Post-its from Practice
An ever-decreAsing shAre ?
One of the things I am most proud of in the 27 years I have been a GP is the way many working in primary care responded to the challenges posed by treating substance misuse and dependency , with the resultant growth in shared care services . In Birmingham , where I am based , the number of practices providing OST rose from 8 per cent to over 65 per cent in a decade . I now fear that all this progress is under threat from multiple directions and if lost , all that experience and enthusiasm
‘ I now fear that all this progress is under threat from multiple directions .’
Allowing shared care to dwindle is putting patients ’ all-round physical and mental health at risk , says Dr Steve Brinksman
will be very difficult to replace . The years of austerity have been hard for many , but the move of public health into local authorities has opened up drug and alcohol treatment services to far more financial constraints than if they had remained inside health budgets . Retendering and enforced cuts in existing contracts have left providers with no option but to make significant changes . Some have been forced to merge , and despite what is supposed to be a culture of ‘ localism providing tailored local solutions ’, the number of options has dwindled . It is hard to see services being awarded to small local third sector organisations in this climate .
Where providers have to make cut-backs , the cost of providing services from multiple primary care settings can seem expensive compared to operating out of one or two hubs with central prescribers and workers . ‘ Payment by results ’ targets , based on numbers completing and being discharged from OST , can also work against shared care with a perception that fewer complete treatment in primary care .
Given this , why am I so passionate that shared care should continue ? Most of the people I see who are on OST are incredibly complex – not so much from their drug use but as an ageing cohort with an array of physical and mental health problems . Many of these such as COPD , coronary heart disease , hepatitis C , renal failure , depression , anxiety and PTSD are chronic conditions that need long term support and management in a primary care setting . Engagement with treatment for these conditions can be erratic and by silo-ing off the OST into a specialist service , I worry that our ability to treat these people will be severely compromised .
If our aim is to provide holistic care and improve the lives of those affected by substance use then we need to commission services that deliver health , OST and recovery as a single package . Until then having an option for shared care treatment built into local provision at least gives the opportunity to some . It would be a sad day for me if , at the end of my career in general practice , shared care for people who use drugs had dwindled back to the minority interest it was when I first started out .
Steve Brinksman is a GP in Birmingham , clinical lead for SMMGP and RCGP regional lead in substance misuse for the West Midlands clinical eye strength in numbers
Could the problem of recruiting and retaining good nurses be solved by better networking opportunities ? Ishbel Straker makes the case
In the last couple of months , I have attended some really interesting conferences on addiction . I have had the privilege of spending time with colleagues in the field – consultants , doctors , psychologists , pharmacists , and a smattering of nurses . I came away from these learning and networking opportunities questioning where are all the nurses ?
Some weeks before these dates , I met with a nurse whose light had started to
‘ I challenge nurses and organisations ... to encourage attendance at addiction conferences and be inspired !’
fade . They had come to me because they felt a dwindling lack of passion for their vocation and hoped for it to be reignited . We spent time together , but whatever came from our meeting feels slightly irrelevant if we as nurses are not taking care of our passion and giving ourselves the time and space to allow it to continue to burn .
I really do feel a step towards this is networking and seizing opportunities to meet with colleagues in the field . So the question I ’ ve been asking myself is why aren ’ t nurses attending these functions – and my two guesses are workload and organisational opportunities .
If nurses are carrying huge caseloads of complex clients then I appreciate it may not feel like a priority to travel across the country to attend a conference – but I would say that it needs to be made a priority . I also understand that there are certain staff that naturally attend conferences , and I would suggest that organisations need to look at this and alter the focus so others get the chance .
I cannot stress enough the need for nurses to expand on their learning , meet other nurses with a passion for the field , and feel valued by their employer . I guarantee that when services make a point of doing this for their nurses they will see a cultural change within the workforce , including better retention .
Not only is it inspiring to talk to others who are going through the same issues as you , but it encourages best practice and gives an opportunity to shout about it .
So , I challenge nurses and organisations over the next six months to encourage attendance at addiction conferences and be inspired ! I hope to see you there !
