Peterborough Adult Drug Treatment Care Pathways

Transcription

1 Peterborough Adult Drug Treatment Care Pathways Drug Treatment System Pathways.indd 1 31/07/ :52

2 Contents Page Introduction to Drug Treatment Care Pathways 1 Common Referral Pathway 4 Drug Rehabilitation Requirement 5 Specialist Prescribing 7 Shared Care Prescribing 9 Treatment Pathway 11 Inpatient Drug Treatment 13 Residential Rehabilitation 15 Targeted Testing Pathway 17 Young Person s Substance Misuse Pathway 19 Service aims and outcomes for children and families 21 Peterborough contact details for drug & alcohol services 22 Bordering counties contact details for drug and alcohol services 23 Pharmacies offering needle exchange services Drug Treatment System Pathways.indd 2 31/07/ :52

3 Introduction to Drug Treatment Care Pathways This guide acts as an information resource for professionals, service users and potential service users to describe: How elements of the local adult drug treatment system link together How different treatment interventions are delivered How particular client groups are supported and case managed Aspire; the local adult drug treatment service, defines adult as anyone 18 years of age or above. Services are open to residents of Peterborough. Ensuring all practitioners are aware of pathways enables them to support service users, making informed choices about their treatment and to promote flexibility in terms of service users moving through the treatment system in line with identified goals and changing needs. Pathways This document comprises of three groups of pathways: System pathways give a top-level overview of the treatment system Aspire Treatment pathways describe the anticipated course of a specific intervention Specific service user care pathways describe how treatment case management for a discrete group of service users with specific needs will be delivered locally The pathways take the form of diagrammatic representations of the expected course of treatment for a service user along with some descriptive text. They do not necessarily describe a person s entire treatment journey but will cover the key steps. The advantages of clearly describing pathways are: Service users often have complex needs and access multiple services or interventions. Pathways support effective coordination of multiple interventions They ensure consistency and parity of approach They reinforce the central role that service users play in planning and reviewing their own treatment Drug Treatment System Pathways.indd 1 31/07/ :52

4 Local specialist drug intervention provision Aspire This service offers: A rapid access for criminal justice drug interventions Referrals to other services Recovery worker support Advice and information Service user involvement Activities Mutual aid Peer Mentor support Parent and Carer support Harm reduction services Hepatitis B vaccination Hepatitis C screening Housing support Prison in-reach Aspire will link in with the prison drug treatment services to ensure treatment continues going into prison and on release Targeted Testing and required assessments - for people arrested for certain offences Restrictions On Bail Assessments - where a court gives bail to someone with the requirement that they go to a drug service for an assessment A brief stimulant intervention service Specialist needle exchange Drug Rehabilitation Requirement (DRR) programme for people sentenced to a DRR by the courts Prescribed, medical treatment either through Aspire or in partnership with a Shared Care GP A service user may access more than one intervention type at a time, or one after another depending on their needs. Before drug treatment commences services will ensure: There is a full assessment or review of the service user s needs A written care plan is agreed with the service user A named recovery worker who will provide key worker and case management support is allocated Pharmacies A number of local pharmacies offer the following drug services: Needle exchange and harm reduction services Advice and information Dispensing substitute medication and supervised consumption. General Practitioners There are a number of GPs in Peterborough who are involved in the delivering of prescribed treatment to drug users. Shared Care GPs work with Aspire to deliver the Shared Care prescribing service. GP Shared Care is a partnership between specialist drug treatment services and general practitioners which aims to provide treatment in the most appropriate setting for individual service users Drug Treatment System Pathways.indd 2 31/07/ :52

