Post-its from Practice- Time to change

We must stop talking numbers and develop a real interest in positive health outcomes, says Dr Steve Brinksman

During October each year we have the annual SMMGP conference, which this year was in London. It was our first conference since becoming a registered charity and as such it was followed by our first ever AGM.

 The day was well attended as always and had a stimulating line up of speakers and challenging topics. Taking part in a question and answer final session with Linda Harris from the RCGP and Pete Burkinshaw, chaired by Post Its from Practice’s previous contributor, Chris Ford, it became clear to me that shared care as we know it must change. To clarify, I do genuinely believe that a primary care based treatment system cannot be effective if it entails no more than a GP signing prescriptions for OST. And whilst I know this is not what happens in most shared care schemes, to date this is what our contracts have usually paid us for. 

 We are moving into an era where public health is to be the driving force behind drug and alcohol commissioning, albeit, I hope, with strong links with progressive minded and proactive clinical commissioning groups. We must recognise that those of us in primary care working with drug and alcohol users need to show the added value of the care we deliver above and beyond the provision of a prescription. If we are not able to do this – especially in a landscape of competitive retendering of services – then economies of scale will dictate that providers consider reducing costs by employing centrally based doctors rather than the multi-practice approach currently found in many areas.

 So not only do we need to loudly proclaim the obvious benefits of primary care treatment both as provider and users of these services, but also we need to highlight the less obvious but still tangible benefits that occur as a result of this.

 Primary care based treatments offer easy access to locally based programmes that can be delivered by practitioners with an intimate understanding of the local community – services that are delivered in a non-stigmatising setting and that can accommodate the complexity of poly-drug use in people who often have other co-morbid medical conditions.

 The time has come for us to move away from the blunt instrument of a payment system that is purely based upon the number of patients prescribed for, and I issue a challenge to both primary care practitioners and more importantly to commissioners to develop mechanisms that measure the positive health outcomes achievable in primary care and stop simply counting ‘bums on seats’.

 Shared care has contributed dramatically to improving services, something we can be proud of. It may well now become a historical note in the evolution of drug services, however I believe in transforming it – we can usher in an era where primary care is acknowledged as a major provider of evidenced based, recovery orientated high quality care within an integrated treatment system; and one that keeps the individual at the centre. It is a place where those wishing to embrace abstinence, and where those whose recovery ambitions might entail many years in treatment, can both be supported. 

 Steve Brinksman is a GP in Birmingham and clinical lead of SMMGP. He is also the RCGP regional lead in substance misuse for the West Midlands