Brief Insight 1: Angus Integrated Drugs & Alcohol Recovery Service (AIDARS): Same day access to Opiate Substitute Treatment (OST)

Background

Angus Integrated Drug and Alcohol Recovery Service (AIDARS) is an integrated health and social care service focused on person-centred care and harm reduction interventions. AIDARS have been working on improving their referral processes to support same day access to opiate substitute treatment (OST).

Impact

Since January 2023, revision of the screening of referrals has improved access to care for people entering the service. When AIDARS now receives a referral showing opiate dependency, the person is allocated to either a non-medical prescriber or a medical prescriber.  The prescriber works with them to determine what options are available to them, if they want to start opiate substitution therapy, and, if clinically safe to do so, starts them on their chosen medication as quickly as possible.

The original process involved a key worker (nurse or social worker) assessing the referral before passing on to a prescriber. Initial service data now shows a reduction in waiting times. The changes to service delivery have also been well received by team members who can see the difference it is making to people they support. Improved screening also allows better signposting to other services where appropriate.

Learning

The service has increased their team numbers by training 2 new non-medical prescribers. This has supported improved access for people and made the workload more manageable for the team.  This may also be due to a reduction in the number of opiate related referrals.  The majority of service referrals are currently for alcohol, cocaine, and benzodiazepines rather than opiates.

At the start of the project some of the team were concerned about the level of risk involved with same day prescribing but confidence has grown with the understanding that this is only implemented when it is clinically safe to do so.  IT systems have also challenged service development. Different reporting schedules and competing requirements have also been a barrier for services and require review. The service continues to monitor improvement progress through national and local data collection and analysis.

Top Tips

• Ensure flexibility, making best use of the available clinical expertise according to evolving need.
• Invest in staff learning and development so they feel confident, skilled, and supported to make decisions.
• Involve people accessing services and their family in service improvement activity to ensure that planned and implemented changes align with need.

Next Steps

AIDARS are developing workforce learning and development plans and intend to introduce virtual case review huddles soon. The service will also review data from recent surveys to assess the impact of their service provision.