Home Affairs Committee - Drugs: Breaking the CycleWritten evidence submitted by Substance Misuse Management in General Practice (SMMGP) (DP126)

Summary of Main Points for the Committee to Consider

The treatment of problematic drug and alcohol use has always been an emotive subject and like many complex issues has no simple solutions. For many years England has had an effective and pragmatic drug policy that has acknowledged the known evidence—getting people who use drugs and alcohol into treatment to prevent premature death, reduce offending and provide respite from the repetitive cycle of daily illicit drug use.

A more recent focus on the concepts of recovery is welcomed, albeit with certain caveats. Recovery needs to be focussed in the light of each individual’s need and not as a statistical construct in which one policy size fits all. We believe the opportunity exists to enhance the existing good work of current and previous drug policies and provide a first class holistic treatment system by embracing these concepts. At the same time there are several threats and we are concerned that the siren calls of principles over evidence could destabilise the lives of many who have benefited—and continue to benefit—from their current treatment.

As well as the ideological challenges there are many practical obstacles in the light of current fiscal policy and the proposed changes within the NHS commissioning structures that will move the field primarily into the public health setting.

Some of the areas that we believe will pose challenges are set out in more detail below:

1.Disbanding of the National Treatment Agency for Substance Misuse and its role being moved into Public Health England, and as part of this process a move towards localism. We fully support the concept of local areas being able to produce solutions for their own unique problems, however there are many issues common to all areas and there is a risk that a loss of national direction and framework will allow disinvestment both strategically and financially in some areas.

2.Removal of ring fenced funding and the impact on those who are most stigmatised. Despite the fact that many of the health problems impacting on society today have a significant “lifestyle” component, there is yet more stigma attached to those with drug and alcohol problems and the loss of ring fencing for funding will inevitably have a negative impact in some areas, due to competing priorities for funding at a local level.

3.Legal frameworks—drug and alcohol treatment has often been seen as separate mainly due to the different legal frameworks related to their use. Divisions like this are unhelpful and it also become further blurred when we consider the increasing availability of new psycho active substances (legal highs) which often pass from licit to illicit use by legal decree. The issues that matter are around the problematic use of all drugs, their impact on an individual’s physical and mental health, ability to work, family and other relationships and the cost to society. Future drug policy needs to be framed around all substance misuse harms.

4.Commissioning—the impact of the rebalancing of the treatment system, including the recommissioning of services. The proposed changes to the NHS outlined in Liberating the NHS with the formation of primary care based Clinical Commissioning Groups risks creating a disconnection with the commissioning of drug and alcohol services via Public health England. Despite drug and alcohol treatment not being part of core GMS services for GP practices, large numbers of GPs have engaged in working within this field and the possibility exists that this will be lost when the proposed changes take place. We believe that meaningful recovery for individuals takes place within the communities where they live and that having recovered, they act as a beacon for others to follow. The normalisation that happens by being part of a primary care treatment system is hugely influential.

5.Payment by results (PbR) in primary care based drug treatment—this outcome measure is being piloted in several areas and whilst measurable positive outcomes are important, it risks oversimplifying a complex issue. There are many people who are cared for over long periods in primary care, who are severely affected either by their substance misuse, or who have turned to drugs and alcohol as a result of complex problems. A system that financially rewards services that may “cherry pick” those individuals they perceive as having more “recovery capital”, compared to primary care that commit to seeing all for as long as necessary, is flawed.

January 2012

Prepared 8th December 2012