Clinical & Policy Updates:
SMMGP Policy Update January-February 2012
|Download the PDF version of this Update here! (PDF*, 298K)|
By April 2013 local authorities will be responsible for commissioning drug and alcohol treatment. Effective drug treatment will require partnership working to enable people to fully realise their recovery potential. The National Treatment Agency soon enters its final 12 months of operation. Under the "Building Recovery in Communities" umbrella and as part of the preparation for the transfer of its functions to the new executive agency - Public Health England - a range of support packages for developing locally-owned drug and alcohol treatment systems, using NDTMS data, is offered on the NTA website.
The series of Joint Strategic Needs Assessment (JSNA) papers are in an easy-to-follow format for how investing in local drug treatment and recovery systems benefits individuals and communities. The first, top level "Why Invest?" presentation is aimed at informing and influencing Directors of Public Health and other key decision makers, and designed in an easy, take-away, "infographic" format with high visual impact - offering an at-a-glance understanding of the impact of drug misuse and the importance of investing in drug treatment.
Two further important documents are available in this series from the NTA:
JSNA Support Pack for Strategic Partners which sets out what the investment in drug treatment means for specific areas and the benefits of it. It presents data from NDTMS, TOP and DIP programmes, with national comparison data, and estimates the prevalence of opiate and/or crack cocaine use.
JSNA Support Pack for Commissioners (which is aimed at joint commissioning managers in local drug partnerships) to inform the commissioning of a recovery-orientated system, and which replaces the treatment planning guidance process. It requires effective integrated commissioning of services with partnership working between local authorities, health and social care and criminal justice. It offers a series of prompts to consider in relation to the provision of drug treatment, for example: Is commissioning based on best practice outcomes in the 2010 Drug Strategy? Do the partnerships have mechanisms for reporting drug treatment and recovery progress? Are there links being developed with clinical commissioning groups?
It includes a pragmatic harm reduction approach - is there ready access to injecting equipment, advice and information on blood borne viruses and alternatives to the most harmful ways of taking drugs? Is medication-assisted treatment available to service users for as long as it is clinically appropriate? Do prescribing services have a plan to implement and review the interim recommendations of the Recovery Oriented Drug Treatment report? Read the full set of documents on the NTA website.
JSNAs are to be a statutory responsibility and much of what is described above is already happening, despite it all being subject to the Health and Social Care Bill becoming law. The planning timetable published with the JSNA pack for commissioners suggests that partnerships must have their plans in place at the start of the 2012-13 financial year - a month from now. From recent meetings with our NTA contracts managers, in an echo of the words of Quentin Crisp "ask not if there is anything outside you want, but whether there is anything inside that you have not yet unpacked" (Quentin Crisp, "The Naked Civil Servant") - the message is clear: "how prepared are primary care systems for the new drug treatment commissioning environment; and are you engaging?"
Data for local areas - and indeed down to local service level - is already available on www.ndtms.net to registered users - and with the move towards transparency and accountability, will soon be available to anyone who has an interest in viewing it. With the emphasis shifting more and more on to outcome monitoring, it is imperative that primary care data is recorded as accurately as possible, and to ask for help from the NTA NDTMS teams if needed. If you believe that your service is doing well, data is going to be the way in which you can demonstrate it in future.
A GP recently posted on our forums looking for support because his shared care scheme was being decommissioned prior to a retendering exercise. The thread has generated a lot of interest and comment. In case you haven't seen it, also read Steve Brinksman's excellent Soapbox in the latest DDN "Shared Care: Stirred, not Shaken".
From the overwhelming response and support to this post, please ask for help or advice if you need it!
As a vital two way conduit between our members and the powers-that-be, SMMGP will continue to represent the views of our network and members of the primary care drug and alcohol treatment workforce. The very good news is that the NTA have confirmed our funding for 2012/13. With your valued contributions, we will continue to fulfil this important role into PHE, and beyond. But it's all happening right now, folks, and we need to stay ahead of the game!
Professors John Strang, Thomas Babor, Jonathan Caulkins, Benedikt Fisher, David Foxcroft, Keith Humphreys. Lancet Vol 379 Jan 7, 2012
Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence, say the authors of the above paper.
This paper, from a recent series in the Lancet (The Lancet Vol 379 Jan 7, 2012) reviews relevant evidence and makes the point that it is fortunate that evidence-based interventions are increasingly being identified as having an impact across all domains related to drug misuse including being capable of making drugs less available, preventing drug use initiation in young people, reducing violence in drug markets, and lessening misuse of legal pharmaceuticals. The paper's key messages are:
- Drug policy should aim to promote the public good by improving individual and public health, neighbourhood safety and community and family cohesion, and by reducing crime.
- The effectiveness of most drug supply control policies is unknown because little assessment has been done. Supply controls can result in higher drug prices which can reduce drug initiation and use but these changes can be difficult to maintain.
- Wide-scale arrest and imprisonment have restricted effectiveness, but drug testing of individuals under criminal justice systems produce substantial reductions in drug use and offending.
- Prescription regimens minimise but do not eliminate non-medical use of psycho-active prescription drugs.
- Screening and brief intervention programs have on average only small effects, but can be widely applied.
- The collective value of school, family and community prevention programmes is appraised differently by various stakeholders.
- The provision of opiate substitution therapy for addicted individuals has strong evidence of effectiveness, although poor quality of provision reduces benefit.
- Peer based self-help organisation are strongly championed and widely available but have been poorly researched until the past 2 decades.
- Health and social services for drug users covering a range of treatments, including needle and syringe exchange programmes, improve drug users' health and benefit the broader community by reducing the transmission of and mortality due to infections disease.
The key messages from this comprehensive review of the literature (with 108 papers referenced) are broad ranging and timely and when principles and values and political processes are having such a marked influence as drivers of the drug policy in this country, evidence of effective treatment, which is also cost effective, cannot be emphasised enough.
Good drug treatment, backed by sound evidence, and which impacts across all the important areas where drug misuse has an effect, is already - and readily - available in primary care. SMMGP, with the support of our passionate and committed membership, and via collaborations with the Substance Misuse and Allied Health (SMAH), will continue to champion the role of evidence-based treatment of substance misuse management in primary care.
SMMGP: Provision of external supervision and appraisal for primary care based drug treatment.
Last year SMMGP had the opportunity of undertaking a pilot to provide external supervision and appraisal for the shared care component of a primary care treatment system.
This has proved to be extremely successful and was well evaluated by the commissioner and the GPs involved. We have been re-commissioned by that partnership for the next financial year and we have also been asked to replicate the model in a London partnership area next year.
We are therefore excited to announce that we will soon be publicising this initiative on our website as we are offering it from April 2012 on a consultancy basis, with the aim of supporting GPs and upholding quality in primary care based drug treatment systems, including clinical assurance. For more information, contact any member of the SMMGP project team.