Author Topic: Time limit  (Read 9703 times)

John Divney

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Re: Time limit
« Reply #15 on: December 18, 2015, 02:05:52 PM »
Its worked out fine for me and I feel I am being treated where I am best suited, my choice as someone has already said.
I pick up my script like a 'normal' patient. Seen the GP twice now in seven months and a practice nurse twice for blood tests. Not much to ask and if I need more I am sure the GP will refer me if needed. He seemed knowledgeable about what was on offer, but aware that it was not for everyone.
There is not a sign of a recoveree lurking behind a cheese plant ready to pounce, no sign of a drama group or cake baking group, no ominous abstinence posters.
In short, I feel like a patient looked after by a professional and courteous medical center. Hope it lasts and there's the rub really, I still feel anxious that someday, someone will be there at my next appointment and inform me that I have to attend a group or the script is finished. No other patient group gets treated like this I'm sure.

misgog

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Re: Time limit
« Reply #16 on: December 18, 2015, 02:25:43 PM »
Its worked out fine for me and I feel I am being treated where I am best suited, my choice as someone has already said.
I pick up my script like a 'normal' patient. Seen the GP twice now in seven months and a practice nurse twice for blood tests. Not much to ask and if I need more I am sure the GP will refer me if needed. He seemed knowledgeable about what was on offer, but aware that it was not for everyone.
There is not a sign of a recoveree lurking behind a cheese plant ready to pounce, no sign of a drama group or cake baking group, no ominous abstinence posters.
In short, I feel like a patient looked after by a professional and courteous medical center. Hope it lasts and there's the rub really, I still feel anxious that someday, someone will be there at my next appointment and inform me that I have to attend a group or the script is finished. No other patient group gets treated like this I'm sure.

That made me spit my coffee !

Mark Gilman

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Re: Time limit
« Reply #17 on: December 18, 2015, 07:27:00 PM »
You say LOCALISM Mark as though that answers everything we are all concerned about.

What then is the point of a National Drug Strategy, to be renewed in March. NICE Guidelines, the Orange book, the Governments own Advisory Groups on drugs and recovery.
Do you mean that if the Local Authority in my area decided to not bother in providing drug treatment, MMT based or recovery based, then they do not have to.

That's right John. They can do whatever they decide locally and there is nothing that anyone in London can do about it. That was the whole point of the LOCALISM platform which the government was elected on

Scallywag

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Re: Time limit
« Reply #18 on: December 18, 2015, 07:58:18 PM »
That's right John. They can do whatever they decide locally and there is nothing that anyone in London can do about it. That was the whole point of the LOCALISM platform which the government was elected on

A recipe for disaster. I honestly don't think anybody actually realised what they'd voted for under the Tories. Their manifesto isn't worth the paper it was written on. Look at their 'green' credentials post Paris agreement as an example. I remember the 80's and crime linked to drugs.. feels like dejavu is on the horizon. What is it about Tories and riots?

John Divney

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Re: Time limit
« Reply #19 on: December 19, 2015, 11:48:50 AM »
The politics of all this is very Personal V Political and quite stark.
MMT seems to be closely associated with the left, with The Labour Party, an old style way of treating addicts that plainly in the eyes of the Tories does not work. It maintains addicts on a state medication and a state income, and because its the NHS its centrally controlled too. All anathema to Tories.
Recovery is very Tory though, very capitalistic and plays right into the hands of the modern Tory. Cheaper of course because its not regulated, market based and open to competition, its philosophy is to get people standing on their own two feet, paying rent and earning the minimum wage somewhere, no longer reliant on benefits and medications. As its not NHS its also not centrally controlled, its run by a board of trustees at best, a recovery guru at worst, and all bidding for dwindling local resources along with everyone else in a mad free market. Thatcher did it with our heavy industries, this lot are doing it with social services and the NHS.

I suppose we on this site, mainly working and on MMT fall between the two stools, not happy with either approach and finding being in whats left of treatment services difficult to maintain. We don't seem to have a voice anywhere. To guess the future then, now the Tories are in power on their own, we should look at the political makeup of our local council. Tory led and controlled, say goodbye to MMT and the NHS, Hello to recovery and cheery, cheap, unregulated charities. Labour controlled councils will I expect, try and maintain the status quo but the cuts forced on them by Osbourne will probably force the issue eventually and the new order will prevail.

