A case study on accessible substance use services in the community
“Our company motto is ‘treating patients like family’ and that could not be more true than with this client group.”
Samantha Reid, Pharmacy Owner
This case study describes how Buchanhaven’s team of pharmacy staff have developed a holistic package of services to ensure that people who use substances are provided with accessible services focused on their needs. They aim to take a stigma-free approach to offer people effective, accessible, acceptable and person-centred care for as long as they need.
Buchanhaven is located on the edge of Peterhead, the largest town in Aberdeenshire with a population of approximately 19,000 people. The population they serve consists of a wide demographic, ranging from the most affluent to the most deprived socio-economic backgrounds.
The pharmacy acts as a one-stop place for prescribing, signposting and onward referrals, administration and supply of treatment for substance use and other health conditions. The community pharmacy seamlessly merges their services with those offered by their local board and health and social care partnership.
When Buchanhaven Pharmacy was first purchased by its current owners 18 years ago they supported only four people seeking medication assisted treatment services. During the COVID-19 pandemic they were managing up to 100 prescription collections, and at present have approximately 40 people actively accessing services including:
- Substance use prescribing clinic
- Injecting equipment provision
- Wound and skin infection management
- Administration of long-acting injectable Buprenorphine and take-home Naloxone.
Patients also have access to Pharmacy First Services for managing common ailments.
- The pharmacy has regular monthly training sessions on current topics including naloxone, motivational interviewing and needle exchange.
- The key to patient centred service delivery is having all team members trained to answer queries at the first point of contact.
- All pharmacy staff deliver services in a way that avoids stigma and is respectful of people’s right to confidentiality.
- The pharmacy prides itself on treating all patients, regardless of their reasons for visiting the pharmacy with the highest standard of care.
- The pharmacy has two entrances, providing a choice of access using either the main entrance, or through an additional secure side door.
- People who use substances prefer to use the side entrance as they benefit from a more discreet way of accessing services.
“ ..all your staff had been very encouraging, professional and non-judgemental … Because of this the patient is feeling very positive about their recovery”
Local Mental Health Nurse
Within the pharmacy, there is a strong sense of the need for staff to treat all patients consistently with dignity and respect. This creates a welcoming environment that has resulted in the majority of substance-use clients in the area using their services.
This respect is mutual and helps to build a strong therapeutic relationship between staff and patients, it also has the effect of getting and keeping substance use patients into treatment. Evidence presented in the Scottish Drugs Death Taskforce’s Changing Lives report shows this is the safest approach in terms of reducing drug-related harms.
Any pharmacy that works with substance use patients will encounter occasions when tensions can arise due to things like missing prescriptions and disagreements over clinical decisions.
When things do not go as planned the pharmacy adopts a trauma informed approach to dealing with conflict. This type of flexible and person centred approach helps maintain treatment continuity. At the same time, mutual respect between staff and the people who use their services means that disruptions are brief and rare.
“Lack of stigma is infectious and it breathes from person to person.”
Buchanhaven pharmacy staff member
The commitment of staff to build and foster a no stigma environment is ‘catching’ and makes the pharmacy a welcoming place to visit and work.
The pharmacy benefited from being able to extend into an adjoining property. A layout redesign created an opportunity for a patient-centred review of how services were delivered.
- Involve the whole team in delivering services and planning training by getting suggestions from all staff members.
- Get feedback from all sources including pharmacy staff, and other health and social care staff.
- Most importantly take the time to ask your patients ‘What matters to you?’
- Do not underestimate the impact of social issues, such as financial stressors.