We have been promoting the potential advantages of primary care-based drug treatment, including a reduction health inequalities and the stigma associated the use of drugs. Following a well-attended meeting in the summer to look at ways of promoting primary care-based treatment we will be publishing a series of case studies describing how primary care based drug treatment is working in different areas. The first case study describes how Gateshead is working with GP surgeries to provide drug treatment.

Primary care-based drug treatment in Gateshead

Background

Gateshead Recovery Partnership (GRP) was commissioned in Nov 2018 following a competitive tendering process by Gateshead Council. GRP is led by Change Grow Live (CGL) working in partnership with Recovery Connections and 6 Primary Care GP surgeries within Gateshead’s Clinical Commissioning Group (CCG).

The new service model was developed following an independent review completed by Gateshead Council which explored the gaps in provision. The main areas of change for the new model were to encompass the following:

• Removal of existing shared care contracts and re-introduction of partnership working with primary care via sub-contracts with provider (CGL)
• Introduction of enhanced recovery support and quasi rehab
• Increased clinical provision across the borough of Gateshead, including community detoxification for alcohol
• Wider geographical spread of locations offering pharmacological interventions
• Better relationships with wider Primary Care Networks to provide brief intervention, and more integration with local secondary care including presence within the local hospitals
• More connected partnership working with police, probation, local healthcare primary and secondary, housing etc on a daily basis to discuss the care and treatment planning for those service users involved in multiple agencies and including attendance at strategic board meetings and local operational meetings

The contract was awarded for 4 years with a potential extension of 1 + 1 + 1 (this has just been extended for 1 year only last month).

Scheme structure

As a subcontractor within GRP, Recovery Connections deliver recovery support interventions and the Quasi-Rehab.

CGL sub-contract 6 primary care GP surgeries in Gateshead. CGL contract opiate substitute therapy (OST) services in primary care settings for people who use opiate-based substances. The aim is to work holistically with service users, and the wider partnership, to provide personalised care and to achieve self-identified goals in an individual’s treatment plan. Plans are tailored to need and provide an equal focus on recovery, as well as harm reduction.

The partnership employs a Primary Care Lead who ensure all key messaging and connection is made between GRP and the wider Primary Care Networks. Training is delivered to primary care within their scheduled time in/ time out sessions as well as any significant changes to guidance.

There are clear pathways between primary care and specialist services should there be a need to transfer services users back and forward to each service dependent on their need.

Service users are seen in the GP surgeries supported by a Multi-disciplinary Team (MDT) to ensure visible recovery and wider access to wrap around services. Every person is allocated Recovery Co-ordinators attached directly to these surgeries.

The contracts are managed by the service manager with regular Partner Optimisation Board meetings and sub-contractor meetings to discuss progress, effectiveness with a reporting framework in place to support the wider health needs within primary care e.g. blood borne virus data, and drug related deaths information.

Practices are paid a financial amount per service user quarterly and invoice GRP direct.

Benefits

Working in partnership with Primary Care has allowed for additional opportunities which may not have been available previously. This has included vaccination programmes for covid and flu, delivering clinics on site for our service users. During covid, and with the utilisation of pop up vaccine clinics alongside Gateshead CCG and Basis Homeless Services, GRP were able to vaccinate 134 of our service users.

GRP have also been able to jointly bid for funding for cross agency roles. For example, we now have a dedicated Nurse Practitioner working with homeless populations and most recently CGL provide placements for GP registrar training with a 6 month rotational placement, supported by our GP and Primary Care Lead.

Further benefits include;

• It allows the partnership to provide a more holistic offer to service users, ensuring the wider health needs are met.
• Improved access to opioid substitute treatment via primary care. There are currently 265 service users within the primary care system who are working in collaboration with their GP and GRP
• Improved relationships between primary/ secondary care services and with substance misuse
• Case recording onto GRP data system (CRiiS) and GP system (EMIS). This allows colleagues in primary care and vice versa to ensure accurate records can be reviewed at point of appointments and communication is timely, effective and accurate.

Andrew Martin, National Integrated Care Systems (ICS) Lead and Sarah Beat, Performance Manager,  Change Grow Live