ACCESS TO SERVICES IN GENERAL PRACTICE

Service users described the services available to them when they attended their GP. General practice afforded them a place to sort

things out. There were 127 references extracted from 23 sources where research participants referred to what was and what was not available for them when they attended their GP. These were further broken down to identify service structures such as appointment times and services provided by the medical team. These were described as when you can get sorted i.e. appointment times and availability and what you can get sorted. Lack of services are described as what you can’t get sorted.

There were thirty four references from 15 sources discussing appointment times and when you can ‘’’get sorted’’. All attested to the fact that they knew when they were to arrive. In general, appointment times suited and the majority complied with the surgery structure.

Ken Yeah, I have me own time you know what I mean, I have me own time to come in and sort things out.

Only one service user was negative about attending weekly.

Erica I think it’s ok but like every week fifty bleeding ­two weeks a year!…I do think it’s flexible all right but like I work and I have to turn down some parts of my work so that I haven’t got it on (says day of week) morning.

ICGP guidelines on attendance: Drug misusers on methadone should be seen regularly for review. The frequency of review will depend on the stage of their treatment programme. (ICGP2008:22)

There were 98 references extracted from 23 sources describing the services provided in general practice as what you can ‘'get sorted’’. Services which were described ranged from care for minor illness, child health, womens’ health (smears and coil insertion) asthma checks, health promotion including weight reduction, advice on hyperlipademia,

phlebotomy and viral screening, investigations of infertility, antenatal, pregnancy and post­natal care, blood pressure taking, dermatology, flu vaccinations, childhood vaccinations and managing depression and back pain. Ten women and 2 men described using general practice as a place to have their children looked after. Overall there were 19 service users who had children (Appendix 7 Table 3).

Niamh It’s a place where you can bring your kids.

Sibh Yes if I’m sick I come, if they’re sick, I come. AR Oh you bring the kids as well?

Sibh Oh yes, he’s the kids GP as well.

AR OK, so and it’s fine for all that kind of thing. Sibh Yeah it’s brilliant!

Olwyn… but no all in all, it is a good general practitioners like, I can’t say it isn’t, like anything that I’ve ever needed I’ve got.

Eleven of the service users spoke of the practice nurses in terms of seeing the nurse (7), talking with the nurse (1) and the nurse testing urine (3).’’Seeing the nurse’’ involved phlebotomy, cervical smear taking, ante­natal care and urinalysis.

R So what does the nurse do for you then? Olwyn I’d go in and give her supervised urine. R Oh she goes into the loo with you?

Olwyn Yeah.

Saoirse…when you go in (doctor or nurse) they spend the same time with a Methadone patient than they would with a non methadone patient. You know for different needs any thing like that but like they’re very good and (Nurse) is great cause she reminds you of your appointments like, she was chasing me for the past three years for a smear test and she actually got it from me.

Bracketing Interview 4

R I think one of the big issues is the under resourcing in general practice by the practice nurse and I’m disappointed because the original research which was started in 2001 when I went into practices and spoke to the practice nurses involved in the same general practices that I’m back in now, they felt they had a huge part to play. – This is further illuminated by the following extract

Masters Research: Informant 3 (69) You contribute, you’re not just liaison because of their protocol, they’re seeing you because they have needs and issues like every other patient …you know its very much holistic care rather than… ehm they are not just methadone protocol.

This bracketing interview and previous research extract illuminates how although the nurse feels she contributes significantly to the care of the service user, the role of the practice nurse is viewed as one which is task orientated, providing services but not specific psychological care.

There were 59 references from 19 sources describing counselling facilities which revealed that there was a general lack of this type of service provision in general practice what you can’t ‘‘get sorted’’ Although counselling was available on site in four of the practices and service users had access to services outside the practice in the community, it was a service need understood as being important when receiving treatment. Geographical boundaries affected access to on site counselling as highlighted from this extract:

Sean… as I was saying its a bit ridiculous that I can’t access a counsellor from here do you know what I mean ?even though I’m in (names locality) now … that’s the good thing about the counsellor I’m linking in with , he’s an ex addict, he knows exactly what its like.

There was concern that emotional well being was being overlooked.

Erica …you get someone who has gone through misuse as a child and it doesn’t have to be sexual misuse, emotional, physical, anything you like. It’s stuff where they can’t

relate to people, they can’t develop relationships, they are not socially capable of just communicating …. Going into restaurants and having a meal, that’s not part of their life cause they find it difficult. General practice isn’t helping any of that!.

R You don’t think?

Erica No, I don’t think so I really don’t! And I think there should be a way of incorporating that into methadone treatment.

Even though the relationship with GPs was considered to be good it was considered by all who described their experiences that counselling was a service which provided a specific need whether they wished to attend or not. This need was considered to be outside of the remit of the GP.

Craig Like I’d started talking to (doctor) what I’d started talking to the counsellor about, I started off talking to (doctor) first like (doctor) acted as a counsellor first, for me problems and all…

Daithi Yeah I went to counselling myself separately; I never used my GP for that.

R Do you have counselling here?

Niamh No, in the community drug team…. yeah I can talk to the doctor but I wouldn’t go in and deep and talk to me doctor but I do find I can talk to me doctor, which is good but also the doctor doesn’t have the time to sit and talk and listen

On site addiction counselling was available for Craig who revealed:

C ‘I’d rather that time kill two birds with the one stone’.

Field Note re Craig

He was uneasy at first but then settled down during the course of the interview and began to engage with the process of telling his story.

Difficulty was expressed in accessing counselling in a treatment clinic as this means that the service user has to re­engage with this environment and other drug misusers to attend.

Tadgh No, there’s nothing here like you have to go down to see the… you’d have to go down to (clinic)…but that’s where they go for the phy, all the worst of the worst go there you know that way?

This overall description of ‘’getting sorted’’ describes the users’ perception of what services are provided for them in general practice. The slang of ‘’getting sorted’’ is often also applied to the process of obtaining heroin.

SUMMARY

The findings of this first theme described service users’ lived experience of attending a GP for methadone treatment. The overall description of the experience was described by comparing past experiences within treatment clinics to present experiences in general practice. The transformed meanings were expressed as a place to be treated as an individual, a place to get clean, a place which is confidential, a place to reduce, a place to develop relationships, a place to sort things out and what you can’t get sorted. These findings will be discussed further in chapter 6.

Bracketing Interview 5

R They knew that this was a different place, their identity would change almost by going into general practice.

5. 2. THEME 2

THE SIGNIFICANCE OF METHADONE FOR THE SERVICE USER

Figure 2 The significance of methadone for the service user. (NVivo Model)