5 Other services Other services are available to people in treatment with Aspire and who meet the relevant eligibility criteria. These are: Inpatient Drug Treatment detoxification and / or stabilisation in a local hospital ward Residential Rehabilitation intensive treatment, usually for around 12 weeks, with accommodation at the unit. Placements are outside of Peterborough. Linking in to the wider system Drug services offer specialist services to drug users. The focus is on reducing the harm caused by drug use and supporting drug users in reducing their use or stopping completely. However, service user needs will inevitably be wider than this and can be addressed by a specialist service. Recovery workers will be responsible, in discussion with the service user, for ensuring referrals to other appropriate services are made. The exception to this will be if overall case management for a service user rests with another service. In this case the recovery worker will be responsible for coordinating the service user s drug treatment alone. Case management All service users should have a single, named recovery worker or case manager within Aspire who is responsible for supporting the service user throughout the treatment episode and reviewing care plans with the service user. There are a number of elements to case management: Assessment carrying out comprehensive and ongoing assessment of the service user s needs and any risk issues Care planning developing and reviewing care plans in partnership with the service user and with other service providers as agreed. This includes, where appropriate, the development and regular review of risk management plans Coordination ensuring all other providers, as agreed with the service user, are informed of current plans, changing need and progress against goals and milestones Further information and guidance in relation to care planning and / or case management there is available from the National Treatment Agency (NTA). Visit All treatment interventions that have been agreed the service user will be accessing, must be recorded on the service user s care plan. In some circumstances the service user s overall care will be coordinated externally by an agency with a requirement to do so. For example, Offender Managers for service users with a DRR order or the named healthcare coordinator for service users under Care Planning Arrangements. In these cases the substance misuse case manager will input to the overarching care plan in terms of substance misuse related issues and interventions. Overall case management responsibilities will remain with the external care coordinator Drug Treatment System Pathways.indd 3 31/07/ :52

6 Common Referral Pathway The general referral route to treatment services and the generic starting point for interventions will basically be the same for all specialist drug treatment. The basic process is as follows. Adult drug user requests support to reduce drug related harm, reduce drug use or to abstain from drug use Referrals by telephone, correspondence or in person Referral to services. Either: Self-referral/Open access Referral by a professional with the service user s consent Initial assessment to identify presenting issues, priority needs and to provide information and advice about treatment options Referral to other support services as required and agreed Risk assessment and management where required Structured treatment requested: Comprehensive assessment Identification of other involved professionals Identification of treatment related needs Development and agreement of care plan identifying treatment interventions, goals and milestones and the review date. Discharge and aftercare plans to be included as appropriate Treatment commences Drug Treatment System Pathways.indd 4 31/07/ :52

7 Drug Rehabilitation Requirement (DRR) Adult drug user is referred to Aspire through the Probation Service recovery worker and service user will complete a DRR assessment, which will go to court No to DRR Order, could engage with Aspire voluntarily Yes to DRR- 6, 9 or 12months Service user is seen by the recovery worker within 24 hours and they will have an induction, with an assessment and commence prescribing. Care Plan is created with requirements of the DRR which consists of drug tests, one to one sessions with the recovery worker and activity involvement. Service user has a review once a week with the recovery worker until the DRR has completed If the service user misses an appointment they will be issued with a warning letter to attend probation with a valid reason for non-attendance Service user continues with treatment post DRR, structured or non-structured Service user successfully completes treatment If the service use continues to fail to attend this will be classed as a breach and the service user will have to appear at court. If the service user fails to attend court a warrant will be issued Drug Treatment System Pathways.indd 5 31/07/ :52

8 Service description A service user attends Aspire as part of a DRR (Drug Rehabilitation Requirement) order which will allow them to access treatment through the DRR prescribing service in line with their DRR attendance requirements for one to one sessions and activities weekly. Programme outcomes Reducing the number of days a service users uses illicit drugs Improving a service user s physical and psychological health Increasing a service user s quality of life Reducing the number of days a service user commits a crime Reducing the number of crimes a service user commits Client group and exclusions The target client group is adult drug users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 6 31/07/ :52

9 Specialist Prescribing Service user and recovery worker agree prescribed medication would be helpful and appropriate as part of assessment and /or review If service user is pregnant, it will be confirmed through a pregnancy test, and the service user will be referred to the neo-natal midwife who will oversee the prescribing and become the service users recovery worker for up to 1 year post natal. Clinical assessment carried out at Aspire prescribing clinic with a specialist doctor medical treatment that best meets their needs is identified and agreed. Max 10 days between assessment and doctor s appointment Prescribing intervention not appropriate at this time Clinical assessment includes drug testing to confirm dependency / regular use Prescribing treatment started: specific medication dependent on service user needs, identified goals and clinical considerations Treatment regime in line with evidence base for effective treatment, best practice guidance and clinical guidelines Opiate dependent (heroin, methadone etc): Titration and review at one week Methadone stabilisation and maintenance Methadone reduction programme Methadone detoxification Subutex detoxification and maintenance Naltrexone relapse prevention treatment Alcohol detoxification: Referral to Drinksense Benzodiazepine detoxification: Managed through Aspire, Shared Care service Treatment review with recovery worker and at prescribing clinics with specialist doctor /nurse carried out on a regular basis Shared Care considered if appropriate. Treatment completed successfully. Other needs identified, referral to other service Further treatment /treatment continuation agreed between recovery worker, doctor and service user Treatment completed successfully. Exit Drug Treatment System Pathways.indd 7 31/07/ :52