OP8S

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Re: Time limit
« Reply #20 on: December 19, 2015, 01:08:53 PM »
If enforced reductions do take place / time limited treatment then the Tories have managed to make the treatment sector a self sustaining care service with people leaving treatment only to enter it again dependant on dope & very probably in poor health. A nice little earner for prescriber's lacking in any compassion as well as all those dealers who will only be too happy to see their old customers again.


Say you started using dope while being reduced , could a Dr in all honesty say that it was in your best interests to carry on with the reduction ? I very much doubt it.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

sapphire

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Re: Time limit
« Reply #21 on: December 19, 2015, 04:59:17 PM »
I don't think people gave proper thought to what they'd get with the Tories. People wittle on about benefits, but 50% of benefits is pensions, and the next 38% is housing benefit, most of that paid to people IN WORK, but that are not paid a living wage.

People seem quite happy to complain about benefit scroungers/asylum seekers, but then when it starts to affect them, they call the Tories the nasty party. People should have known from what the ConDems were like what we were going to get with the Tories.

Not that I think Corbyn would be much better, but Labour under a different leader would be what I'd like to see. At least we know from history that they're more understanding of drug treatment.

I don't seriously think though that any local authority are stupid enough to stop drug treatment services. They know that crime, hospital admissions and deaths would go through the roof and cost them more than the actual treatment!

John Divney

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Re: Time limit
« Reply #22 on: December 19, 2015, 05:17:29 PM »
"I don't seriously think though that any local authority are stupid enough to stop drug treatment services. They know that crime, hospital admissions and deaths would go through the roof and cost them more than the actual treatment!"

I think you are probably right Sapphire...Probably! I can't see Liverpool doing it or any city or any relatively busy town but more rural areas.
Would Cheshire for example carry on funding Congleton drug service or Sandbach or Northtwich, if there is one that is. And other more rural counties will think again about what they actually fund and maybe look to GPs to provide treatment. They are their patients anyway and why shouldn't they provide a prescription. Big cities are different as GPs are powerful and they wouldnt want to see their surgeries rammed with drug users again as they were in the late eighties.

I think there are big changes ahead in the way that drug treatment is actually delivered. Mind you I am a gloomy bastard most of the time, Victor Meldrew on methadone.

sapphire

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Re: Time limit
« Reply #23 on: December 21, 2015, 02:55:25 PM »
In some rural areas I don't know why they don't continue with shared care, and have a travelling key worker. It would save a lot of money!

Where I live, which is a massively deprived area, all the GP's have been written to, and told that they cannot prescribe methadone for the treatment of substance use, it ALL has to go through the local DSP, so they've actually had to offload a few unfortunate folk who I feel sorry for, having to go from not getting hassled at your GP, to all the pro abstinence nonsense at the local DSP.

I think that it's pretty much like that in the whole of the North West that they're telling GP's they got to send everyone to the local DSP, rather than allowing them to prescribe if they want to. Some Gp's are GPwSI in substance use, so they would like to be prescribing for us, so it's a shame that in some parts of the country they're not being allowed to.

You do get the snob factor though, were GP's think the surgery is just going to be rammed with addicts saying "my dog ate my script", when you can cut that off at the root by getting patients to sign something when they start seeing you saying you won't replace meds/scripts for any reason.

I do worry that if the government continues in this vein for the next parliament (if they get elected again, god help us), that they will have a field day, and just start cutting funding even more. But, like I say, I don't think they'd ever cut it completely, as it's seen as a crime reduction initiative (CRI nicked the name!!).

John Divney

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Re: Time limit
« Reply #24 on: December 21, 2015, 03:19:56 PM »
The money for drug treatment is with the Local Authority and GPs are funded through the Clinical Commissioning Groups, seperate funding, seperate bodies.
The La is responsible for drug treatment not the CCGs, I think? Thats what my old Wirral GP told me anyway.

John Divney

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Re: Time limit
« Reply #25 on: December 21, 2015, 04:06:10 PM »
So for example on the Wirral, the LA commissioned CRI to be the new treatment provider, the DSP, and that by default also meant the hundreds of people getting a script from their GP. Presumably leaving the sole responsibility for drug treatment with the LA and their team of managers or commissioners. The CCG not wanting to pay GPs I suppose when they can turn round to the LA and say you get the money for drug treatment not us. Not sure if shared care exists on the Wirral, it must do really, there were an awful lot of people getting a script from their GP. Many, like me, would not relish the prospect of having to go to the DSP again, maybe thats why a lot of them are now back drinking and hanging round Greggs downtown. The council are now refusing to give new shops a license to sell alcohol citing the attraction to street drinkers of late night offies on estates, police have said it causes trouble.

