Drink and Drugs News DDN Dec 2017 | Page 13

More on commissioning at www.drinkanddrugsnews.com ‘Patients have stopped attending’ Dr Peter Exley witnessed the dismantling of responsive healthcare I was a GP with a special interest (GPwSI) in substance misuse for around ten years, providing a clinic from my surgery to local and neighbouring practices. When substance misuse services were transferred from the NHS to local authority control in 2013, the service was put out to tender. The existing service was based on GP patient lists, but the new service was based on local authority bound ar ies. As we were a mile from the county border, quite a few of our patients could no longer be treated. We used to carry out services in a well- equipped, centrally located, modern medical centre. We provided nine hours a week of doctor time spread over two days, with flexibility to see patients outside the scheduled clinic times every day of the week. Patients could collect scripts and provide urine specimens from 8am to 6.30pm, Monday to Friday, and access urgent medical advice or discuss issues with pharmacists. Medical reviews were set as needed, from weekly to every six weeks. The new service was set up in a church hall with no medical facilities, on the far edge of the geographical patch, and many drug users did not attend as they couldn’t afford the bus fare. Three hours of doctor time were provided one after noon a week, and there was no easy access to medical support outside this time. Staff had their own problems to worry about – the TUPE’d drug workers were very demoralised as some had needed to reapply for their jobs three times in two years. I have spoken to patients who have not received a medical review or given a urine screen for more than a year, and have been unable to obtain a change to their OST for over two months. I would frequently treat people’s medical problems when they attended the substance misuse clinic – mainly mental health issues, infections (especially chest), groin abscesses, DVT etc. After the change in service, patients stopped attending for medical problems and turned up in A&E. In the ten years that we ran the service, one patient died. In the 18 months after the service ended, before I retired, three patients died – although one of these was probably not drug related. GPs preferred the old system, patients preferred the old system, drug workers preferred the old system – but the new system is cheaper. www.drinkanddrugsnews.com ‘Our patients are casualties of the climate’ Dr Simon Tickle has lost trust in the system We’ve run a GP practice with additional PMS [personal medical services] funding for socially excluded patients since 2001, but without any increase since about 2005. Some of our patients have lives that might make an ‘accidental overdose’ welcome, but a treatment environment has developed which I feel has made that option more attractive. Frankly, without increased funding, we did need the help of the new drug treatment contractors with our 150 shared-care patients, but after two years and eight changes in workers they decided they needed to crack the whip. Within three months of starting a programme to take the least stable and more complex of our patients out of shared care because they were unsuitable for it, we had two heroin overdose deaths – and we’d previously had none for years. One was a woman with whom we had had a warm and close relationship and had supported through many ups and downs. She had learning difficulties and was on a high dose of oral methadone and ‘injecting on top’. The other was a man whom we had managed to support successfully, but on transfer he disengaged from treatment as he did not want to lose his relationship with us or be managed under their policies, and he too was soon dead. A supportive relationship with a known care worker is a lifeline for such patients and they need to be able to opt to stay with the person or agency they trust, or at least have any transition dealt with very sensitively. I’m not attributing blame, but I would like to see more compassion and contrition. My concerned email to the local service was copied to the commissioner, but so far it has gone no further and I feel that the episode has been quietly kicked into the long grass. These patients are casualties of a climate which puts a positive spin on what has happened in substance misuse management in recent years, but which is in fact deeply sad and bad for many. I have lost trust in the system – the same as many of my patients did very early in their lives. DDN December/January 2018 | drinkanddrugsnews | 13