NMPs in Substance Misuse Services – An increasingly visible force

Posted by guest blogger Rosie Mundt-Leach, Head of Nursing for Addictions South London and Maudsley NHS and Membership Secretary, National Substance Misuse Non-Medical Prescribing Forum (NSMNMPF)

Non-Medical Prescribers (NMPs) have become an increasingly visible force within the substance misuse treatment staff mix. Although the majority of NMPs are nurses, there are also a significant number of specialist pharmacists who have taken on the prescribing role. Until 2012 NMPs were subject to legal restrictions in their practice and were only able to continue prescribing controlled drugs for the treatment of substance misuse and could not initiate new treatment programmes. The law changed in 2012 and now (with the exception of highly specialised treatments such as diamorphine) NMPs can play a full role in prescribing treatments across all addiction care pathways.

The commercial diversification of the substance misuse sector has enabled NMPs to find roles in every type of provider organisation. The Forum has members employed in the NHS, third sector, community interest companies and the independent sector. NMPs are working in community pharmacies, acute hospital liaison, prisons, community drug and alcohol teams, in-patient detox/rehab and primary care.

The widening of the scope of the NMP role has contributed to the increasing popularity of Non-medical prescribing, but arguably the main factor driving the growth of numbers is the relatively lower cost of employing NMPs compared to doctors.

Public Health England guidelines – Non-medical prescribing in the management of substance misuse – looks at the practicalities of having NMPs working in services and some of the strategic issues that commissioners and managers need to consider when training or employing NMPs:

http://www.nta.nhs.uk/uploads/nmp-in-the-management-of-substance-misuse.pdf

In my role as Head of Nursing for South London and Maudsley NHS Addictions services, I see the benefit of having NMPs every day. We have NMPs in our shared care services and CDATs and they are able to provide a comprehensive treatment programme for patients at all stages of treatment. We now encourage as many eligible staff as possible to undertake the training and find that those who do, increase in their confidence and enjoy the additional responsibility. The services definitely benefit from having an increased flexibility in staffing structures. They certainly haven’t replaced doctors but the increased prescribing workforce means we are able to target resources where they are most needed to meet the needs of people in treatment.

Qualified and trainee NMPs have a free forum for professional education and support, namely the National Substance Misuse Non-Medical Prescribing Forum, which has its own website:

http://www.nmpsm.org/

There are members in England, Scotland, Wales and Northern Ireland and associates in Eire.

– Rosie Mundt-Leach, NSMNMPF Membership Secretary

Return of the “Post Code Lottery”

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Feb-2016) appears below with kind permission from DDN.

My practice has long had a reputation in Birmingham for working with people who use drugs and alcohol, and who are much more complex than those seen in most shared care practices. We were recently approached by the newly commissioned service to see if we would treat a man whom – for a variety of reasons – wasn’t engaging with the main drug service. This has happened before and no doubt will again; as whilst a commissioned service is designed to deliver a good level of service to the majority of its clients, by virtue of commissioning arrangements it has to work within defined parameters.

So what happens when a client falls out with a service, or a service falls out with a client! It is a fact of life that we don’t see eye to eye with everyone and sometimes irreconcilable differences develop, in my experience within drug and alcohol treatment this is frequently due to intransigence in both parties. However the service user can’t fall back on or blame “procedures”, “staff shortages” or “we aren’t commissioned to do that” statements!

Previously when drug and alcohol treatment was part of health services, a service user would usually be placed in an alternative treatment system bearing in mind that access to NHS treatments should be fair, equitable and available to all. However since Public Health has moved into the realm of local government this seems to have changed. All councils will commission drug and alcohol services but I suspect they are less willing to fund the “square pegs” that may need to be sent to a different service. I have come across a number of clients now who simply fall through the cracks and due to a breakdown in the relationship with the “only show in town” are outside of treatment and despite wanting help, they can no longer access it.

We are fortunate in Birmingham to have a number of highly skilled GP practices as well as the central service for drug and alcohol treatment, so it is usually possible to accommodate most clients who have a problem with one provider, in an alternative service – albeit that a client may need to embrace change within themselves too for the arrangement to work.

I worry about what may happen elsewhere in the country if this diversity isn’t available, how many people are excluded from their local treatment provider [for whatever reason] and simply not able to find an alternative? And what should we do about it?

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.