Drugs deaths: National Mission Clinical Advisory Group minutes - June 2023

Attendees and apologies

Attendees    

• Marion Bain, Co-Chair – Deputy Chief Medical Officer
• Catherine Totten, AHP Professional Advisor Mental Health, Scottish Government
• Steven Short, Programme Lead - Out-of-Hospital Cardiac Arrest
• Professor David Lowe, Clinical Director Health Innovation (Scot Gov) and Consultant Emergency Medicine NHS GGC
• Roy Robertson, Professor of Addiction Medicine at the University of Edinburgh and Retired General Practitioner
• Adrian MacKenzie, MAT Standards Clinical Lead, Healthcare Improvement Scotland
• Chanpreet Blayney, Consultant Psychiatrist at Health Improvement Scotland
• Susanna Galea-Singer, Clinical Lead and Consultant Psychiatrist/Chair of the Education Committee / Co-Chair Faculty of Addictions Psychiatry
• Sarah Donaldson, Specialist Pharmacist in Substance Use, NHS Tayside
• Julie McAdam, Lead Pathologist, University of Glasgow
• Duncan McCormick, Consultant in Public Health Medicine at Public Health Scotland
• Isabel Traynor, Consultant Clinical Psychologist/Head of NHS Fife Addictions Psychological Therapies Service (APTS) and Lead Psychologists in Addiction Services Scotland (LPASS) representative
• Kirsty Nelson, Parish Nurse, Queen's Nurse
• Dr Ryan McHenry, Clinical Research Fellow and Registrar in Emergency, Pre-Hospital and Retrieval Medicine
• Tara Shivaji, Consultant in Public Health Medicine, Public Health Scotland
• Trina Ritchie, Lead Clinician, Greater Glasgow and Clyde Alcohol and Drug Recovery  Services
• Duncan Hill, Specialist Pharmacist in Substance Misuse , NHS Lanarkshire
• Michelle Watts, Scottish Government
• Tracey Clusker, Nurse Consultant, Public Health Scotland/NHS Lothian

Deputies in attendance    

• Dr Katie Browne, GGC NHS deputising for Dr Saket Priyadarshi
• Kristine Gilmour, Turning Point Scotland deputising for  Mandy Ramsay

Apologies   

• Hazel Torrance, Head of Forensic Toxicology Service, Scottish Police Authority
• Dr Saket Priyadarshi, Associate Medical Director and Senior Medical Officer - Glasgow Alcohol and Drugs Recovery Services
• Mandy Ramsay, Head of Clinical and Care Governance/ Registered Nurse Mental Health and Registered Nurse Adult at Turning Point Scotland
• Duncan Hill, Specialist Pharmacists in Substance Misuse
• Carey Lunan, Scottish Government
• Dr John-Paul Loughrey , Consultant in Emergency Medicine  and Vice- President, Royal College of Emergency Medicines
• John Harden, Co-Chair- Deputy National Clinical Director

Also in attendance    

• Elinor Dickie, Public Health Scotland
• Maggie Page, Scottish Government
• Morris Fraser, Scottish Government
• John McLaughlin, Scottish Government
• Diane Lavery, Scottish Government
• Geraldine Smith, Scottish Government
• Paul Sutherland, Scottish Government
• Chloe Taylor, Public Health Scotland
• Lauren Gallagher, Public Health Scotland

Items and actions

Welcome and introduction

The Chair welcomed members, attendees and nominated deputies to the first formal meeting of the National Mission Clinical Advisory Group. 

Board governance

The minute of the set up meeting on 28 April 2023 was approved.

It was agreed that a summary minute will be published within one month of the meeting.

A membership list of the CAG will be published online, with members consulted ahead of this to ensure the information is accurate.

MAT 7 team presentation 

 TS/ED referenced slide deck issued (MAT 7 drug treatment in primary care discussion for CAG) and presented to the group.

Discussion 

First question to the CAG: We have presented the MAT programme’s current picture of primary care practice – is this reflective of your experience and understanding?

CAG members offered advice including:

• it is important to reflect the different circumstances across Scotland, including rural, inner and deprivation profile differences
• GPs need to be supported to deliver what is needed. Shared care models should be part of this
• the patients’ experience is key, especially in considering how that is affecting their choice of engaging with treatment. Stigma continues to be an issue 

Second question to the CAG: Scope of proposals for change - the Scottish shared care model is largely based on access/initiation via secondary care and transition to primary care. Is the Scottish primary care system able to accommodate alternative models? What are the opportunities for developing different models? 

CAG member offered advice including:  

• we must enable GPs to be able to restart people in treatments as patients often don’t want to access MAT through primary care and prefer to do so through their GPs 
• GPs are under significant pressure with existing demands 
• GPs should be given capacity to decide to do things differently. Lots of different work is being done which creates a lot of learning
• GPs should be supported to be innovative and learning from the different approaches already being taken forward should be shared

Third question to the CAG: System readiness to deliver on learning - how will changes in practice be achieved? What support is required for implementation? What are key considerations for new ways of working? 

CAG member offered advice including:

• shared models including flexibility to allow different models to be used where required are important
• contributions and joint working with other clinicians is needed when GPs are dealing with patients with lots of complexities
• there are some good examples where third sector partners are imbedded and working very effectively with GPs 
• the IT picture is very variable across Scotland. Joint work to consider what is needed to support this group and deliver is required
• more direct engagement with GPs to develop this further should be undertaken

Focus of next meeting

The Chair indicated that the focus of our September meeting will be on workforce. A future main agenda item for the group will be Benzodiazepines. 

Members were invited to send agenda suggestions to the co-chairs and secretariat. 

Any other business and close 

The next meeting is scheduled to take place on 12 September 2023 between 11.30am and 1pm and the 5 December 2023 between 2pm and 3.30pm.