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-April 2013

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Adobe Acrobat DocumentDownload the PDF version of this Update here! (PDF*, 113K)

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Alcohol and Drug Policy Beyond 2013 (webinar)

Drugscope's Director of Policy, Marcus Roberts, presented a webinar on the changes taking place in the drug and alcohol treatment sector from April 2013 to Homeless Link on the 25th March. The webinar provides information on how alcohol and drug service funding will change as a result of significant policy changes, and how these changes may affect service commissioning and delivery. Whilst the webinar is aimed at those working with homeless people, it contains information that is applicable to anyone working in the field. The full Drugscope lecture (52 minutes) can be viewed on the "Homeless Link" website.

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Falling Drug Use: The Impact of Treatment

See www.nta.nhs.uk.

Published by the NTA last month, prior to their transition into Public Health England, the above report is offered as testimony to the success of the drug treatment system over the past decade. The report is based on prevalence figures from researchers at the Centre for Public Health in Liverpool, which indicates that the number of heroin and crack users has fallen below 300,000 (for the first time since data has been collected). A significant fall in the numbers of people who inject drugs is also highlighted in the report.

Commentary

Now that we no longer have a central national body dedicated to drug policy, it is helpful to have come across the lecture by Drugscope, the UK's leading independent centre of expertise on drugs and drug policy in a readily accessible format. In his presentation, Marcus Roberts gives a general overview of the immense changes that have taken place and discusses the detail around structures and funding.

We are also reminded of the useful guidance documents as part of the NTA legacy e.g. the excellent Why Invest? to guide us through the maze. Whilst we acknowledge the massive contribution services have made to reduce the prevalence of crack cocaine and heroin use in the UK, and note that heroin use is falling all over Western Europe, new psychoactive substances appear to be causing increasing harm and there remains a great deal of work to be done regarding problematic alcohol use in the UK.

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Drug and alcohol resources (NTA website)

On 1 April 2013, the NTA became part of Public Health England (PHE), an executive body of the Department of Health. It has been established to protect and improve the nation's health and wellbeing and to reduce inequalities. It will lead on the development of a 21st-century health and wellbeing service, supporting local authorities and the NHS to deliver the greatest possible improvements in public health.

For a transitional period, the former NTA website (www.nta.nhs.uk) will continue to be available with existing and new information and resources relevant to the drugs and alcohol sector. PHE corporate information including press releases relating to drugs and alcohol are available on the PHE website www.gov.uk/phe.

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Local Authority Commissioning Public Health Services from Primary Care

See Department of Health (DH) narrative (PDF document).

DH has published an explanation of the arrangements for local authority (LA) commissioning of public health (PH) services from primary care as from 1st April 2013. Many public health services were commissioned by PCTs prior to the end of March and local authorities will take ownership of relevant PH contracts that have an expiry date beyond 1 April 2013, or take responsibility for contracts commencing from 1 April 2013.

Following transfer of the contracts, LAs will be able to manage the arrangements set out in these contracts. Once the transferred contracts expire, LAs should commission services from providers in a manner which ensures delivery of high quality PH services and which supports continuity and integration of services. Primary care contractors (and other providers) do not have "preferred provider" status for any newly commissioned PH services. The transfer of pre-existing arrangements for PH services will be made through a "transfer scheme" as set out in the Health and Social Care Act 2012.

Many PCTs had established LESs to fund areas of PH activity that are transferring to local authorities, including for alcohol misuse and substance misuse where this is part of the established LES contract. LAs will not be able to commission LES contracts for services that commence after 1 April 2013 as these are primary medical services which only the NHS Commissioning Board may commission. In these circumstances, the LA will use its own commissioning powers and contracts to deliver public health services including from primary care.

Commentary

By the time you read this, the above will be happening in your area, or hopefully all the contracts will be in place. The full DH document summarised above is available on the SMMGP website as a pdf and contains a FAQ section (see link above).

Whilst the majority of contracts have moved over in their current form, it is important for those involved in primary care based drug and alcohol treatment to engage with their new public health commissioners soon to begin to discuss contracts for 2014/15; practitioners should consider the myriad of ways that treatment provided from primary care can support the public health outcomes set as local priorities.

