope Is the target population clear and unambiguous? Page 3 of 5 Comments Have any key limitations of the scope been made clear? Inclusion and exclusion criteria 4. Key roles and responsibilities 5. Are key roles and responsibilities clear and unambiguous? Format and style Does the document comply with the standard format presented in the policy on the development and

14 management of procedural documents? es/no Comments Does the document comply with the style guide? Is the document in plain English? Are abbreviations appropriate and have they been explained? Has the document been spell checked? Has the document been proof read? Content Does the document present information in a clear and logical manner? Are the requirements of the document reasonable and achievable? (e.g. training and competency, equipment, staff capacity) Evidence Base Have key sources of information been checked? NTA website Has relevant evidence been appraised and used appropriately? Are key sources referenced? Equality impact assessment Has the equality impact assessment been completed, signed by a member of the equality and diversity team and attached as an appendix? Consultation Page 4 of 5 N undergoing Has sufficient consultation been undertaken? Widely consulted 0. Implementation and monitoring

15 . Further comments: Is it reasonable to expect immediate implementation of this document? Are the stated monitoring arrangements reasonable and achievable? Development and consultation Is a summary of the document s development and consultation processes attached as the final appendix? Were there any particularly contentious issues to be managed during this process? If yes, how were they resolved or do they remain contentious? es/no N In introduction Comments Difficulties with getting paperwork from prisons, onward work being undertaken outside the scope of this protocol to resolve this. This document was checked by document sponsor: Name: Liz Barrett Title: Clinical Lead Date: 7//20 Page 5 of 5