There have been damaging changes in policy direction for alcohol and drug services since 2012 which have caused real problems on the frontline. One of the main issues has been the movement of drug and alcohol service funding from the NHS budget to public health budgets, which are held by local authorities. These budgets have suffered under the government’s local authority cuts, and this has reduced the funding for drug and alcohol provision. Faith in the recovery agenda has led to services being funded in a “payment by results” fashion, measured by the numbers of people able to recover from drug and alcohol dependency. This has further reduced the budget for services and has been very damaging to service users, who are now faced with an even narrower choice of treatment options.
In most areas of the UK, the budget has been cut such that services have been forced into constant exercises of restructuring. These have been costly, and have led to a reduction in the workforce. Often the most experienced staff are let go in order to meet budgetary targets. This has affected the efficiency with which services are able to respond to service users. (Fernandez J, 2017).
However, the main problem for drug and alcohol services has been the reduction in the provision of shared care, based in GP surgeries. This has led to NHS services in this area diminishing. By focusing purely on recovery, and allocating budgets accordingly, the wider health needs of drug and alcohol patients have been neglected.
Unless we rethink the recovery agenda policy approach, the health gains from primary care for patients with drug and alcohol issues will be lost as primary care will have a diminishing role in service provision.
One way in which general practice can play a more central role is by involving nurses more in the treatment of drug and alcohol patients. Experienced nurses in primary care can assess patients presenting to services and prescribe for a large range of complexity in primary care. This makes primary care more effective in the treatment of alcohol and drugs and it is also an efficient model, reducing the need for onward referral to specialist services and placing services provision closer to communities. It also makes use of already existing infrastructure and clinical resources.
This existing model, of nurses working in primary care to treat drug and alcohol patients, should be reflected in the guidelines. Working alongside GPs, shared care nurses are able to free up GPs to focus their attention elsewhere in primary care.
It is crucial that we retain experienced clinical staff. Higher paid and more experienced staff positions have been severely reduced in order to manage tight budgets. This loss has resulted in reduced clinical leadership, which in turn leads to reduced clinical supervision and poorer services. Training budgets have also been cut making it even harder to provide good and consistent clinical leadership.
We propose a proper debate around how to provide a sustainable and relevant shared care model for alcohol and drug treatment services. This should include how current services are delivered and how they can be improved. GP’s have an increasingly influential role in commissioning services and they will need to advocate for shared care drug and alcohol services to continue within their practices if they do wish to see them survive in the current climate.
Jeff Fernandez works for Primary Care Alcohol and Drug Service (PCADS), Islington, London.
Competing interests: None declared.
Acknowledgement: Thanks to Chris Sargeant, Senior Clinical Lecturer at Brighton and Sussex Medical School.