Kate Halliday, SMMGP Policy and Development Manager
In my last blog post (“We must act now to secure the future of primary care based drug and alcohol treatment“) I argued that existing Locally/Nationally Enhanced Service (NES/LES) contracts have largely failed to evidence the range of recovery focused outcomes that primary care can achieve. I also suggested that we need to engage with local commissioners, including Health and Wellbeing Boards, Clinical Commissioning Groups and Police and Crime Commissioners to encourage ongoing commissioning of primary care treatment. But how can we do this?
Comments on the last blog post pointed towards a valuable resource that primary care has to support this: the template. For those not familiar with templates, they are a computerised list of interventions that clinicians can pull up when seeing specific patient groups, and they are used widely across a range of health issues in primary care. So when a primary care clinician sees a patient with diabetes, they will more than likely pull up a template that suggests a range of actions including eye examinations and checking injection sites. The template acts as an aide memoir, allows clinicians to see when previous interventions (e.g. test results) were carried out, and provides a structure to easily audit interventions with patient groups.
Perhaps because of the way primary care drug and alcohol services have been commissioned to date, the use of templates has not been wide ranging in the field. However, the template offers a number of advantages and may answer some of the criticisms, sometimes unfair, that are levelled at primary care. A common complaint of primary care drug treatment is that GPs ‘just sign scripts’ and ‘don’t see patients’. A template is able to record a full range of activities and interventions which would evidence exactly what interventions are being carried out with patients by the primary care team, and how often. It could in fact highlight much of the value for money that primary care offers, in particular regarding health interventions, which can be difficult to achieve in specialist settings.
So regarding a patient receiving treatment for drugs or alcohol, interventions that are being carried out but are not necessarily currently recorded include sexual health interventions such as contraception, smears, sexual health advice; screening and immunisation; mental health screening and intervention; smoking cessation advice; blood pressure monitoring… the list goes on. At a time when opioid users are ageing, increasingly with comorbid health problems, primary care is well positioned to deliver a range of health interventions to a group who have often had poor contact with healthcare services. And with the increasing health issues related to alcohol, templates may be a valuable tool for evidencing health interventions amongst problem alcohol users. There is no reason why other recovery focussed interventions such as advice regarding peer mentoring services, education and housing support could not be included, as templates can be designed locally to fit the specific needs of each service.
And measured against time, these interventions could form the basis of an outcomes approach that the government and commissioners are seeking. Audit of templates could evidence for example, increased numbers ceasing smoking, and increased uptake of immunisations, both of which are public health outcomes.
Perhaps use of a locally agreed template could be part of a solution to replace the outdated LES/NES contracts? This would begin to evidence the true value primary care offers, which has largely been hidden, and would also provide assurance to commissioners that the outcomes they are commissioning for are being achieved. As the LES/ NES contracts come to an end in April 2013 this is a good time to start to consider what the new contracts will look like. It is these sorts of arguments we need to be taking to local commissioners.