BMJ Awards 2019: Primary Care Team of the YearBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1665 (Published 16 April 2019) Cite this as: BMJ 2019;365:l1665
- Jacqui Wise, freelance journalist
- London, UK
Novel approach to opiate use
Station Practice in Hastings developed a novel, holistic model of care to wean patients with chronic pain off opiates when they identified a problem with opiate prescriptions. “We were finding people who had been parked on fentanyl patches or industrial levels of opiates for decades. They now feel they’ve got their lives back,” says GP Anthony Dann.
The practice identified over 350 patients with chronic pain who had been on high doses of oxycodone, buprenorphine, or fentanyl for more than three months. “We explained that their pain system has become dysfunctional and the opiates are actually making things worse,” says Dann. The team developed resources to get patients on board, including a 12 step chronic pain tool kit and a self help group led by a motivational worker.
“We found we didn’t need to change patients onto other drugs such as gabapentin or tricyclics,” says Dann. “Listening to the patient’s pain journey had the most profound impact, followed by social work support such as with benefits or debt.” The practice also ensured that any anxiety or depression was diagnosed and treatment for any comorbidity was optimised.
Since starting the service in March 2018, 40 patients have stopped using opiates with a further 120 in the process of being weaned off the drugs. They have also seen a significant improvement in patients’ quality of life, pain, anxiety, and quality of sleep scores.
Rapid GP transformation
The loss of baseline funding and difficulty in recruiting GPs meant that Parchmore Medical Practice in Croydon was struggling to manage a rising workload. “We were using locums, which was costly and reduced continuity of care,” says GP partner Agnelo Fernandes. “Morale was low and we knew something had …