Doncaster Metropolitan Borough Council
YORTender Ref: 9RFM-3E4FNF
Adult Substance Misuse Recovery System
Closing Date:
12:00 noon 30/06/2015
Service Specification No.
Adult substance misuse recovery system
Authority Lead
Helen Conroy
Provider Lead
2016/17 - 2019/2020
Date of Review
1. Population Needs
1.1 Introduction
Doncaster Metropolitan Borough Council has been through a process of redesigning the
previously separate drug and alcohol treatment services into an integrated recovery
focused service with a single point of access function. The Council is seeking to further
reshape service delivery to procure a ‘whole system’ recovery focused substance misuse
The new service will include all aspects of substance misuse interventions ranging from
needle exchange, harm reduction, brief interventions, structured psychosocial
interventions, prescribing, structured day care, recovery and aftercare support, inpatient
detoxification and access to residential rehabilitation.
The term ‘substance misuse’ refers to all illicit and performance enhancing drugs, new
psychoactive substances (‘legal highs’), alcohol and prescribed and ‘over the counter’
This specification outlines the framework which will contribute to the outcomes that the
Council wishes to achieve. One service provider will be appointed to deliver the service
through a single contract and must demonstrate within their tender return how they will
structure the service to meet the outcomes outlined in this specification. The Provider is
encouraged to demonstrate innovation and added value in their service design.
The Council reserves the right to review and amend the Service Specification on an
annual basis (or more frequently if appropriate) to take account of changes in national
policy, funding and local needs. Any reviews and subsequent amendments will be
undertaken in consultation with the service provider, no amendments will be implemented
without the agreement of the service provider.
The commissioning functions at the Council are currently based with the Public Health
Team with funding secured from the Public Health Grant.
This specification has been developed following consultation with key stakeholders,
service users, families and carers in line with national and local strategies and other policy
1.2 Strategic Context
This service specification has been developed in line with national and local strategies and
policies including (but not limited to):
The National Drugs Strategy: Reducing Demand, Restricting Supply, Building Recovery:
Supporting People to Live a Drug Free Life (Home Office, 2010) sets out the
Government’s approach to tackling drugs and addressing alcohol dependence.
The Strategy recognises the need to respond to emerging issues, considering
dependence on all drugs and alcohol, not just heroin and crack, in addition to addressing
the complex causes and drivers of dependence to support people to enter sustainable
recovery. The strategy also sets out a shift in power to local areas that will have
responsibility for designing and commissioning services which meet the needs of their
local communities. The strategy has two overarching aims with regard to treatment:
 Reduce illicit and other harmful drug use, and
 Increase the numbers recovering from dependence.
The Public Health Outcomes Framework 2013-16 (Department of Health, 2012) sets out
the desired outcomes for public health and how these will be measured:
 Successful completions of drug treatment.
 People entering prison with substance dependence issues who are not previously
known to treatment.
 Alcohol related admissions to hospital.
The Government’s Alcohol Strategy (Home Office, 2012) outlines the need for local
commissioners to work together to meet local needs as identified in the Joint Strategic
Needs Assessment and ensure specialist treatment is available.
Substance Misuse has been identified as a key strategic priority in Doncaster:
Borough Strategy
Doncaster Health and Wellbeing Strategy
Strategy_revised Feb2013_final_tcm33-109613.pdf
Doncaster Substance Misuse Strategy 2014-17
Doncaster Substance
Misuse Strategy 2014 (4).docx
1.2.1 Vision
The Council is seeking to procure a recovery-focussed substance misuse system which
will support individuals to reduce and stop using alcohol and drugs and underpinned by a
recovery approach which involves three overarching principles – wellbeing, citizenship and
freedom from dependence.
The recovery system will enable service users to develop their potential, improve their
overall health and well-being, build relationships with others, achieve their goals, and
contribute to their community. This will involve addressing people’s substance misuse
earlier, and developing and building an individual’s ‘recovery capital’ – the assets needed
to start, and sustain recovery from drug and alcohol dependence. These assets are
defined as:
 Social capital - e.g. family, partners, children, friends and peers.
 Physical capital – e.g. financial assets, stable accommodation.
 Human capital – e.g. employment, education, skills, mental and physical health.
 Cultural capital – e.g. values, beliefs and attitudes held by the individual.
To maximise and sustain recovery outcomes the Service must work collaboratively with
partners and mutual aid and recovery networks to increase opportunities within the
community throughout treatment and on leaving the system.
The Service will be easy to access and deliver a range of effective, evidenced based
interventions which meet the individual needs of the service user whilst also having a
holistic whole family approach.
