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Issue 9 September 2004
A national newsletter on substance misuse management in primary care
New GP Contract-
what you think
Questionnaire responses - vexed, perplexed and delighted
GPs whilst still unsure about the full impact of the new GMS contract, have given some
encouraging responses. Of the 200 of you who responded to last edition’s survey, a majority
of GPs believe the new GMS contract will lead to an increase or maintenance of drug
treatment in primary care. A third (32%) of our readers believe it will lead to an increase in
local treatment for drug users in primary care, while 37% believe it will lead to no change.
However, the SMMGP survey reveals a lingering anxiety among our
readers about the contract. 31% believe the nGMS will result in a
decrease in the number of practices prepared to treat drug dependency
locally. Possible indications of this can also be seen in the initial reaction
to the contract among practices. Although early days, when asked
whether the new contract had lead to an actual change in the number
What is treatment?
of practices prepared to treat drug dependency locally, 29% of you
Can you answer this to your patients’ satisfaction?
reported reductions compared to 8% reporting an increase, while 63%
Dr Gordon Morse gives a personal view on what substance
users should get from GPs. PLUS Alan Joyce reveals what
reported no change. 16% reported an increase in primary care
users want from GPs. Pages 4-5
investment, 73% reported no change, and 11% reported an increase in
secondary care investment - respondents did not indicate any alarming
Is buprenorphine useful for maintenance?
shift in the balance of resources from secondary care to primary care.
Chris Ford and Nick Lintzeris present evidence for the effective
use of this drug. Adapted from the 2nd edition of the
buprenorphine guidance. PLUS we ask is it safe to crush
NTA new contract survey responses
buprenorphine tablets in our new Pharmacy Page. Pages 5-6
GP anxiety about the nGMS is somewhat counterbalanced by an NTA
Under contract: how practices are dealing with the nGMS contract
regional survey of commissioners (May 2004) on the impact of the
First in series, we highlight a plan to offer local and
contract. A total of 117 practices in England will start to treat drug
national enhanced schemes in a key PCT area. Page 3 users over the coming financial year. Whilst the NTA believe the new
Cultural considerations – improving community engagement
GMS contract has not affected the trend of increased GP involvement,
Is your practice set-up to treat Asian heroin users and
the NTA survey showed four GP practices in England stopping
other minority ethnic groups? Jeff Fernandes reveals some
provision of treatment for drug users as a result of the new contract.
important considerations a service reaching out to work The NTA believe there are no grounds for complacency as such
with different cultures. Page 8
practices still have the potential to have a negative impact upon
neighbouring practices and increase the burden on local specialist
services. The NTA survey found that almost every DAT area was
News digest
planning to maintain the financial status quo through Local Enhanced
The latest news on the knock-on effect of Harold Shipman,
Services (LES) specifications with the majority of GP payment funding
NICE take on drug treatment, treatment numbers to rise coming from DAT pooled treatment budgets. There were only four
and SMMGP website a hit. Pages 2-3
examples given of PCTs providing part-funding although a further
Pharmacy Fix
three were currently exploring this option and another exploring PMS
Now a regular feature we continue the debate on
crushing buprenorphine tablets. Plus the new
advice section with ‘Pharmacy Fixit’. Page 6
Local commissioners are meeting the nGMS with a variety of responses.
Spotlight on Adfam
There is strong support for local commissioning with 42% reporting
Listening to the families of substance users. Page 7
locally enhanced services (LES) compared to 22% nationally enhanced
service (NES) arrangements, while 10% had both NES and LES and 24%
had other arrangements in place.
Books and key papers reviewed. Page 9
Dr Fixit
The SMMGP and NTA findings reveal some mixed but encouraging
Our GP fixes it for a GP unsure of buprenorphine
response regarding the new contract among primary care teams. Chris
maintenance prescribing and explains how to help an
Ford GP Adviser for SMMGP and advisory editor for Network said
Asian heroin user and his family Pages 10-11
“The nGMS contract is here to stay and we must ensure that we try to
Bulletin board
use it as positively as we can. If you have questions or uncertainties
Events and announcements not to miss. Page 12
share them with us; and if you are having trouble writing that service
level agreement ask as well, In this issue we give an example of one area
(Oldham) that has gone for a mixed NES/LES package. Future issues will
look at LES only NES only responses.”
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