10 Service description Specialist prescribing is community prescribing delivered by a specialist drug service (Aspire) including specialist doctors. Treatment offered includes medication that can substitute for heroin, other opiates and medication to help people abstain from heroin. Service outcomes Achieve abstinence from drug use where appropriate Reducing the number of days a service user uses illicit drugs Reducing the number of days a service user injects Increasing a service user s physical and psychological health Increasing a service user s quality of life Reducing the number of days a service user commits a crime Reducing the number of crimes a service user commits Specialist ante-natal support, care coordination and case management for pregnant drug users. Service outcomes Minimise risk to the unborn child Minimise risk to the pregnant woman Support positive substance misuse treatment outcomes as identified and reviewed through the Treatment Outcome Profile system Client group and exclusions The target client group is adult drug users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 8 31/07/ :52

11 Shared Care Prescribing Existing service user and recovery worker agree prescribed medication would be helpful and appropriate as part of assessment and /or review Recovery worker contacts Shared Care GP to explore the possibility of GP led substance misuse prescribing A GP can also refer a client to Aspire and start Shared Care Shared Care GP agrees to support substance misuse prescribing treatment: Opiate (heroin, methadone etc): Methadone stabilisation and maintenance Methadone detoxification Subutex detoxification and maintenance Naltrexone relapse prevention treatment Benzodiazepine (Valium, Temazepam, Nitrazepam etc): Benzodiazepine detoxification Treatment regime in line with evidence base and clinical guidelines Regular reviews between service user, recovery worker and GP at least every 12 weeks initially Treatment completed successfully. Other needs identified, referral to other service Further treatment /treatment continuation agreed between recovery worker, doctor and service user Treatment completed successfully. Exit Drug Treatment System Pathways.indd 9 31/07/ :52

12 Service description Shared Care prescribing is community prescribing delivered by a GP with support from Aspire (a specialist drug service). Treatment offered includes medication that can substitute for heroin and other opiates, medication to detox from benzodiazepines (Valium, Temazepam, Nitrazepam etc) and medication to help people abstain from heroin. Service outcomes Reducing the number of days a service user uses illicit drugs Reducing the number of days a service user injects Increasing a service user s physical and psychological health Increasing a service user s quality of life Reducing the number of days a service user commits a crime Reducing the number of crimes a service user commits Client group and exclusions The target client group is adult drug users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 10 31/07/ :52

13 Treatment Pathways Service user and recovery worker identify at initial assessment that regular support would be helpful Service user requires support while waiting for additional structured treatment to start e.g. waiting for GP Shared Care prescribing appointment Recovery worker and service user agree appointments plan of work recorded on service user s care plan Range of support will include regular therapeutic appointments with the recovery worker. The service user would also have access to: Alternative therapies Harm reduction work General support with related issues e.g. finances, healthy lifestyle, relationships Support with issues as identified between service user and their recovery worker Attending group activities Structured group work, FOR (Foundations of Recovery) Peer Mentor support Mutual aid Counselling Family and carer support Stimulant support Life skills i.e. Cooking Social i.e. Breakfast club Referral on to other services if more in depth, specialised support is required e.g. to Peterborough Citizen s Advice Bureau for debt counselling, Relate for relationship counselling, JCP, Housing etc. Regular review of care plan with recovery worker every 12 weeks or as and when needed. Treatment completed successfully. Exit Continue with post treatment recovery support and aftercare via regular reviews Drug Treatment System Pathways.indd 11 31/07/ :52

14 Service description A care planned package of support that includes regular one-to-one sessions with the recovery worker. This includes a range of structured and non-structured activities. A service user can build up a personal timetable based on what will help. Service outcomes As identified in the service user s care plan and in line with standard treatment outcome measures Client group and exclusions The target client group is adult drug users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 12 31/07/ :52

