Dr Neil Kerfoot

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Dr Neil Kerfoot

• Drug Lead South Glos PCT/DAT
• GPwSI Drug Misuse
• Neil.kerfoot_at_GP-L81063.nhs.uk

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Prescribing How to Deliver?

• Where we used to be?
• What we did?
• How effective have we been?
• What's still to do?

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Where we used to be?

• Pre 1990 GPs were prescribing in isolation
  sporadically across the patch
• 1 statutory service Drug Worker into 1 practice 1
  session per week
• Most patients on W/L for Stat sector prescribing
• Caring and well meaning GPs not supported
• BUT in general GPs in my area did see prescribing
  for opiate users as a GP service Why?

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What we did?

• We had a DAT dynamically led with a vision to
  create a service
• We had an interested GP lead
• We had funding to provide shared care
• We had a DAT prepared to listen and learn about
  general practice and how it worked
• We had a non statutory provider (BDP) that wished
  to expand what it offered in our area

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What we did?

• Most importantly in 2001
• we set up a SCMG

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What we did?

• Using Orange book wrote some local guidelines
• Offered all practices the chance to have a shared
  care worker attached to the practice
• Set up regular training events for GPs and
  invited shared care provider along to these
• Despite all of the above
• We still had interested and committed GPs!!

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What we did?

• Looked at the service and audited its effects
• Shared this audit with GPs and used the results
  to influence funding decisions at PCT level to
  expand the service
• 23/30 practices offered shared care
• Still had a gap in provision so looked to the PCT
  for an answer

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What we did?

• Amazingly they listened ( ratings!)
• Provided additional funding for a sessional GPwSI
  clinic in North of patch
• This started Nov 2005
• Complete coverage with GP prescribing for 245
  patients

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How effective have we been?
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SGDAS figures from Oct02- Mar03
Total spend on drugs alcohol fell from
83,529/month to 27,486 (67 ) 53 in
injecting and 65 in episodes of drug
alcohol use
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SGDAS figures from Oct03- Mar04
Total spend on drugs alcohol fell from
85,000/month to 29,750 (65 ) 54 in
injecting and 28 in episodes of drug
alcohol use
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Whats it like for SEG PCT patients addicted to
opiates

• 23 out of 30 practices offer a shared care
  prescribing scheme
• 7 practices have access to GPwSI clinic
• 25 separate pharmacies offer supervised
  consumption
• SGDAS have capacity to support 120 ½ hour
  sessions to provide support for patients being
  medically treated
• 70 of prescriptions are thought to be for
  maintenance

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How effective have we been? 2005/06 data

• Average age 30 yrs.
• Drug use average 7 yrs before Rx
• Average methadone dose active Rx 37.8ml daily
• Average MMT dose 39.3ml
• 25 being prescribed benzodiazepines

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How effective have we been? 2005/06 data

• 50 supervised consumption
• 65 urine tested in past 6m
• 50 have no illicit opiate in last urine
• 51 offered Hep B screening
• 46 offered Hep C screening
• 33 full hep B vaccination
• 14 partial hep B vaccination

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• The audit has allowed us to look at each practice
  and write to them suggesting an action plan for
  2006-7
• This will be followed up in year by a meeting
  with the Shared Care manager, Shared Care worker
  and all relevant GPs. (PCT pay for this 100)

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Hopefully

• Once the practice has a care plan they may work
  towards their goals.
• Lapse it inevitable but with regular shared care
  input hopefully we can stave off full relapse
• Need to focus on BBV testing and immunisation
  this year
• Benzodiazepines?

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What's still to do?

• Now developing aftercare with a specific worker
  involved in helping service users to get back
  into education and work
• Home detox worker just started
• Drug users are re accessing services following a
  fall off after recommissioning
• Need to address woeful BBV data
• Questionnaire asking service users what they
  think of service and what could be improved

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What's still to do?

• Most importantly I believe effective care
  planning keeps everyone engaged in treatment
• This includes the GPs as we need to know what the
  short and long term goals of the service users
  are so when goals are achieved we get some
  positive vibes this keeps us interested!

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• My own view of drug services is that the ride
  is bumpy at times but rewarding when we get it
  right
• And in general we are beginning to get it right
• Thanks for listening