The role of the Consultant Addiction Psychiatrist is uniquely commissioned in the NHS and is an indisputable asset when it comes to the successful and efficient running of addiction treatment services and providing support across primary as well as secondary physical and mental healthcare services, as highlighted in the current treatment system in Bristol.
What is the role of the Consultant Addiction Psychiatrist in addiction services?
Dr Ben Watson is a Consultant Addiction Psychiatrist with Avon & Wiltshire Mental Health Partnership NHS Trust, and is the Clinical lead for Bristol ROADS (the commissioned drug and alcohol treatment system). He explains that “here in Bristol we have a small NHS specialist addictions service which delivers specific interventions such as complex community detoxes, maternity service for pregnant women, rapid prescribing for prison releases, some specialist psychological treatments and an NHS inpatient detox unit (IPU). The majority of addiction treatment is however centred around primary care and delivered by our third sector partner organisations Bristol Drugs Project (BDP) and DHI (Developing Health and Independence).”
In his role as Consultant Addiction Psychiatrist, Dr Watson provides a remarkable amount of support through an advice and liaison service, which provides clinical advice to primary and secondary care services across Bristol. “My role is to support the shared care workers and GP’s in delivering opiate substitute treatment and community alcohol detoxes. I liaise with about 50 GP surgeries across the city, 3rd sector organisations, the Homeless Health Service, 2 general hospital trusts, the maternity hospital as well as all community and inpatient mental health services. Being an NHS Consultant makes me immediately identifiable to other professionals and facilitates working across these different settings. In addition to providing clinical advice, I deliver teaching and training, specialist clinical supervision to drug and alcohol liaison hospital nurses as well as supporting clinical governance processes within the various NHS Trusts.”
“If the role of Consultant Addiction Psychiatrist is diminished, the impact will likely be felt heavily across the whole of the healthcare system”.
Why is the role of the Consultant Addiction Psychiatrist so important?
A key function of the role of Consultant Addiction Psychiatrist is to provide clinical advice and guidance, liaising between various stakeholders who have involvement in addiction support and treatment services. Such a role also enables the coming together and sharing of expertise and information with a range of healthcare professionals who might not normally have such detailed knowledge and experience of working with those with an addiction problem.
In Bristol, the involvement of the Consultant Addiction Psychiatrist from the very beginning of the patient journey also means that with GPs’ enhanced knowledge on drug and alcohol addiction, referrals to specialist services are reduced.
As Dr Watson explains: “I have found that I can deal with so many concerns by speaking with them [GPs] face-to-face or over the phone. As a result we have found that our referrals rate has dropped dramatically because those concerns are being addressed in an advice/ liaison capacity. It is about saying, rather than have a siloed secondary service, let's direct the resource to support primary care - hence how my current role came about”.
“If you haven't got that dedicated role you are not going to get that level and breadth of influence and specialism in addictions. His expertise and knowledge, experience around addiction and being the clinical lead across our commissioned treatment service in Bristol is invaluable”.
The role also provides the unique opportunity to advocate for the care of some of the most vulnerable and most marginalised people in society and facilitates influence over how current systems might be modified in order to find new and increasingly effective ways of treating service users.
Dr Katherine Pitt is a GP at the Wellspring GP Surgery in Bristol and advocates; “I work predominantly as a GP in a relatively deprived part of Bristol, where there is a large number of patients with addiction problems and substance misuse issues. It's a group with significant health needs and I’d previously had limited training in this area. Ben’s help is absolutely invaluable in advising us on complex issues and devising treatment plans. He also provides education sessions to us, which are extremely helpful.”
Dr Alia Medniuk is a Consultant Anaesthetist and Acute Pain Service Lead at Southmead Hospital in Bristol (North Bristol NHS Trust) and describes the role of Consultant Addiction Psychiatrist as “amazing and invaluable. He [Dr Watson] provides support for my team, and is also a mentor to me, so I am able to do my job better. I am able to look after our complex needs patients with a considerable degree of expertise. We are really fortunate to have him. He is an NHS consultant which immediately offers this extra component - he’s fluid and able to work between both the trusts in Bristol, and he is also able to facilitate cross-site-working because he is an NHS consultant. Ben also supports the junior doctors, and in fact the senior doctors. He is someone who is an expert in a particular area and provides great assurance that what they are doing is the right thing”.
What do other healthcare professionals and commissioners consider to be the benefits of the Consultant Addiction Psychiatrist role?
Dr Mike Taylor, Lead GP at the Homeless Health Service in Bristol, has a monthly session with the Consultant Addiction Psychiatrist, where Dr Watson answers questions on specific cases, and also provides teaching sessions:
“He [Dr Watson] is able to give a first class comment or teaching and long may it continue. He is valued by the whole team. It is working very well....As an NHS consultant he is completely unconflicted in the process….without specialist expertise in this area it would be risky for GP’s and very much to the jeopardy of the patient”.
Paul Moores is the Public Health Commissioning Manager for Bristol ROADS at Bristol City Council. He has found that having someone who works right across the system to be “really beneficial”:
“From a commissioning perspective he can identify areas for future commissioning and comment on any other reviews or revisions to current service models. If you were to take that role out of the equation, it would have a massive impact on primary care and our providers. In the long term it wouldn't be cost effective to take that role away. If you haven't got that dedicated role you are not going to get that level and breadth of influence and specialism in addictions. His expertise and knowledge, experience around addiction and being the clinical lead across our commissioned treatment service in Bristol is invaluable”.
How has this role been pivotal during Covid-19?
Specifically within Bristol, during the pandemic, Dr Watson has been involved in prioritising continuity of OST and promoting alcohol harm reduction advice. He explains, “there was a big piece of work around supervision and relaxing collection regimes to support social distancing with pharmacist’s pressures - we had to come up with new ways of working without timely national guidance. So during this time people look to their clinical leads to provide that steer. I was therefore benchmarking our approach with colleagues from services across the UK and advising and supporting local drug workers and GP’s. The adjustments in drug and alcohol treatments services during this time has been about taking positive risk decisions. So the role here in Bristol has been about containing the spread of the virus, supporting and advising people, whilst also providing a rationale for the decisions that have been made. When the Bristol Nightingale Hospital was built, I was also asked to provide specialist addictions advice to its clinicians should it be needed for any patients being admitted.”
How are other services supported?
Nicky Auguste is a Diverse Communities Link Worker at Bristol Drugs Project. He explains how crucial Dr Watson’s role is in supporting his work in connecting with diverse communities within Bristol regarding alcohol treatment: “It's really useful to have Ben deliver the clinical aspect of it, and the weight it carries in those communities is really useful. I think what is really important from a service user perspective is that everyone is singing from the same hymn sheet and receiving a quality of service irrespective of your background, ethnicity, or sex. It is important that everyone receives the same quality of service. This starts right at the top and so the message coming down from Ben around clinical provision is uniform across the city, it’s really important that it continues”.
“My advice for those wishing to set up similar programmes in their area would be to build a relationship with the clinical lead and integrate them within your team to make it part of your working practice. It is important to understand the clinical position and what it looks like for the service user on the ground”.