Primary care
A risktoo far
Poor commissioning practice is putting patients ’ lives at stake , declared the GPs ’ conference
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Only recommission services if they are ineffective , dangerous or wasteful – not on a whim ,’ said Dr Gordon Morse , speaking at the 22nd RCGP / SMMGP conference , ‘ Managing drug and alcohol problems in primary care ’. ‘ Don ’ t recommission services that are absolutely fine .’
Throughout the day , GPs from the platform and the floor expanded on this theme with passion and anger . The existing three-year cycle of commissioning was destructive , it was agreed , and was damaging continuity of care . Delegates shared their stories of how well-functioning services had been retendered and lost to a cheaper bidder , with quality of care sacrificed in the race to slash budgets .
‘ There were over 3,700 drug-related deaths registered in 2016 in England and Wales – a 44 per cent increase on 2012 figures ,’ said conference chair Dr Stephen Willott . ‘ That ’ s more than ten deaths a day and each one is a tragedy .’
The government ’ s drug strategy has long moved away from harm reduction , OST and choices , and the ‘ destruction of drug services ’ through dramatically reduced funding and constant retendering has increased the risk level for those on the bottom rung of this ‘ unequal society ’, he said .
More than half of those who died from drugrelated causes were known not to have been in contact with treatment for at least five years , so ‘ engaging in drug treatment clearly has a protective effect ,’ he said . But why were so many people not in treatment , he asked . ‘ Is it because of cutbacks , or are our services not accessible enough ?’
The ACMD had recommended that access to allied healthcare and other services was important in promoting recovery from problematic drug use and reducing premature deaths . But local authorities often dealt with cuts by recommissioning in three-year cycles , which was ‘ bad for all , with dips in services and quality , damage to continuity for individuals and arbitrary changes in prescribing ,’ said Willott .
Throughout the day delegates were invited to share their experiences , and a picture soon emerged of ( as one GP commented ) ‘ primary care being hammered so badly that there will be no capacity to re-engage ’.
Agreeing that commissioning cycles should be at least five years , the conference called for a change in practice – to ‘ recommission services only if the service is failing , after support to change the service has been tried ’.
‘ The government ’ s drug strategy has long moved away from harm reduction , OST and choices .’
Dr STephen WillOTT
‘ I ’ m left trying to plug the gaps ’
A local GP is stretched to breaking point
As a GP , I ran a local enhanced service for patients with a drug problem in my practice for about 14 years . Now LESs have gone , a new agency is commissioned by the council to provide treatment to my patients , and they use my service to deliver the treatment .
Continuity is key in providing an effective service , particularly to this group of patients , but the contract has been transferred every three years – so we ’ re now on our third agency in four years . Each time the contract is put out to tender the budget is slashed .
Each agency has completely different ways of working , staff , protocols , markers of success , referral and assessment forms , and ways of communicating . We had a reliable , stable support worker with the previous agency and had just managed to set up a support group at the local youth centre . All this was lost in January of this year when the new service took over . We ’ ve had three different workers and more than six months with no worker at all , when I was left trying to plug the gap myself . My patients are thoroughly fed up with the changes and the poor reliability and continuity of the service .
The budget means staff are spread thinly , there is poor morale , retainment is low , and sickness among workers is high . Patients have come for appointments and not been told the worker is not coming . They have told their stories of past trauma and then not seen workers again – so why should they bother coming to appointments ?
I can provide continuity but I don ’ t have the time to provide all the support that is needed . It should be so much more than a script . I ’ m relieved to say we haven ’ t had any drug-related deaths among our patients since our service started 14 years ago – but it is requiring so much more time and effort from me to fill in the gaps and keep the service safe .
I could not sell this type of work to other GPs with things as they are . Previously I would say how rewarding it was , and how good it was to work as part of a team . It ’ s now stressful for all the wrong reasons , that have nothing to do with the patients .
12 | drinkanddrugsnews | December / January 2018 www . drinkanddrugsnews . com