Our chance to influence Bradford’s drugs and alcohol services

Bradford Care Alliance has been established so that Primary Care can have a strong cohesive voice in areas where services are being re-commissioned on a “population health” basis as has been the case with diabetes. Under the terms of our shareholder agreement part of the process for getting involved in any new service is to bring it to the members and get agreement that this is an area appropriate for BCA to act on behalf of our members.

Drugs & Alcohol – A New Opportunity for Primary Care

A new opportunity has arisen which the BCA board believe is appropriate for us to be involved in and the board is now seeking that formal approval from the members to do this. This is for a new drug and alcohol service that is being commissioned by Bradford Council. The council are looking to commission this from a single provider in the same as way as they did for sexual health and have recently gone out to tender on this. This tender is the result of a review of all the services provided currently and the development of a service proposal by the CCG and council leads in these areas.

The Planned Drugs & Alcohol Partnership

An alliance of providers locally including the Bridge Project, Addaction, Project 6 and hopefully Bradford Care Alliance is forming together to bid for this contract. This strong alliance of well-respected, established local contractors will be very hard to beat. Having a Primary Care presence in that alliance influencing how services are delivered will hopefully help avoid some of the issues that arose with the sexual health contract and Locala by being able to influence the services from the outset.

Commitment to Involvement does not mean your Practice will have to provide the service

Other than a very few practices who provide some specialist services there is very little involvement currently from Primary Care in the delivery of these services. One of the key features of the new specification is that the services should be far more embedded in Primary Care. To be clear from the outset this does NOT mean that practices will be required to deliver these services directly and this new contract is unlikely to create any direct financial gain for practices from provision of services. Our role in this alliance will be one of a strategic partner rather than a delivery partner. Practices with a specialist interest in these services will have the opportunity to continue this via a sub-contract arrangement with the alliance (directly). It would also be hoped that any practices that do want to get more involved will have the opportunity to do, and that most us would get the opportunity to host these services within our practices where appropriate so that the links with our alliance partners to enable better joined up care for our patients close to home.

Making Drug & Alcohol Services work for Primary Care

Graham Sanderson, who is taking a lead on this for Primary Care (wearing his provider hat rather than as CCG lead) has been very insistent from the outset of discussions with other providers that the following “Primary Care clause” is key to any alliance that we have:

“An acknowledgement that interventions with demonstrable impact on physical & mental health have parity with those on substance misuse, and that the development of the interface between these three elements is key to the future service.”

Graham goes on to say that:

“As partners we will have a real say in directing service provision to individuals and patient cohorts who we identify as needing intervention – preventative and treatment. This should improve the health of the individual patient, reduce use of Primary Care clinical time, and contribute to a reduction in unplanned admissions – if the Partnership isn’t achieving this Primary Care (via BCA representation) are on the inside to make it happen, rather than sending RAPS to a detached Provider.”

What could a new Drugs & Alcohol Service look like?

Other key features of the model being proposed by the alliance of providers are as follows:

  • A Single Point of Contact telephone referral and enquiry system.
  • Use of SystmOne across the partnership.
  • A commitment to a vision to move more resources over time into prevention and early intervention.
  • A bespoke offer to GP practices, providing onsite services that encompass the full range of interventions, from brief advice, extended brief interventions through to structured treatment and shared care for the range of substances: i.e. alcohol, heroin, NPS, addiction to medicines etc. Basically a model where GPs could opt into whatever services they want to see delivered in their practice. Many for example would want to see brief interventions for alcohol but a much smaller number would be interested in shared care for opiate users.
  • Comprehensive training programmes for the whole PHCT team.
  • Offering some elements of group work in Primary Care/community venues.
  • An acknowledgement that interventions with demonstrable impact on physical & mental health have parity with those on substance misuse, and that the development of the interface between these three elements is key to the future service.

What we are asking now of Members

The Bradford Care Alliance board support BCA being partner members of this provider alliance in submitting a bid for this tender. The board is seeking approval from members to be so involved as set out above. Unfortunately timescales are short with work on the tender submission well under way. Whilst a full shareholders meeting would be ideal to discuss this and formally vote on this it is felt that involvement in this project on the basis set out above seems a sensible and natural route forward. Therefore at this stage it is proposed to see if any strong objections are raised at this stage via an email debate. The views of members are of course crucial. If it becomes clear a meeting is needed we will call one, otherwise we will formally ratify BCA involvement and discuss further at the next members meeting in October.