Ishbel Straker is a clinical director , registered mental health nurse , independent nurse prescriber and board member of IntNSA
14 | drinkanddrugsnews | June 2018 www . drinkanddrugsnews . com
comment
Post-its from Practice
An ever-decreAsing
shAre?
Allowing shared care to
dwindle is putting
patients’ all-round physical
and mental health at risk,
says Dr Steve Brinksman
One of the things I am most proud of in the 27 years I have been a GP is the way
many working in primary care responded to the challenges posed by treating
substance misuse and dependency, with the resultant growth in shared care
services. In Birmingham, where I am based, the number of practices providing OST
rose from 8 per cent to over 65 per cent in a decade. I now fear that all this progress
is under threat from multiple directions and
if lost, all that experience and enthusiasm
will be very difficult to replace.
The years of austerity have been hard for
many, but the move of public health into local
authorities has opened up drug and alcohol
treatment services to far more financial
constraints than if they had remained inside
health budgets. Retendering and enforced
cuts in existing contracts have left providers
with no option but to make significant
changes. Some have been forced to merge,
and despite what is supposed to be a culture
of ‘localism providing tailored local solutions’,
the number of options has dwindled. It is
hard to see services being awarded to small
local third sector organisations in this climate.
Where providers have to make cut-backs,
the cost of providing services from multiple
primary care settings can seem expensive compared to operating out of one or two
hubs with central prescribers and workers. ‘Payment by results’ targets, based on
numbers completing and being discharged from OST, can also work against shared
care with a perception that fewer complete treatment in primary care.
Given this, why am I so passionate that shared care should continue? Most of
the people I see who are on OST are incredibly complex – not so much from their
drug use but as an ageing cohort with an array of physical and mental health
problems. Many of these such as COPD, coronary heart disease, hepatitis C, renal
failure, depression, anxiety and PTSD are chronic conditions that need long term
support and management in a primary care setting. Engagement with treatment
for these conditions can be erratic and by silo-ing off the OST into a specialist
service, I worry that our ability to treat these people will be severely compromised.
If our aim is to provide holistic care and improve the lives of those affected by
substance use then we need to commission services that deliver health, OST and
recovery as a single package. Until then having an option for shared care treatment
built into local provision at least gives the opportunity to some. It would be a sad
day for me if, at the end of my career in general practice, shared care for people who
use drugs had dwindled back to the minority interest it was when I first started out.
Steve Brinksman is a GP in Birmingham, clinical lead for SMMGP and RCGP
regional lead in substance misuse for the West Midlands
‘I now fear
that all this
progress is
under threat
from multiple
directions.’
14 | drinkanddrugsnews | June 2018
clinical eye
strength in
numbers
Could the problem of recruiting and
retaining good nurses be solved by
better networking opportunities?
Ishbel Straker makes the case
In the last couple of months, I have attended some really interesting
conferences on addiction. I have had the privilege of spending time with
colleagues in the field – consultants, doctors, psychologists, pharmacists, and a
smattering of nurses. I came away from these learning and networking
opportunities questioning where are all the nurses?
Some weeks before these dates, I met
with a nurse whose light had started to
fade. They had come to me because they
felt a dwindling lack of passion for their
vocation and hoped for it to be reignited.
We spent time together, but whatever
came from our meeting feels slightly
irrelevant if we as nurses are not taking
care of our passion and giving ourselves
the time and space to allow it to
continue to burn.
I really do feel a step towards this is
networking and seizing opportunities to
meet with colleagues in the field. So the
question I’ve been asking myself is why
aren’t nurses attending these functions –
and my two guesses are workload and
organisational opportunities.
If nurses are carrying huge caseloads
of complex clients then I appreciate it
may not feel like a priority to travel
across the country to attend a conference
– but I would say that it needs to be
made a priority. I also understand that
there are certain staff that naturally
attend conferences, and I would suggest
that organisations need to look at this
and alter the focus so others get the chance.
I cannot stress enough the need for nurses to expand on their learning, meet
other nurses with a passion for the field, and feel valued by their employer. I
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