Clinical & Policy Updates:
SMMGP Policy Update May-June 2012
|Download the PDF version of this Update here! (PDF*, 364K)|
NICE - Draft Quality Standards (QS) for Drug Use Disorders documents are now out for consultation and the closing date for comment is 19 June 2012. Briefly, a QS is a set of specific statements that act as markers of high quality, cost effective patient care across a clinical area. Once they are signed off, it is obliged to have regard for QS in planning and delivering services in health and social care. The draft quality standard for drug misuse disorders consultation document is available by clicking on Drug use disorders draft quality standard.
This is an important piece of work and the views of primary care practitioners on it are essential. Steve Brinksman, SMMGP clinical lead, is on the expert group, but in order to reflect an organisational view from our membership, we need your input. See also the SMMGP Forums.
There is now an online bulletin for the Payment by Results for Recovery Pilots with all the latest news about the programme, news of events to promote payment by results and information from the pilot sites on how implementation is progressing.
SMMGP recently attended the DH provider day, when the PbR provider pilot sites presented their various models. Our overall impression of the cross-government representatives was the emphasis on localism and local decision-making. There is clearly a lot of enthusiasm for PbR from the top level civil servants who head up the programme, and certainly, the pilots (or "early adopters" as we heard more than once on the day) have approached their task too with gusto, whilst acknowledging in the workshops that there are many issues that are often only identified as the pilots find their way during implementation. And there was an acknowledgement that all the risks are perhaps not yet fully clear in the various local models, each model of course being different too. Working the system by "gaming" (the deliberate manipulation of statistics and not "playing by the rules") is an acknowledged risk, as has been said more than once. The Gaming Commission has published a report on PbR (it is on the website mentioned above). How to ensure quality care for each person sitting in front of you, with a price attached to their treatment upon which payments will be made, with much bureaucracy and all the variables in each local system (not to mention against funding cuts) is another. All the presentations from the provider day, as well as the report from the Gaming Commission are now available on the website.
As frustrating and even alarming as working within these changes to the way treatment is funded may be, if how PbR for drug and alcohol treatment will work has seemed ill-defined, make time to get to grips with it by exploring the website. Perhaps it is too soon to say it has fully arrived, but it is certainly being implemented already in various guises and innovation in many parts of the system, apart from in the official pilots. See also the Drugscope report Building for Recovery commented on separately elsewhere in this update.
It has never been more important to champion the benefits of drug treatment - engage with your local commissioners, including the emerging Health and Wellbeing Boards, to ensure that providers are involved in any outcomes that may be set locally. There will be more about all the challenges we face, including with PbR, at our conference. We hope to see you there!
For a summary of the PbR drug and alcohol recovery outcomes, see "Payment by Results Drug and Alcohol Recovery Outcomes - Summary of Final Outcome Definitions".
In November, new Police and Crime Commissioners will be elected in each police force area in England and Wales, and candidates will take up their posts a mere week later, immediately having to meet planning and strategic commitments. Individuals seeking election to the PCC posts come from a range of backgrounds, not necessarily policing - John Prescott is one of the Labour party candidates in Humberside and there were reports of other "high profile candidates". We found information about candidates on the Police Foundation website (PDF).
DrugScope have produced an accessible and helpful guide to the introduction of PCCs and the implications for the drug and alcohol sector (PDF).
The policy guide includes Q&A e.g. find out the answer to "Is there anything we should be doing now?"
A key way of getting drug treatment on to PCC's agendas and sustaining support for drug treatment is via the JSNA process. There is also a Home Office funded project underway, which includes Drugscope and other organisations, to co-ordinate communication with PCCs and make it more coherent for the voluntary and charity sectors of the system. The project is currently putting together resources for substance misuse.
The importance of local structures working together to join up local strategies cannot be overemphasised (e.g. health and wellbeing strategies with police and crime plans). Relationships within the community will be crucial to the success of the scheme and PCC taking up office will immediately face major decisions about priorities. There are reports that the public are disinterested in PCCs - not least because of a perceived lack of understanding of their role. But, we cannot afford not to be interested and we urge our members to become familiar with developments around PCC appointments locally - now!
The report is available on the Drugscope website (PDF).
The above report from Drugscope makes a contribution to support on-going dialogue about recovery following on from the Drug Strategy 2010. Key messages from the report include the commitment to recovery as "an individual, person-centred journey, as opposed to an end state"; recognition of the importance of social integration; the requirement for balanced, integrated and evidence-based services. It notes concerns about the potential for local disinvestment.
We welcome this contribution to the dialogue. From discussion of the report on our forums a genuine concern is how clinical governance and NHS Constitution rights and pledges will apply to drug treatment when responsibility is transferred to local authorities. Both NHS and VCS have an important role to play in working collaboratively to develop and maintain good treatment systems to "build for recovery" and that is where the real challenges may lie, within the climate of financial constraints. See also UKDPC report "Charting new Waters"
The report is available on the Home Office website.
The recommendations for government from the recent report by the ACMD on naloxone are:
- Naloxone should be made more widely available, to tackle the high numbers of fatal opioid overdoses in the UK.