We'd be interested to hear from SMMGP GP members whether any of you are on Clinical Commissioning Groups; and what challenges and opportunities are presented in your area as a result of the changes, please drop us an e-mail on admin@smmgp.org.uk.

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Addiction to medicines: commissioning services after the health reforms

The NTA organised a national conference in February 2013 to consider the future commissioning and provision of services for dependence on prescription and over-the-counter medicines (especially benzodiazepine tranquillisers). The key note speaker was Anna Soubry, Parliamentary Under-Secretary for Public Health. She spoke of the wide range of medicines that can cause addiction problems and said that primary care services, commissioned by the NHS Commissioning Board, would be the first port of call for anyone experiencing problems with over the counter or prescribed medications. She set out plans for action agreed by a roundtable of experts and patient groups convened by the Department of Health:

Presentations from the event are available on www.nta.nhs.uk.

Commentary

There is an increasing demand for education and training about the challenging issue of addiction to medicines such as over the counter and prescription only drugs including benzodiazepines, and we are holding an SMMGP one day CPD training event in Birmingham on the 28th June 2013. Booking for the day is brisk, so if you are interested in learning more about addiction to medicines, including prescription drugs, benzodiazepines, how to deal with overuse of pain medication etc. sign up for the training day now. The programme is designed around a strong clinical content, including case studies, plus an update on the direction of travel in government policy, and a pharmacist's perspective.

For more details see our Courses & Events section.

See also Steve Brinksman's "Post-it from Practice" in the latest issue of DDN Magazine and on our website.

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National survey of needle and syringe programmes

A national survey was announced by the National Needle Exchange Forum (NNEF), NICE and Public Health England (PHE) this month with an aim of providing a complete picture (as far as possible) in terms of provision of needle exchange services, also quality, interventions and equipment and what type of service e.g. specialist (fixed sites, mobile units, pharmacy etc).

This survey - the first in the country for 8 years - is important not least because it will be the first one conducted since the formation of the new executive agency (PHE) who has a brief to work with national and local governments "to protect and improve the nation's health and to support health choices".

Continued support for and improvement in needle and syringe programmes are essential to effective recovery-orientated drug treatment systems.

The survey aims to better understand:

  1. How widely NICE Public Health Guidance 18 (Needle & Syringe Programmes) has been implemented, including if there have been any barriers to implementing the guidance. This is to inform NICE's update of the guidance (PDF document).

  2. The current type and level of NSP provision in England, including a profile of past and current activity. This part of the survey will be repeatable to track changes in NSP following the wide-ranging changes to health and social care systems in April.

There are two surveys, one for Commissioners and one for Providers.

Any published findings will remain anonymous.

For further information:

Commentary

The NTA's Needle Exchange Monitoring System (NEXMS) was not as successful as was hoped due to low uptake. Please support this important national survey to provide a current baseline. If it does not apply to you, please bring it to the attention of colleagues for whom it may be relevant.

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The Commission on Narcotic Drugs (CND) 56th session

The Commission on Narcotic Drugs (CND) held their 56th session in Vienna on 11-15 March 2013. The CND is the central policy body within the United Nations that deals with drug-related matters. This year there was a resolution passed on HIV, Hepatitis and tuberculosis endorsing the WHO guidance on Hepatitis prevention for people who inject drugs, which was welcomed by the civil society groups present.

Civil society groups have long campaigned, largely unsuccessfully, to have a voice in the CND debates, but they have gained ground in recent years and the civil society representation at this year's meeting was strong, with over 160 organisations attending.

Commentary

It is important that civil society groups with a harm reduction ethos, with their calls for the implementation of harm reduction measures in treatment supported by adequate funding, continue to bring pressure to bear on this UN forum to recognise the enduring importance of recognising the evidence for harm reduction in the treatment of drug misuse. A side meeting was held with the UNODC Executive Director, Yuri Fedotov which provided NGOs with the opportunity of having a dialogue on their concerns, nicely summarised in a blog by the International Drug Policy Consortium (IDPC). Also listed are all the statements submitted by NGOs and civil society organisations, including IDPC/Drugscope.