Mark Gilman

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Re: Time limit
« Reply #26 on: December 21, 2015, 06:25:37 PM »
So for example on the Wirral, the LA commissioned CRI to be the new treatment provider, the DSP, and that by default also meant the hundreds of people getting a script from their GP. Presumably leaving the sole responsibility for drug treatment with the LA and their team of managers or commissioners. The CCG not wanting to pay GPs I suppose when they can turn round to the LA and say you get the money for drug treatment not us. Not sure if shared care exists on the Wirral, it must do really, there were an awful lot of people getting a script from their GP. Many, like me, would not relish the prospect of having to go to the DSP again, maybe thats why a lot of them are now back drinking and hanging round Greggs downtown. The council are now refusing to give new shops a license to sell alcohol citing the attraction to street drinkers of late night offies on estates, police have said it causes trouble.

Once again John you are quite right. The local authority will also ask why GPs wanted to be paid extra for prescribing methadone to their patients? I have had to explain to local authority people why GPs need to be paid extra for seeing their patients who happen to need OST. "So, they [GPs] want paying twice for treating their drug addict patients?" This is the question you will get when you take this to local authorities.
« Last Edit: December 21, 2015, 06:40:01 PM by Mark Gilman »

sapphire

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Re: Time limit
« Reply #27 on: December 24, 2015, 03:55:02 PM »
Yes, it does come via the local authority, but if the local authority is controlled by an MP that's anti 'all that sort of thing', and a local council that also feel that way, you're going to have problems.

I do know that in big parts of the NW that GP's have been written to and told they can't prescribe methadone any longer and must send everyone back to the DSP's. Whether some GP's take pity on the odd patient and say they're prescribing it for pain management or whatever, I don't know.....

They're cutting back on the number of alcohol licenses they're allocating/renewing here too John, as alcohol is such a massive problem that costs such a lot for our local police force/hospital/social workers. Thing is, a lot of them are people that were previously doing OK at the DSP, then before the big change here last year, people were basically being told to reduce or piss off, so piss off they did, right back to active addictions.

Mark - so would even a GPwSI in substance use treatment expect to get extra payments for treating people with substance us problems? Seems a little bizarre to me..... Are there any other areas were GP's get extra payments to see a particular sort of patient?

Mark Gilman

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Re: Time limit
« Reply #28 on: December 24, 2015, 05:14:54 PM »
Yes, it does come via the local authority, but if the local authority is controlled by an MP that's anti 'all that sort of thing', and a local council that also feel that way, you're going to have problems.

I do know that in big parts of the NW that GP's have been written to and told they can't prescribe methadone any longer and must send everyone back to the DSP's. Whether some GP's take pity on the odd patient and say they're prescribing it for pain management or whatever, I don't know.....

They're cutting back on the number of alcohol licenses they're allocating/renewing here too John, as alcohol is such a massive problem that costs such a lot for our local police force/hospital/social workers. Thing is, a lot of them are people that were previously doing OK at the DSP, then before the big change here last year, people were basically being told to reduce or piss off, so piss off they did, right back to active addictions.

Mark - so would even a GPwSI in substance use treatment expect to get extra payments for treating people with substance us problems? Seems a little bizarre to me..... Are there any other areas were GP's get extra payments to see a particular sort of patient?

Simon will know more than me about how it works in practice as (as far as I understand it anyway, but maybe wrong) he and his practice have been operating outside of the commissioned DSP main contract for many years and as such has been able to provide the kind of service that he does.

John Divney

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Re: Time limit
« Reply #29 on: December 24, 2015, 06:32:05 PM »
My GP prescribes outside of the bigger arrangements, his words, and my script is handwritten and on his practice address. I get three blues every time, which gives me two weeks on the last blue to make an appointment. Sometimes I am reminded to arrange to see someone, him or the nurse. At my last GP on the Wirral the scripts were computer generated and had St Catherines hospital as the address, where the drug service was based. I usually just picked them up as the chemist reminded me they were due. I never had a missed script in all the years I was with them but saw a keyworker rarely and the GP even less. No intimation yet that my current GP wants to stop seeing me.

I am off for a Xmas meal now with some old friends from Wales, hope I don't get caught up in the spirit of the season and drink too much. Takes me a week to get over a hangover these days. Harm reduction advice anyone or should I stick to orange juice. Happy Xmas to you and your families by the way, you can shove New Year!