an opportunity to really deliver Shared Care Anna

an opportunity to really deliver ‘Shared Care’ Anna Livingstone Ruth Walters Chris Ley TH Substance Misuse Clinical Lead TH GP Care Group Director of Quality & Assurance Network Director

History Pre Millennium ‘Tough on crime, tough on causes of crime’ Blair Govt and Drug Tsar Halliwell. EL&C LMC negotiated funded shared care scheme for OST to support patients and GPs 2004 GP contract-first TH enhanced service Drugs/OST shared care 2010 alcohol E/S added > then joint NIS Alcohol screening/advice Drugs/OST shared care NHS commissioned with DAAT at LBTH 2017 - P-RESET Health goal and partnership working in care Problem alcohol and drug focus OST shared care. ELFT RESET single point of entry to treatment at Mile End. LBTH DAAT & Public Health commissioned.

Context National Drug Strategy 2010 two overarching aims of the strategy regarding treatment: • Reducing illicit and other harmful drug use, • Increasing the numbers recovering from dependence National Alcohol Strategy 2012 • four key objectives underpinned by a recovery orientated approach to treatment Tower Hamlets Substance Misuse Strategy 2016 -19 The strategy builds on the existing ‘three strands’ approach to tackling drugs and alcohol in Tower Hamlets through: Prevention and Behaviour Change Treatment Regulation

New P-RESET Service LBTH Public Health & DAAT have commissioned an integrated approach to problem drug and alcohol use based in local General Practice for all Tower Hamlets registered patients (with the exception of those registered with Health E 1 homeless practice provided by ELFT) • Opioid substitution therapy (OST) in general practice in Shared Care with RESET Treatment Service care coordinators for ‘less complex’ people with opiate/opioid dependency as part of broader treatment. • Alcohol screening of longstanding patients at a population level, using AUDIT C and if score 5 or over, full AUDIT, identification of problems, brief advice and referral if appropriate. NHS contract requires NP assessment. • Primary care focused Annual Health Check and Health Action Gaol with Plan for those in treatment from RESET (ie currently on National Data base - NDTMS) for those in treatment either for opiate and or crack problems or for alcohol problems who have had an Audit score of 16 or more in the last year – Shared Health Care beyond script.

New P-RESET Service CLINICAL STANDARDS Competencies: • Clinicians should be competent to deliver an evidence-based approach to the treatment of substance misuse in primary care • Free e-learning is available to all healthcare professionals via the RCGP website • At least one clinician in each practice should have the RCGP part 1 certificate in substance misuse, and the RCGP certificate in alcohol management, or exceptionally equivalent qualifications and experience • All prescribers of OST should have at least the RCGP part 1 certificate or approved equivalent Safe Cover: • Ensuring safe cover for prescribing, Practices (or Networks) need clear arrangements for cover of planned and unexpected absence of clinicians. • For safety, this service will be provided within the NORMAL WORKING HOURS of general practice

New P-RESET Service Information Sharing • RESET inform all service users that they will share data with their GP • We are able to share data with RESET for anything related to direct care for an individual Practice Register • Monthly reconciliation with list sent from RESET 1: of those on the NDTMS register and of those 2: in treatment for opiate/crack use and/or alcohol (Audit 16 or over).

New P-RESET Service The Finances- Headlines £ 95% of Money Paid up front each Quarter Extra Money per month for OTS per patient (uplift from £ 31. 94 per month to £ 35 per month from old NIS) Cost of Mobilisation Training Courses paid/organised through CEPN Incentive for Practices - Data up load Locality Substance Misuse Leads No targets before April 18 – Baseline collection

The Targets

New P-RESET Service The Mobilisation Team: Anna Livingstone TH Substance Misuse Clinical Lead anna. livingstone@nhs. net Ruth Walters TH GP Care Group Director of Quality & Assurance ruth. walters@nhs. net Nicola Hagdrup TH GP Care Group (Deputy Director –outgoing) nicola. hagdrup@nhs. net Chris Ley Network Director chrisley@nhs. net Ekramul Hoque CEPN Training Manager ekramul. hoque@nhs. net

New P-RESET Service