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drinkanddrugsnews
| June 2013
RCGP/SMMGP |
Primary care conference
www.drinkanddrugsnews.com
‘J
oining the dots’ was the theme of the Royal College of General
Practitioners’ annual primary care conference. As GPs and health
workers gathered in Birmingham to hear speakers examine the critical
role primary care plays in working with drug and alcohol users, their
families and carers, it became apparent that while the dots were being
joined in many areas of clinical expertise, the overall public health picture was far
from complete.
Would drug and alcohol treatment survive the maelstrom of competing
priorities now commissioning had been handed to local authorities as part of
Public Health England (PHE)?
‘We worry that our clients will be low on the priority list,’ a delegate told
Anna Soubry, public health minister, in a session that she turned over entirely
to Q&A. ‘In the last 20 years we have had improved drug services, but the top
priority for politicians is potholes in the road.’
Soubry replied: ‘I have faith in local authorities to do the right thing. For
example, teenage pregnancy rates are as low as they are, and dropping, because
local authorities worked with health authorities. Drug services can be the same.
The robust partnerships betweenmany stakeholders, including police and housing,
will help councillors understand that public health coming back to local authorities
gives them both great responsibilities and opportunities for their local area.’
Rosanna O’Connor, director of alcohol and drugs at PHE, said that drug
recovery and the alcohol agenda would be one of the top priorities that PHE
would track and monitor on a regular basis. The joint alcohol and drugs
function would include prevention, treatment and recovery and would ‘hold
the banner for evidence-based practice’, she said.
With local structures ‘shaping up as we speak’ a key piece of work for PHE
was to support local authorities in altering the behaviour of local communities.
But with many health and wellbeing boards prioritising alcohol over drugs,
she warned of the need to be ‘mindful’ that ‘other public health priorities may
prevail at local level’ now that the drug treatment budget was proclaimed
‘unringfenced’. ‘We need you to keep drugs and alcohol on the agenda of health
and wellbeing boards,’ she said.
A workshop session on ‘commissioning in the new public health
environment’ provided an environment for airing concerns.
‘Should we be dancing in the street at the chance to influence the localism
agenda?’ asked SMMGP’s Kate Halliday, who chaired the session.
‘It’s time to fasten our seatbelts,’ said Gill Burns, shared care manager at
Tower Hamlets clinical commissioning group (CCG). ‘Health and wellbeing
boards have all been formed in different ways,’ she said. ‘They haven’t really
firmed their agendas up.’ With different power bases in each area and the
threat of more cuts to come, there was a risk that money could be moved away
from patient choice. What was needed was a framework that meant the
relevant voices could feed into commissioning reference groups. ‘It’s about
getting smart,’ she said, ‘and thinking of integration and cooperation with our
public health colleagues on things like sexual health and mental health. There
are opportunities if we get smart.’
Jim Barnard, manager of Inclusion Drug and Alcohol Services, gave a provider’s
perspective of the commissioning environment. Contrary to the expected scenario
of more integration, simpler service specs, more focus on outcomes and the
achievement of financial savings, it was a ‘messy picture’ in reality, with ‘massively
reduced commissioning teams in some areas’, complicated service specs, and
complete disregard of TUPE in some tender notices.
Other delegates added their concerns. ‘In Sunderland there’s no shared care
– we’ve built informal shared care for alcohol,’ said John Devitt, CEO of
Counted4 CIC. ‘Understanding of drugs and alcohol has disappeared from
tenders and this is dangerous… it’s not joined up.’
Dr Joss Bray of the Huntercombe Group said commissioners were turning
their backs on residential rehab as expensive, compared to daycare – the only
option in the North East. ‘If you don’t want that, that’s it,’ he said. ‘What
happens to people who need something else? It’s cheaper for local authorities
to have deals with one or two providers to get a better price.’
Dr Anna Livingstone, a GP in Tower Hamlets, said welfare cuts meant many
more families would be affected, accentuating the divide between ‘poor people
and rich drug companies profiting. There are conflicts of interest everywhere –
we need to be clear that our service users deserve services,’ she said.
Dr Tim Horsburgh, a clinical lead of adult services in Dudley, said it was
important to be clear about the difficulties. ‘The amount of money in deprived
urban areas is going to be reduced. An unringfenced budget for drug users isn’t
going to fly very far. There’s local talk of evicting drug users – we’re facing a
tidal wave that’s going to be very difficult for councils to cope with. Our service
This year’s GPs’ conference had the
tricky task of linking primary care
to each element of the new and
uncertain public health agenda,
while urging colleagues to keep
calm and carry on.
DDN
reports
JOINING THE DOTS