Brief Insight seven: NHS Forth Valley: Community Buprenorphine prescribing pilot

Background

The beginning of the COVID-19 pandemic was the catalyst for the NHS Forth Valley Substance Use Service’s buprenorphine pilot. Inspired by the adoption of buprenorphine prescribing within the Scottish Prison Service, they were keen to design and roll out a similar model in the community.

They developed their own service-specific clinical guidance, initially keeping it tight and focused on a small group. These were people who had shown an interest in buprenorphine and who had fewer complexities in their treatment needs. In this first phase, service leaders realised their team members required more support to adapt to their new ways of working. Training was secured from the buprenorphine suppliers and team members were supported to learn new skills and build their confidence.

Impact

Very quickly, the pilot expanded to support people with more complex needs. This rapid scaling up of the project was in response to the demands of those accessing the service. The recovery community were sharing their positive experiences and encouraging others to seek support. On occasions this increased demand has led to challenges with supply, but the team are working on streamlining processes to meet demand.

Learning

The success of the pilot has been driven by people seeking the service. Many, although not all, appreciate the freedom and dignity afforded by this treatment option. The commitment and dedication of the staff involved in the design and delivery of the service has also been a significant success factor. The need for Home Office licences for the storage of buprenorphine has posed challenges and the team are progressing applications to allow this for several of their local sites.

Top Tips

• Strong senior leadership is required to secure engagement and buy-in.
• Focus your service development and team culture on patient choice.
• Promote the evidence base for this treatment option.
• Empower team members with the skills and confidence needed to deliver the service.

Next Steps

While aiming to sustain the gains already achieved in this pilot the project the team aim to:

• Continue to gather and respond to feedback from people accessing their services,
• expand their workforce by gaining funding for more non-medical prescribers to offer a more flexible service, and
• develop formal processes to track and review their buprenorphine prescribing activity ensuring treatment options are available in all areas including primary care and community pharmacies.