Case studies
Back to previous pageMaple Access Practice, Northampton
DAT(s): Northamptonshire.
Region(s): East Midlands.
Last updated: 18 March 2004
Summary: Service for chaotic drug users, including sex workers.
The need
Maple Access Practice is a GP surgery that is easily accessible to chaotic drug users, including sex workers, in Northampton.
The Maple Access Practice engages with very chaotic drug users, many of whom have further issues such as homelessness and sex work.
About 100 of Maple’s patients are on scripts (medication as a substitute to heroin). About 55 of their clients are female sex workers, of whom about 25-30 are on scripts. The majority of these women use crack and heroin. The combination of issues such as drug use, homelessness and sex work create a chaotic lifestyle with further implications for women’s health.
Northamptonshire’s statutory services are characterised by formal engagement procedures, which often prevent more chaotic users from accessing their services.
The idea
Maple’s priority is harm minimisation and retention in treatment. It therefore endeavours to be as flexible as possible to be accessible to even the most chaotic clients.
Maple has initiated contact with some drug users by its drop-in sessions. The service has also engaged with sex workers after active outreach by one of Maple’s Patient Support Workers and workers from CAN homeless service, working as part of the Swan Partnership.
Maple directs clients to other services for more structured rehabilitative treatment, or help with other issues such as housing. Maple sees itself as fulfilling its part of a jigsaw of services for drug users.
How it works
Maple started as a charity. It developed into a GP surgery and Personal Medical Service Plus (PMS+) practice.
It provides an afternoon drop-in service (2 - 3:30 pm) for:
- engaging with clients;
- script renewals;
- smear tests;
- signposting;
- maintaining its ‘retention in treatment’ ethos.
Two GPs with Special Interest in Substance Misuse (GPwSI) and a Nurse Practitioner in Mental Health (who is also an Extended and Supplementary Independent Prescriber) staff the surgery. Both the Nurse Practitioner and GPs have successfully attended the Royal College of General Practitioners’ (RCGP) course in Substance Misuse.
A medical drop-in service operates in the morning for non drug-related problems that patients might experience.
Group work is inappropriate for clients at this early stage of treatment or contact with services because they are still too chaotic for the more structured regime that group work requires. In addition to individual sessions with clinical staff, Maple provides access to a practice counsellor and an Arts Psychotherapist for people who lack verbal skills.
Maple’s Patient Support Workers know regular patients (returning for scripts) by name. This makes the service more approachable and human.
Links to other agencies
Maple liaises with the Council about housing, probation about drug use, and social services about child protection issues.
A Welfare Rights Advisor visits Maple once a week.
Maple has a particularly good relationship with CAN homeless service. Originally, both services operated from the same building but the services outgrew their premises. However, in their present locations they are still only about ten minutes from one another.
If Maple requires assistance for a client with tenancy support or a similar issue, they can refer that individual to CAN. In return, Maple receives clients from CAN who need scripts or help with drug issues.
This relationship is maintained through regular meetings between staff at the agencies.
As a PMS practice, Maple receives most of its funding from the PCT. It also retains some funding from its time as a charity, which will pay for a drug worker for the next two years.
Maple also receives a contribution from Northamptonshire DAT. The service intends to be a commissioned drug service in the future (with interim money from CJIP).
Key Benefits
Maple’s flexibility makes it appear less adversarial than some services, and more accessible. This enables it to engage with users, and support them in treatment.
Chaotic individuals receive a holistic approach to their complex needs.
An afternoon drop-in service is more accessible for sex workers who commonly work late at night.
Once the service has engaged users for drug treatment, it can then address their other health and general needs.
Comments
Maple recognises that complicated, long-term drug use (coupled with sex work from an early age) requires patient, one-to-one support over years.
Personal and one-to-one relationships are very important in the treatment of chaotic users. Drug users have often been rejected and marginalised. They can therefore be suspicious and defensive.
Providing accessible services to women at drugs services should not risk marginalising young males.
Maple’s flexibility has also made it accessible to BME individuals. Male Kosovan, Somali and Traveller clients have accessed the service in the past.
CAN homeless service finds Maple’s service invaluable for its clients because there are relatively few doctors surgeries that have expertise in drugs.
For further information
Northamptonshire DAT
Sue Whitaker
DAT Coordinator
Northamptonshire County Council
Social Care and Health
20 Oxford Street
Wellingborough
NN8 4HY
Tel: 01604 237604
Email:
swhitaker@northamptonshire.gov.uk
Maple Access Practice
Dr Catherine Hewitt
GP Partner
6 Castilian Terrace
Northampton
NN1 1LD
Tel: 01604 250969
Email:
catherine.hewitt@gp-k83621.nhs.uk