15 Inpatient Drug Treatment - detoxification Service user and recovery worker identify that inpatient treatment may be an appropriate treatment option Alcohol detox managed by Drinksense clinical staff Management of inpatient access by clinical staff member linking with the service user s recovery worker Inpatient treatment plan identified and agreed between service user, recovery worker and clinical lead Preparatory work: may include community based reduction of drug use prior to admission Local inpatient treatment at a local hospital Treatment programme agreed: length and nature of treatment dependent on clinical criteria Out of area treatment at a residential detox / stabilisation unit prior to entering a rehab Treatment delivered at a local hospital (Cavell Centre), clinical lead liaises with ward staff Direct transfer to rehab coordinated by recovery worker Rehab placement (see residential rehabilitation care pathway) ongoing case review with local case manager Inpatient treatment completed: discharge back to community services Community-based treatment and aftercare as agreed with recovery worker. Usually to include relapse prevention Drug Treatment System Pathways.indd 13 31/07/ :52

16 Service description Drug treatment provided in an inpatient setting delivered in line with DoH Clinical Guidelines and NICE guidance. Treatment may include: Medically supervised assessment Stabilisation on substitute medication Detoxification / assisted withdrawal from opiates and alcohol or brief respite interventions Emergency care for drug users in drug-related crisis Service outcomes Reducing the number of days a service user uses illicit drugs Reducing the number of days a service user injects Increasing a service user s physical and psychological health Increasing a service user s quality of life Reducing the number of days a service user commits a crime Reducing the number of crimes a service user commits Client group and exclusions The target client group is adult drug users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 14 31/07/ :52

17 Residential Rehabilitation Rehab identified as a treatment option by service user and recovery worker Recovery worker and service user undertake rehab assessment Service users does not meet local criteria for rehab community interventions continued as agreed Recovery worker and line manager discuss and agree that rehab is an appropriate option and identify possible placement Recovery worker and service user visit rehab, arrange to undergo the rehab s assessment/ admission process, report progress to the Rehab Panel Funding not available in current year: Recovery worker discusses and agrees treatment options with service user Rehab Panel to discuss case and ensure the case meets the eligibility criteria and, if there are competing cases, whether the case is prioritised for funding Criteria met, funding available Service user meets rehab criteria for acceptance and completes preparatory care plan goals and milestones Rehab placement commences on agreed date. Recovery worker undertakes monthly reviews for duration of the placement Criteria not met or another case is prioritised Service user does not meet the rehab s acceptance criteria or does not meet a preparatory care plan goal or milestone identify other rehab or continue with community based interventions Community-based interventions continue if agreed between recovery worker and service user. Potential re-referral in the following financial year or if there is significant change to the service user s circumstances. Exit Discharge Review Community care continues Drug Treatment System Pathways.indd 15 31/07/ :52

18 Service description A range of treatment delivery models or programmes to address drug and /or alcohol misuse, including abstinence oriented interventions, within the context of residential accommodation. Some residential rehabilitation providers also offer inpatient drug treatment services; please see the inpatient drug treatment care pathway for how this should link into local treatment. Please refer to the Peterborough Residential Rehabilitation Procedure for further information and guidance relating to accessing funding for this treatment option. Service outcomes Reducing the number of days a service users uses illicit drugs Increasing a service user s physical and psychological health self-rating Increasing a service user s quality of life self-rating Reducing the number of days a service user commits a crime Reducing the number of crimes a service user commits Client group and exclusions The target client group is adult drug users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 16 31/07/ :52

19 Targeted Testing Pathway Anyone over 18 yrs who is arrested and gets taken into custody Detained person is drug tested if they meet the criteria for targeted testing Negative result, ask if there are any issues and advise of open access at Aspire Positive- required assessment process with Aspire Courts- Restrictions On Bail Conditional Caution issued Referred to Aspire to work with a recovery worker from the Criminal Justice Interventions Team Court/Probation Drug Rehabilitation Requirement If they do not do the assessment, an arrest warrant will be issued Prison release Police custody, prison sentence. Structured interventions Drug Treatment System Pathways.indd 17 31/07/ :52

