NHS Grants for Drug Misusers - A Guide to GP Services

Transcription

1 THE AYRSHIRE MODEL Or The Milwall defence This is no treatment programme!! R.C.G.P. Guidance 1. Entitlement to health care Drug misusers are entitled to high quality NHS services just as anyone else is. GPs must provide general medical services and take into account the implications of the drug misuse in its widest sense when offering advice and treatment. 2. for drug misusers Effective services for drug misusers involve clinicians working together in primary care, secondary care or across both sectors; professionals must be appropriately competent, trained and supervised. Most areas have support agencies providing key worker services to misusers; it is becoming common for drug agency workers to see patients within the GP surgery, with the GP available to offer medical support and prescribing. TIMELINE Substitute Prescribing service starts Mid 90s approx 1000 people receiving a service Mid 90s 1 st meeting with GP subcommittee social not medical problem 18 months later 2 nd meeting agree medical component but entirely specialist service Service continues as specialist service only 1

2 TIMELINE priority groups introduced no other ingress gradually more rigorous enforcement 2009 Absolute bar on new methadone prescribing I I can confirm that the long term, often re- iterated over the last 20 to 30 years, opinion of the GP Subcommittee is that addiction services are part of secondary care. There is no obligation to carry out these services free of charge within general practice. They do not form part of the 2004 contract. G.P.Sub Comm Public Health concerns re Anthrax re- opens programme apparently unlimited but budget for drugs only P.D.U. PREVALENCE HEALTH BOARD A & A PDU # In Sub Px Prog Scotland - PDU 1.62 # P.D.U. PREVALENCE COUNCIL AREA East (1834) North (1808) South (1055) Scotland (55238) 2

3 Drug Injectors Health Board A & A 0.99 # Scotland 0.71 # Drug Injectors Council Area East (998) North (756) South (618) Scotland (23933) FUNDING ISSUES 1 3

4 FUNDING ISSUES 2 Apr 09 May 09 Jun 09 July 09 Total FUNDING ISSUES 3 GROSS DRUG COSTS 113, , , , ,297 Apr 09 May 09 Jun 09 July 09 Total DISP. COSTS 85,170 82, ,050 92, ,753 Apr 09 May 09 Jun 09 July 09 Total TOTAL 951,752 for 4 months SUPn. COSTS 25,611 24,296 31,765 28, ,402 FUNDING ISSUES 4 antipsychotic costs methadone costs Apr-08 27, Apr-08 81, May-08 27, May-08 71, Jun-08 27, Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 80, , , , , Jul-08 Aug-08 Sep-08 Oct-08 28, , , , Nov-08 76, Nov-08 28, Dec-08 54, Dec-08 21, Jan , Jan-09 40, Feb-09 73, Feb-09 28, Mar-09 74, Mar-09 28, , , , ,

5 APPENDIX 1 FUNCTIONAL MODEL FOR TREATMENT & REHAB ADDICTION SERVICES IN AYRSHIRE & ARRAN Pre Phase 1 Substance use Council on Throughcare Addiction impacti ng. Alcohol (ACA)* Not engaged with services Brief 1 ST Interventions/Self Phase NON-MEDICATION ONLY MEDICATION Help packs Harm Substitute Home & Community Turning Point - Reductio Prescribing In- Dual SEASTAR Prison DTTO n Team Patient Diagnosis 1 st Team Detox Phase Characterised ****** by: NAC Addiction Ayrshie Chaotic/Complex; Initiate Assessment Care Planning Substance Intensive Support Misuse Team Input from other Specialist Generic as required by Care Plan 2 nd Phase Characterised By: Stabilising/ Normalising; Take Forward & Enhance Turning NAC Point - Addictio SEASTAR n ACA Alcohol Relapse Managemen t Alcohol rehab programme Residenti al Dual Diagnosis Substance Misuse Team NHS Addiction Continued Joint working 3 rd Phase Characterised By: Moving On Reducing Specialist Support Turning Point South & East Addaction Community Alcohol Rehab - SMART Recovery Project - *ACA services in South, & East. In North via NHS funding only. Exit from Specialist Support A&A CHARACTERISTICS Totally specialist service Always insisted on psychosocial support as part of methadone contract Clinics run out of Voluntary and Local Authority agencies Large range of wraparound services Until Feb 2010 largest waiting list Substitute prescribing budget includes large number of psychotropics General Practice Issues Most practices refuse involvement with substitute prescribing A significant number refuse to prescribe psychotropics A significant number uneasy with pain relief issues Clients report major difficulty accessing care Some honourable exceptions 5

6 Scottish Drugs Forum study ½ Waiting list > 12 months ¼ Waiting list > 18 months 94% thought Methadone Px would help 2/3 poly drug use (Heroin/Methadone/Benzos Benzos) >50% increased drug use on W/L >50% worsening injecting practice >50% worsening criminality ½ had mental and physical health issues Scottish Drugs Forum study 2 ½ accessing CHAT < 1/10 accessing Primary Care Previous contact with prescribing evaluated positively G.P. says he doesn t t prescribe Methadone which puts me off asking about other stuff lioke a sore throat I I want them to listen to me. They don t t believe what I m I m telling them. They think we r all down and outs. I just want help before \I I lose my job and house Some disconcerted to hear advice like continue criminal activity from G.P.s 6