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| GP Liaison Scheme |
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| Drug misuse has always presented
itself at local clinics and surgeries; the response from GPs
has mostly been individualistic and unco-ordinated. There
are those who decide not to prescribe at all, those who do
willingly, and those who do but often inappropriately and
with no adequate or relevant support. Because of the scale
of the drug problem on the Wirral, GPs have been involved
with the Drug Service since its opening, referring a good
proportion of the original client base. |
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The treatment provided
at the Drug Unit increases stability and improves health for
a substantial proportion of its clients; after a period of
time it became clear that this group did not need the intensive
input from a specialist Drug Unit and would be far better
placed back with their GP to continue their treatment. This
would enable more chaotic clients to be brought into treatment
at the clinic. |
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| Some GPs were happy
enough to do this but still requested a degree of support.
Wirral Drug Service is one of the first Drug Units in the
UK to formalise this idea into a set of working guidelines
and protocols. |
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worker is attached to a specific surgery and acts as the focal
point for all patients registered at that practice with drug
related problems. Newly registered patients are assessed and
placed accordingly. Patients' care can be transferred back
to the GP from the Drug Service in a planned and co-ordinated
way. Patients are only transferred to the care of their GP
when their drug use has been stabilised
and other aspects of their behaviour and lifestyle have improved.
A set of prescribing rules has been agreed with GPs which
helps to ensure that the surgery manages stable patients.
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The Prescribing Rules
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- Oral methadone, maximum
daily dose 70mgs, is generally the rule.
- No benzodiazepines prescribing,
unless as an agreed reduction plan.
- No prescribing of injectables,
unless as an agreed plan to change to oral medication.
- No prescription initiated
until patient assessed by the GP Liaison worker.
- No methadone tablets, unless
as an agreed time limited reduction.
- Clients who become unmanageable
are transferred back to the Drug Unit.
- Clients who are ill through
drug misuse, eg. Hepatitis C, are usually cared for at
the Drug Unit.
- Pregnant drug users are
normally cared for at the Drug Unit, although many GP's
are now happy to continue with their care at the surgery.
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The
standard clinic operates on a monthly basis, with the client,
GP and GP liaison worker attending at the surgery at the agreed
clinic times. We have learned, however, to be flexible and
GPs who are reluctant to hold clinics in their surgeries for
historical or pragmatic reasons can still be accommodated
within the scheme. Shared care systems of working have been
in place for a number of years, clients are seen at home and
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reviewed regularly by the GP in ordinary surgery
time. In both systems, the GP worker generates prescriptions,
applies for handwriting exemptions, etc and generally organises
the clinics and treatment plan. The GP Liaison worker should
act as the focal point for all patients with drug problems
registered at the practice.
The GP team currently consists of 8 full time staff and one
part time. The team manages around 650 clients, through 52
surgeries and over 140 individual GPs. |
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