20 Service description Targeted testing on arrest is used for identifying drug-misusing offenders. A positive drug test for heroin, crack or cocaine use is an important gateway to ensure the offender can access treatment and other support to tackle their drug-related offending. Service outcomes Anyone who tests positive will be assessed by recovery workers and allocated a programme of support or treatment Client group and exclusions The targeted client group is adult users (aged over 18) who are residents within the Peterborough City Council geographical boundary Drug Treatment System Pathways.indd 18 31/07/ :52

21 Young Person s Substance Misuse Pathway Professional referral Self Referral Parent/Carer referral Triage (Within 2 working days of referral) by service manager/senior practitioner (case co-ordinator) Comprehensive Assessment of Need (Within 15 days of referral) by specialist worker Case co-ordination Care Planning (Within 2 weeks of Comprehensive Assessment in line with NTA guidelines Care planning developed and agreed with young person/parent/carer Review of Assessment with Service Manager (case co-ordinator) for additional needs Delivery of care planned interventions By key worker Multi-agency liaison Review With young persons/parents/carers. Planned and responsive to changes in young persons circumstances Discharge, referral on and after care Exit plan agreed with young person/parents/ carers and Service Manager. This may include: After care pack with Information, Advise and contact details, transitional links to Adult Alcohol Services and Adult Drug Services Multi-agency liaison- includes joint assessment processes with CAMHS, CAF and TAC arrangements, Children s Social Care arrangements, Family Recovery Project, multiagency care planning, partnership arrangements for delivery and transition arrangements Drug Treatment System Pathways.indd 19 31/07/ :52

22 Service description Drink and Drugsense work with parents and young people and offer information, education and preventative work that young people respond well to. For those with more complex needs they offer an intensive outreach service working with young people on a one to one basis, looking at issues such as tenancy and unplanned pregnancies. Service outcomes Support the client to be abstinent of substances Reduce the risks of committing crime Increase the clients quality of life Increasing a service user s physical and psychological health Client group and exclusions The targeted client group is young people (under 18 years old) who are residents within the Peterborough City Council geographical boundary. Parents and Carers who require advice and support around drug and alcohol use issues in relation to their children. Referral Before the client turns 18 years of age, they are referred to Aspire, where they will be assigned a recovery worker. The recovery worker will work with the client for a period of engagement and integration which will help prepare the client for the transition over to adult services Drug Treatment System Pathways.indd 20 31/07/ :52

23 Service aims and outcomes for children and families: Local drug services safeguard children by: Protecting children from harm Preventing impairment of children s health or development Drug services proactively promote children s welfare: Ensuring children are growing up in circumstances consistent with the provision of safe and effective care Creating opportunities to enable children to have optimum life chances so they can enter adulthood successfully Children achieve the five outcomes set by Government: Stay safe Be healthy Enjoy and achieve Make a positive contribution Achieve economic well-being Service should refer to Peterborough Safeguarding Children Board Core Inter-agency Safeguarding Procedures and supplementary documents for further information and guidance, available at Drug Treatment System Pathways.indd 21 31/07/ :52

24 Peterborough contact details for drug and alcohol services: SaferPeterborough Partnership 4th Floor Bayard Place Broadway Peterborough PE1 1HL Telephone: (01733) Office hours: Monday to Friday, 9am 5pm Aspire- (adult drug service) Bridge Street Peterborough PE1 1DY Telephone: (01733) Fax: (01733) Service user 24-hour freephone: Open: Monday, Wednesday and Friday 9.30am 5pm, Tuesday and Thursday 9.30am 8pm Saturday 10am 2pm Drinksense- (adult alcohol services) Alcohol Services Centre, 169 London Road, Peterborough, PE2 9DS Telephone: Fax: Open: Monday 1pm to 3pm, Tuesday 9am to 11am, Wednesday 4pm to 6pm, Thursday 3pm to 5pm and Friday 12pm to 2pm Drink and DrugSense Children, Young People and Families Service 79A Eastfield Rd, Peterborough, Cambridgeshire PE1 4AS Telephone: Fax: Drug Treatment System Pathways.indd 22 31/07/ :52