- Government should ease the restrictions on who can be supplied with naloxone.
- Government should investigate how people supplied with naloxone can be suitably trained to administer it in an emergency and respond to overdoses.
ACMD believe wider naloxone provision could have an impact on drug-related death rates: "...concludes that naloxone provision is an evidence-based intervention, which can save lives. Naloxone provision fits with other measures to promote recovery by encouraging drug users to engage with treatment services, and ultimately, keep them alive until they are in recovery."
We agree wholeheartedly with the recommendations from this timely report as outlined in the accompanying letter from ACMD to Anne Milton, and its significant contribution to preventing drug related deaths and further, to public health aims of education and training around the problem of overdose and drug related deaths.
As part of the Drug Tariff simplification process, DH are making changes to the pricing structure for methadone dispensing which will see the introduction of a "prescription" fee to recognise the extra work involved in dispensing oral methadone liquid. This £4.05 fee will be paid to all contractors once per prescription, alongside the professional fees and CD fee. But, contractors will no longer be paid the professional and CD fees for every single dose container they dispense in bulk - instead they will receive professional and CD fees only when the patient collects the medicine.
The changes come into effect on 1 July 2012.
The impact of these controversial changes for the dispensing of oral methadone remains to be seen, but is likely to mean a significant reduction in funding for many pharmacists who provide substance misuse services. A further consideration is whether it will result in methadone being dispensed in larger single quantities. Many pharmacists, for example, provide weekly pick-up clients with daily dose containers as support. Pharmacists will no longer be funded to do this - issues around safeguarding may arise.
See Home Office website.
This update from the Home Office reiterates the aims of the 2010 Drug Strategy and reports on progress. The three domains of reducing demand, restricting supply and building recovery are covered, with quite a large part of it devoted to new psychoactive substances ("legal highs"), which outlines how the Government intends to reduce demand and improve education in schools, through social media and via the relaunched FRANK website.
The 2012 annual review of the Drug Strategy holds no real surprises. Worth noting though is that it makes no mention of "that document" which we commented on in the Mar/Apr Policy Update (and was discussed on the forums) so we are assuming from this omission that it has probably, or rather, properly, been relegated to "Folder 101".
The official journal of the International Centre on Human Rights and Drug Policy can be downloaded from www.humanrightsanddrugs.org
This edition includes an interesting article by Alex Stevens on "The ethics and effectiveness of coerced treatment on people who use drugs". The journal is open access, and the PDF of the article mentioned is available on our website.
Action Plan for the NTA 2012 -13 DH has approved the NTA's Work Programme for 2012-13, including sign-off of their budget allocations, which in turn includes funding for SMMGP for the financial year 2012/13 (as an independent project within their budget).
NTA have published a summary (PDF) of the responses received last year to the BRIC consultation
The NTA is in transition to PHE. Duncan Selbie was appointed as Chief Executive for PHE during May and will take up post by July.
We welcome this appointment as he has extensive NHS experience and as SMMGP will be part of the change to PHE next year, we look forward to working towards integrating into the public health arena alongside the new organisation. But, for now, whilst the policy changes go on around us, there is ongoing important work to be done. One of our project aims is to be representative of the primary care substance misuse field, and we do this (amongst other things) by sharing information about primary care based treatment and what is happening on the ground with the NTA, as well as commenting on primary care matters as needed. SMMGP project team meet with NTA heads of department and are involved in cross-government events which help to keep abreast of current developments e.g. Payments by Results, Addiction to Medicine round table, NICE Quality Standards for Drug Misuse Disorders where Steve Brinksman is on the expert group (see first item). In addition, SMMGP is frequently invited, as an authoritative representative of the primary care field, to participate in advisory groups e.g. RSA Programme Advisory Board and London Joint Working Group on Hepatitis C.
With all the current policy mayhem, our role in representing the voice of primary care is perhaps more crucial than it has ever been. We are therefore grateful to our members who make their views heard via direct emails, on our forums, and for example at the recent RCGP/SMMGP conference in Cardiff, because without hearing from you, we cannot claim to have any influence upwards nor provide you with useful feedback. Please continue to contact us if there is anything that causes concern in your area, or that you feel needs to be brought to our attention. Post about it on our forums, which are routinely monitored by our able moderators, or on Twitter via www.twitter.com/smmgp or send an e-mail to the Project Manager, Elsa Browne, on firstname.lastname@example.org
Free of drug(s) of dependence
- Drug/alcohol use reliably improved.
- Abstinent from all presenting substances.
- Successful completion of treatment with a planned discharge.
- Following successful completion, no re-presentation to either treatment or criminal justice system in subsequent 12 months.
Health and Wellbeing
- No longer injecting.
- No housing problem at latest review for those initially reporting NFA or with a housing problem at the start of treatment.
- Completion of a course of Hepatitis B vaccinations for those eligible.
- Improved health and social functioning.
9. Reduced Offending
- Treatment database anonymously matched with Police National Computer database.
- Cohort measure: actual offences compared to predicted offences on a monthly basis.
- Payment made per offence saved (penalties for increased offending).