Agenda item

Joint report of Corporate Director for People and Director of Public Health

Councillor Woodings, Portfolio Holder for Adult Social Care and Health, introduced the report.

Tammy Coles, Public Health Principal, presented the report, and stated the following

 i.  in line with NICE and Department of Health guidance, prescribing opioid substitution therapy (OST) is a recommended option for maintenance therapy in the management of opioid dependence. The guidance recommends that when a person starts OST, they should take each dose under the supervision of a nurse, doctor or community pharmacist for a minimum of 3 months;

ii.  Nottingham City Council commissions community pharmacists to deliver supervised consumption for opioid substitution therapy, and there are over 50 branches across the city providing this service;

iii.  a recent report was approved by this Committee for the recommissioning of an alcohol and drug treatment and recovery system, but community pharmacy provision was not initially identified as being in scope for this recommissioning. However, a strategic commissioning review has identified the benefits of including community pharmacy provision as part of the re-commissioned system of community treatment and recovery services, and this paper requests approvals to align and include community pharmacy services accordingly;

iv.  ‘supervised consumption’ reduces drug use, injecting, mortality, and offending. It maintains a service user’s tolerance for opioids, reducing withdrawal symptoms and cravings for opioids. It gives people the stability to focus on broader recovery by helping them come off opioids and OST medication altogether. It also reduces the risks of overdose or under dosing, diversion of controlled medicines and accidental poisonings of children and vulnerable adults;

v.  pharmacists have expertise in the use and interaction of medicines. They contribute to the treatment and care of patients through liaison with prescribers. In the treatment and management of drug use they play a key role in the assessment of appropriate levels of supervised consumption, the provision of take-home naloxone, and provision of needle exchange services.

Resolved to approve

(1)  the inclusion of community pharmacy supervised consumption and other appropriate pharmacy led alcohol and drug use interventions in the scope of the re-commissioning of community alcohol and drug services, within existing delegated approvals for developing the service model, and within the procurement process, up to a maximum total cost of £2,689,709;

(2)  a 3-month extension to the existing community pharmacy supervised consumption contracts, from 1 April 2023 to 30 June 2023, up to a maximum total cost of £65,606.

Reasons for recommendations

Recommendation 1 - This is to enable the procurement processes to align and maximise the opportunities for multidisciplinary working across the proposed new integrated service model. This will optimise outcomes for service users, their families, and communities.

Recommendation 2 – to extend these contracts by 3 months during Quarter 1, 2023/24 to align with the timescales for the procurement of new alcohol and drug use treatment and recovery services.

Other options considered

Do nothing and let the service provision end on 31 March 2023 - This is not a viable option because there is a clear need for this service in the city to continue to ensure the continuity of positive outcomes for people who use opioids. Discontinuation of this service could result in an increase in overdose, accidental poisoning, and diversion of medication. All of these aspects would increase the burden on other departments and organisations such as HM Corner's Office, Nottinghamshire Police, Community Protection and local businesses.

A separate procurement exercise for supervised consumption in community pharmacy would miss the opportunity to align this provision with other community treatment and recovery provision and would not be consistent with the findings of the strategic commissioning review.