Testing orders: the aftermath

[admin]

Hi all,

I've just been chatting with someone about the fact that successful completion of testing orders can leave users in a difficult position, where the DIP won't take charge of their script any more, but the community drug team resents having to put them to the head of the list so that they can have continuity of care, because it's not fair on the people already on the list.  Does anyone know of any protocols in place anywhere which deal with this problem?  It seems crappy that compliance can make it more difficult to stay scripted, but I can see the point of the community service too.
 
Ursula

[simon]

Hi all,

I've just been chatting with someone about the fact that successful completion of testing orders can leave users in a difficult position, where the DIP won't take charge of their script any more, but the community drug team resents having to put them to the head of the list so that they can have continuity of care, because it's not fair on the people already on the list.  Does anyone know of any protocols in place anywhere which deal with this problem?  It seems crappy that compliance can make it more difficult to stay scripted, but I can see the point of the community service too.
 
Ursula

We had something happening slightly like that in our area with most services pretty much full. The way to solve this problem i'm afraid is to throw some money at it.
Our service takes people from DIP the CDT and our own GP registered patients and people with no GP, we did need more staff and that costs.
I guess we can't have it all ways and if money is shoved into criminal justice then money needs to follow the patient for follow on care. A lot of people will stay on prescriptions for a very long time and it's a growing number so will continually need re-evaluating how much is spent in each area. I wonder what things will look like in ten years time.

[mikey]

Ursula,
what exactly is being said here?
1. Are you saying you spoke with someone who had heard about someone who had heard of a problem etc etc?
2. Are you saying you spoke with someone who had heard that their own transition from DIP was causing a service/worker some problem that they had to manage?
3. Or are you saying that you have actual details of a named person unable to continue with their script upon leaving DIP.

If 1. it should not raise any more concern than many other folklores.
If 2. That's what the service/worker gets paid to do. manage situations to enable treatment for their clients. Whether it createsa problem of staffing, funding, admin or wharever, they can whinge all they like as long as they get the client their script through the transition.
If 3. that is serious. Something needs to be done.

I have never heard of a client leaving DIP into services unable to continue getting their script continued. If this is happening then we need to take action on that immediately. If it is not happening then we need to avoid giving the impression that it is.
Can you clarify was this a real case with proper details or just the product of general 'what if?' type chatting?

[admin]

In this particular instance, it was a DIP worker who was having real problems getting the local CDT to take clients whose orders had finished for the reasons mentioned (waiting list mostly, although I suspect that the relationship between the two teams wasn't ideal) but was also having problems getting their boss to accept that they had a responsibility to make sure that there was continuity of care once the testing order was over but the client hadn't yet been scripted in the community.  At that stage, no-one had lost their scripts; there was just a lot of passing the buck going on.

If it had been number 3 on your list, we would have acted.  As it was, it was something we knew was happening but was in the process of being dealt with without our intervention.  As I understand it, the problem has now been solved to the mutual satisfaction of the services.   I use the term "mutual satisfaction" loosely - I'm sure someone is fuming about it but the clients are getting what they need.
 
I posted the thread here at the request of the person I was talking to in case anyone knew of any concrete examples of how to deal with the problem.  And for the record, I'm not really one for posting hypotheticals - unless I say otherwise, anything that looks hypothetical that I post has usually been phrased like that to protect the anonymity of the person who really wants the answer. 

[mikey]

Glad to hear it was just the grumblings of someone who was having to work that bit harder. It's not comforting to think that extra effort was required to overcome lack of co-operation between services, but I'm glad it was not an actual case where a script had been denied. That would really have been cause for concern.