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NETWORK A national newsletter on substance misuse management in primary care network NETWORK 34 APRIL 2012


Responding to change: the challenge for primary care


There is a tide in the affairs of men. Which, taken at the flood, leads on to fortune; Omitted, all the voyage of their life Is bound in shallows and in miseries. On such a full sea are we now afloat, And we must take the current when it serves, Or lose our ventures.


Julius Caesar Act 4, scene 3, 218–224


There are many changes afoot in the health and social care sectors and substance misuse services are mirroring this. In the 20 years I have worked with drug and alcohol users services have undergone dramatic development. I believe that those who commissioned and worked in these services should be proud of the significant improvements they have wrought; the changes in attitude towards the treatment of drug and alcohol users and the large numbers of people brought into treatment have been of immense benefit and there are many people alive today because of this.


In this issue


Steve Brinksman discusses the callanges facing primary care treatment in his article on page 1.


Owen Bowden-Jones describes the changing nature of drug use and how his London clinic has met the challenges of working with people who use club drugs. Page 3.


Asking drug and alcohol patients how to improve communication with their GP revealed many common threads; some things that worked well and others that could improve their treatment experience, as Claire Brown and Chris Ford explain. Page 4.


Swanswell describe how their primary care model has developed to provide a full range of recovery focused treatment in Birmingham. Page 5


Paul Hayes sets the scene for the move of funding to Public Health England. He warns primary care that now is not the time to rest on our laurels. Page 6.


Elsa Browne describes the benefits of following us on Twitter, and SMMGP’s journey into using social media. Page 7.


With the increasing emphasis on abstinence in the drug treatment field, Nat Wright explores the evidence base for opioid detoxification. He compares what happens in the community with what happens in prisons, with some interesting results. Page 9.


Judith Yates provides advice to a GP who is working with an older drug user. Page 10.


See the latest information on courses and events on page 12. We hope you enjoy this edition. Editor


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At the same time I embrace the concept of recovery albeit that it is framed within the definition of an individual’s own journey and not simply a one size fits all approach. Recovery has always been an important part of good treatment systems even if sometimes it was lost in the shadows of counting numbers in treatment. One of the significant issues we face is to maintain the hard won yards in working with drug and alcohol users in primary care; large numbers of patients are treated in GP surgeries and many more GPs and other primary care practitioners now see this as an important part of their role. This expanded, better trained and motivated workforce will be vital as we embrace the challenges ahead such as tackling the agendas around alcohol use and addiction to medicines which would both fit readily into the primary care setting, as well as the challenges of the newer illicit drugs being used as raised in Owen Bowden-Jones’ article on club drugs on page 3.


It has been suggested in some areas that primary care be decommissioned from the treatment system. Turning back the clock to an era when GPs were discouraged from working with those who use illicit drugs and having everyone seen in “drug clinics” is not only retrograde but doesn’t fit in with either the NHS commitment to moving care closer to home or the individual choice about treatment agendas. This bizarre time warp feeling is added to by some suggestions that we should bring back time …continued overleaf


1 NETWORK 34.indd 1 03/04/2012 14:33


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