25 Bordering counties contact details for drug and alcohol services: Cambridgeshire Inclusion- commissioned by Cambridgeshire Drug and Alcohol Action Team For more information or support please contact our countywide single point of contact number on: (all calls charged at local rate). Inclusion Drug Services Cambridge Mill House, Brookfields Hospital, Mill Road, Cambridge, CB1 3DF Tel: Inclusion Drug Services Huntingdon 7 Market Hill, Huntingdon, Cambridgeshire, PE29 3NR Tel: Inclusion Drug Services Wisbech Church Terrace, Wisbech, Cambridgeshire, PE13 1BW Tel: Inclusion Drug Services Ely Market Street, Ely, CB7 4LS Tel: Addaction Wisbech Former Council Offices, Church Terrace, Wisbech, Cambridgeshire PE13 1BW Tel: , Open: Mon-Fri: 9am-5pm Addaction St. Neots - Alcohol service 1st Floor offices, Cross Keys Mews, Market Square, St. Neots, PE19 2AR Tel: , Open: Monday: 9am - 8 pm, Tuesday: closed, Wednesday- Friday: 9am - 5pm CASUS young people under 18yrs and their families drug and alcohol service CASUS North (Huntingdonshire and Fenland) Newtown Centre Nursery Road Huntingdon PE3 8SJ Tel: Fax: CASUS South (Cambridge City, South and East) The Bridge 152/154 Mill Road Cambridge CB1 3LP Tel: Fax: Drug Treatment System Pathways.indd 23 31/07/ :52

26 Lincolnshire Drug and Alcohol Recovery Team Boston: Babbage House, Rear of Boston Borough Council, West Street, Boston, PE21 8QR Tel: Drug and Alcohol Recovery Team Grantham: Beaconfield Centre, Beacon Lane, Grantham, NG31 9DF Tel: Drug and Alcohol Recovery Team Lincoln: Carholm court, Long leys Road, Lincoln, LN1 1FS Tel: Addaction Lincoln: 30 Newland, Lincoln Tel: Addaction Grantham: 71 High Street, Grantham Tel: Addaction Boston: Wide Bargate, Boston Tel: Northamptonshire Adult drug and alcohol services CRI: Tel: Young People s Team: 76 St. Giles Street Northampton NN1 1JW: Tel: Confidential information, education and harm reduction advice around drug and alcohol use Drug Treatment System Pathways.indd 24 31/07/ :52

27 Pharmacies offering needle exchange services PHARMACY ADDRESS TELEPHONE MON - FRI SAT SUN Asda Pharmacy West Rivergate Shopping Centre, Viersen Platz, Peterborough (01733) am-10pm 7am-10pm 10am-4pm Boots The Chemist Queensgate Centre, Peterborough (01733) am pm 8.30am 6pm 10.30am 4.30pm Boots The Chemist Unit 2 Bretton Centre, Bretton, Peterborough (01733) am 12am 8am 11pm 10am 4pm Boots The Chemist Serpentine Green, Hampton, Peterborough (01733) am 8pm 9am 8pm 10am 4pm Mi Pharmacy (Eastchem) 127 Eastfield Road, Peterborough (01733) am 6.30pm Closed Closed Botolph Bridge (Jhoots) Pharmacy Unit B Sugar Way, Peterborough (01733) am 6.30pm Closed Closed City Pharmacy 50 Lincoln Road, Peterborough (01733) am 6.30pm 9am 1pm Closed Millfield Chemist 387 Lincoln Road, Peterborough (01733) am 8pm 9am 8pm 10am 8pm Co-op Pharmacy Chadburn Centre, Paston, Peterborough (01733) am 6.30pm 9am 1pm Closed Co-op Pharmacy Co-op Pharmacy Lincoln Road, Millfield, Peterborough 2-6 Hampton Court, Westwood Peterborough (01733) am 6pm 9am 5pm Closed (01733) am 6pm 9am 5pm Closed Rowlands Pharmacy 178a Mountsteven Avenue, Walton, Peterborough (01733) am 6pm 9am 12pm Closed Lloyds Pharmacy Nene Valley Medical Centre, Clayton, Orton Malborne, Peterborough (01733) am 6.30pm Closed Closed Lloyds Pharmacy 1 Bushfield, Orton Centre, Orton Goldhay, Peterborough (01733) am 6pm 9am 5pm Closed Co-op Pharmacy Stanground Surgery, Peterborough (01733) am 5.30pm 9am 5pm Closed Sainsbury's Pharmacy Flaxland, Bretton, Peterborough (01733) am 11pm 7am 10pm 10am 4pm Drug Treatment System Pathways.indd 25 31/07/ :52