SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Clinical & Policy Updates:
SMMGP Policy Update March 2011

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Adobe Acrobat DocumentDownload the PDF version of this Update here! (PDF*, 308K)
Adobe Acrobat DocumentDownload the PDF version of the associated "NHS of the Future" document here! (PDF*, 180K)

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Draft Health and Social Care Bill Jan 2011

See www.parliament.uk.

See also the diagram of the future NHS for which this Bill is legislating. Regarding the timeline for transition to PHE, please see Department of Health web site.

The Bill (currently going through Parliament) sets out a new legislative framework for the NHS, with a new system of commissioning within the NHS. It establishes accountability across new NHS commissioning bodies, the public and patients, Public Health England, local authorities and ultimately the Secretary of State for Health. The main aims of the Bill, and the changes that it will bring, are:

The Bill provides the legislation that underpins the new Public Health England, including putting health and wellbeing of their communities in the hands of local authorities. It embeds the National Institute for Health and Care Excellence (NICE) in the primary legislative framework and gives standing to health and social care information (via the Health and Social Care Information Centre).

Commissioning structures: The majority of health services will be commissioned by consortia (taking over the commissioning functions of PCTs and SHAs). Each consortium's annual plan must be shared with Health and Wellbeing boards, and once agreed, will be sent to the NHSCB. The NHS Commissioning Board (NHSCB) will commission other health services - that cannot be commissioned by the consortia - e.g. primary medical, dental, ophthalmic, pharmaceutical services. For more reading on the function of GP Consortia, please see "The functions of GP commissioning consortia: a working document"

The NHS Commissioning Board (NHSCB) will have overall national responsibility to promote a comprehensive health service (except relating to public health); it will lead on quality improvement, promote patient involvement and allocate and account for NHS resources. It will be an independent body to which the consortia will have to account for the quality of the services they commission, the outcomes they achieve and their financial performance, and it will intervene where there is evidence that consortia are failing to fulfil their functions.

Health and Wellbeing Boards (HWB): Local authorities are being given a statutory public health duty to protect and improve the health of their communities via HWB. HWBs must include at least one local authority councillor, director of social services, director of children's services, director of public health, representatives of local health watch organisation, commissioning consortia and an NHSCB representative.

The responsibilities of the Health and Wellbeing Boards will be broader than public health, but the role of public health will be critical to their success, as Health and Wellbeing Boards develop. A letter inviting local authority Chief Executives to put themselves forward as "early implementers" has gone out and it is expected that the majority of Local Authorities will have shadow Health and Wellbeing Boards in place by October 2011.

Regulation will be provided by the Care Quality Commission (as before) and Monitor (which becomes an economic regulator for all NHS funded health services).

Accountability The Health Service Ombudsman is given greater powers to share reports more widely. Healthwatch England will be established as a statutory committee within the CQC, and locally, Healthwatch will act as patient champions.

Quality standards (NICE), commissioning guidance, health information

The role of NICE is made concrete in primary legislation in this Bill, including an enhanced role for new NICE quality standards for the provision of NHS, public health or social care services. It becomes the National Institute for Health and Care Excellence (the word "clinical" is dropped from its title). In delivering their duties, NHSCB and HWBs "must have regard to the NICE quality standard" (a legislative requirement once it is endorsed by the Secretary of State).

Health and Social Care Information Centre (the NHS Information Centre) is responsible for the collection, analysis, publication and dissemination of information about the national health service. The Bill expands the Information Centre's powers including publishing of information (unless blocked by Secretary of State or NHSCB or if information allows an individual to be identified). It must establish, maintain and publish a database of quality indicators relating to health and adult social care services in England.

SMMGP comment

An important caveat to note is that much is in a constant state of flux - amendments to the Health and Social Care Bill occur all the time, and it is also still unclear how the government will respond when consultation has closed.

As we strive along with everyone else to understand how the new NHS will look, certain things are clear. There is no specific mention of drug and alcohol treatment in the draft Bill (because it is outlined the Public Health paper). The Public Health consultation on commissioning and funding makes it clear that commissioning of drug and alcohol services will be from local authorities, we assume by their Directors of Public Health (and will interface with local NHS and GPs via Health and Wellbeing Boards):

"Public Health England and local authorities will play a key role in tackling the harms caused by alcohol and drugs. Local authorities will be responsible for commissioning treatment, harm reduction and prevention services for their local population, providing an opportunity to more comprehensively join up the commissioning of drug and alcohol intervention and recovery services locally. At a national level this will be supported by Public Health England, which will provide evidence of effectiveness, guidance and comparative analyses to support local areas in their task."
(Healthy Lives, Healthy People: consultation para 3.18, p.22)

HWBs with input from GP consortia will jointly develop local health and wellbeing strategies, based on a detailed assessment of local needs. As HWBs will include at least two GPs in their membership, there is scope for some influence by primary care.

The Bill sets the scene for competition between NHS providers, private companies and the voluntary sector. SMMGP sincerely hopes that increased competition results in commissioning based on the quality of services rather that on the cost of services.

PHE is due to be up and running - in shadow form - for business by April 2012, and it will be part of the Department of Health. PHE and local authorities will jointly appoint directors of public health who will be responsible for the health of their local populations and will commission drug and alcohol treatment. Broadly PHE will take on full responsibility by April 2012 with shadow local authority budgets in place, and public health budgets are planned to be directly allocated to local authorities a year later (by April 2013) when it "goes live".

As you will be aware from the Press, BMA voted against the draft Health and Social Care Bill and the RCGP vote was also largely against it. It remains to be seen how much attention the government has paid to the strident objections to some of the plans outlined in it.

It is up to everyone working in the field to contribute to ensuring there's a place for drug and alcohol treatment in the new landscape - but who should we be talking to? It is all still a bit vague but there has been some discussion on the SMMGP forums with comments that it is difficult to predict how individual HWB's will behave. A good start would be to forge links with local Directors of Public Health and local authorities.

Paul Hayes from the NTA sits on the PHE executive team and we will continue to update members on developments at the NTA. Currently changes are being made to how their regional teams are deployed in the next 12 months.

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Quarterly update on SMMGP activities

NTA is our core funder and we report to them on a quarterly basis on our work plan. It occurred to SMMGP project management team that a lot goes on behind the scenes that members may not be aware of - but which we do report to others in our "authorising environment" (Mark H. Moore, "Creating Public Value Strategic Management in Government", Harvard University Press,1995). As you are the most important people who authorise us to continue our work, we are pleased to bring you the first of regular quarterly members' updates - a brief summary of some our activities in this final quarter of the financial year (Jan-Mar 2011).

Partnership work

Chris Ford, our clinical lead, was on the executive committee of the RSA Whole Person Recovery project (reported on in our December Policy Update (insert link). Arising from the report on this project, SMMGP got involved in working with RSA to produce an "entry level" GP toolkit, consisting of a brief film and a quiz, designed to reach GPs who are not confident or clear about their roles regarding providing general medical services for people who use drugs and alcohol, often because of the stigmatisations of these groups by society. All primary care practitioners see patients who use drugs and/or alcohol and it is hoped that this will help them recognise not only that these patients are like any others but also that there are numerous ways to help, with or without prescribing. It is envisaged that this toolkit will lead GPs on to completing the RCGP Certificate in Harm Reduction, Health and Wellbeing, and maybe even going on to provide OST. This project is in the final draft stage and will be piloted in the South East before being rolled out by RSA, and will be co-badged by SMMGP.

We met with NTA Information manager last month to discuss taking forward the embedding of NDTMS in EMIS. You will be hearing more about this in the not too distant future as we will be looking for pilot sites to try out the test software once it is available.

Also via the NTA, we are involved in an initiative to explore and identify best practice of recovery and reintegration in primary care drug treatment in the London area; and another project looking at areas (e.g. the Eastern Region) where there are large percentages of people in treatment in "shared care" and the possible reasons for this.

We have been invited by the Mayor's Office in London to participate in a community organisation network meeting on the NHS transition; and to talk about alcohol treatment.

Training and education

Problems with over the counter medicines and addiction to prescribed medication are in the Drug Strategy. We have put together a training day to precede the Harrogate conference - Over the counter and prescribed medication - what can be done about this growing problem?. We hope to see you there.

The RCGP Certificate in Detection, Diagnosis and Management of Hepatitis B and C in Primary Care is progressing according to plan and the pilot day is scheduled for Friday 27 May and we will be asking for volunteers soon so please put the date in your diary.

We were proud to announce the e-publishing of the updated Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care. Thank you for the overwhelmingly positive feedback we have received from our members. As a result of numerous requests from our members, training schemes and prescribers who prefer it in hard copy, we have decided to have a small print run of it soon - please watch the website for an announcement of when it will be available. It may need to be updated slightly quicker than usual in the light of new clinical guidelines and other policy changes, but we feel it is important to get this vital document out.

We have planned our primary care development conference for Thursday 13 October - the title is Recovery - make it work for you. Please put the date in your diary.

Programme will be out soon!

Staffing

SMMGP Clinical Director post

During this quarter, we advertised and interviewed for the SMMGP clinical lead post as Chris Ford is retiring as clinical director of the project she founded. Steve Brinksman was appointed to take over from Chris and we are excited to be welcoming him to the team at a time when there is so much of interest going on.

We welcome to our team on a part time basis Rebecca Murchie, who is familiar with a membership organisation and she has settled in happily.

Membership

Our membership is the most important part of SMMGP. Membership of SMMGP is currently growing rapidly and we averaged 40 new members each month during this quarter - adding to the total which is now in excess of 5000 - truly a case of having strength in numbers. With the NTA transferring to PHE, we are setting up to become a charity later this year to protect our status as an independent organisation - which brings us neatly to the question of money:

Funding

We were able to put forward a convincing argument of the value of networks in general - and SMMGP network in particular to the NTA as they move into PHE. We have therefore secured funding, albeit reduced, for the financial year March 2011 to March 2012. We will continue to engage with our government stakeholders in this transition period, and we are confident of our position in the field to be able to argue the case for continued funding with confidence.

Website stats - and Twitter!

For those who are interested in these stats - and we're sure there are plenty of you - here is a snapshot of your website stats for February 2011:

...And of course during this time we started tweeting. We aim during the course of this year to further expand our social media networking.

International links

SMMGP is the most used substance misuse website nationally and internationally and it is therefore no surprise to learn that we have links with IDHDP - International Doctors for Healthy Drug Policies (www.idhdp.com). This project is entirely separate from SMMGP and has its own funding streams. However, SMMGP supports the network in terms of hosting its website on ours and needless to say it is a pet project of one Chris Ford! From our partnerships with organisations such as IHRA, SMMGP team will be at the IHRA conference in Beirut and will be able to bring you reports of the latest harm reduction news. Whilst there we are also helping to facilitate an exciting IDHDP seminar where international members - all medical doctors - will give an overview of their country's drug policy and how it affects treatment in that country.

SMMGP's journey: where have we come from and where are we going

We presented to NTA staff at an internal seminar last week on SMMGP. This provided a real opportunity to look at how far we had come and consult on where we are going. It is impressive to think that we have grown from having 1 conference and 1 newsletter (as relevant today as it was back in 1996) to a point where we are planning our 16th conference and printing our 53rd Network - and 12,551 people have completed RCGP Certificate Part 1 - thanks to all of you!