1.3 Substance Misuse Profile- Doncaster
(As of Q2 14/15)
In Treatment
1535 Opiate clients
173 Non-Opiate clients
499 Alcohol clients
131 Alcohol and Non-Opiate
Time in Treatment
530 Opiate clients, under 2 years
316 Opiate clients, 6 or more years
5 Non Opiate only clients, 2 or more years
Average years in treatment
4.1 Opiate
1.6 Non-Opiate
Living with Children
832 Opiate clients
73 Non-Opiate clients
190 Alcohol clients
54 Alcohol and non-opiate
Successful completions
6% of Opiate clients
46.2% Non-Opiate clients
39.5% Alcohol
35.1% Alcohol and non-opiate
13.1% of Opiate clients
5% of Non-opiate clients
11.4% of Alcohol clients
13.3% Alcohol and non-opiate clients
Measures of recovery
Public Health Outcomes Framework, who successfully complete treatment and did not represent within 6 months of leaving treatment
7.1% Opiate clients
36.5% Non-Opiate clients
Clients in contact with criminal justice system
In Treatment
536 Opiate clients
21 Non-Opiate clients
32 Alcohol clients
16 Alcohol and non-opiate clients
Successful completions
4.1% Opiate clients
28.6% Non-Opiate clients
40.6% Alcohol
25% Alcohol and Non-opiate clients
Community Pharmacy Based Consumption
73 Pharmacies
143,081 Supervised consumptions/year
Needle and Syringe Programmes
18 community pharmacies
32,306 exchanges/year
2. Key Service Outcomes
2.1 Outcomes
Key outcomes for service users within the treatment and recovery system are:
 Freedom from dependence on drugs or alcohol.
 Prevention of drug related deaths and infection by blood borne viruses.
 A reduction in crime and re-offending.
Sustained employment.
The ability to access and sustain suitable accommodation.
Improvement in mental and physical well-being.
Improved relationships with family members, partners.
3. Scope
3.1 Aims and objectives of service
To reduce Illicit and other harmful substance misuse and increase the numbers recovering
from dependence
This will be achieved by:
 Improving and increasing access and engagement into the system for those needing
support for their substance misuse.
 Developing an asset based approach, which values the capacity, skills, knowledge,
connections and potential in individuals, families and communities.
 Co-ordinating and delivering a personalised recovery package of care for all people
entering the system and ensure continuity of care on entry, during and on leaving
 Supporting and promoting the use of peer recovery networks across all stages of
system delivery and beyond.
3.2 Service description/pathway
The treatment and recovery system will have a hub and spoke structure as described in
the diagram attached below
Hub and Spoke
The following service elements are to be delivered to meet the outcomes outlined in this
Needle and Syringe Programmes
The Provider must ensure needle and syringe programmes are available for the provision
and safe disposal of needles, syringes and other injecting equipment. Needle and syringe
programmes will be delivered from a variety of locations and settings across the Doncaster
district including pharmacies to ensure easy access. Opening times must be flexible to
meet local need and demand and include some evenings and weekend provision.
Currently there are sixteen fixed site pharmacy needle exchanges and one specialist
exchange at the Depot drug team in Mexborough. In addition the provider will establish a
further specialist exchange site in Doncaster town, but not in the Thorne Road area which
is served by a 100 Hour pharmacy. The Provider will be responsible for managing and coordinating pharmacy needle and syringe programmes with a view to develop expanding
provision in areas to meet identified need, in consultation with the Public Health Team.
Pharmacy sites:
The Provider must ensure a range of appropriate equipment is available that meets local
need and is provided alongside harm reduction interventions including (but not limited to):
 Advice on safer injecting;
 Advice on stopping injecting;
 Inspection of injecting-site infections and referral for wound care;
 Advice on safe and responsible storage and disposal of injecting equipment;
 Facilitating access into structured treatment;
 Harm reduction advice and overdose prevention;
 Referral to and access to interventions to reduce Blood Borne Viruses including the
offer of Hepatitis B vaccination and Hepatitis C screening;
Provision must be delivered by competent staff and in accordance with NICE PH52:
Needle and Syringe Programmes and local guidance
All costs related to the provision of needle exchange programmes (including pharmacies)
such as the purchase of equipment, storage, distribution, disposal of all equipment,
payment of contractors, training in accordance with local guidance, or accreditation will be
met by the provider.
The vision for Doncaster’s Recovery Treatment system is for a single point of
access, single referral, assessment and recovery planning process. This will
facilitate quick and easy access into treatment and enable the delivery of holistic,
multi-disciplinary recovery plans.
The single point of access will be a functional entity which delivers assessment,
open access interventions, recovery planning, a unified case management system
and referral into structured interventions.
The Provider shall deliver a screening and referral tool and process for
professionals to use to assess the needs of all Service Users, which utilises
recognised screening instruments which are inter-changeable between services
and are agreed by all parties.
The Provider shall develop a universal assessment framework which will be used
within the Provider Services, with both drug and alcohol clients. This will include an
initial assessment and a full, comprehensive assessment
In line with national guidance, the assessment framework will include a screening
tool and a full comprehensive assessment. It will adopt an holistic approach and
include the Alcohol Use Disorder Identification Test (AUDIT) and the Severity of
Alcohol Dependency (SAD) questionnaire (where appropriate) for all individuals
using alcohol
Every new Service User entering the Service will receive an initial assessment on
their first contact with the Service and a comprehensive assessment prior to starting
specialist structured treatments
The comprehensive assessment will fulfil the requirements of the drug and alcohol
minimum data sets including all current and future requirements of the National
Drug Treatment Monitoring System database and include as a minimum:
a) Current and previous drug and / or alcohol use
b) A physical health assessment, including GP/dental registration, a screening for
blood borne viruses, smoking cessation, nutrition, sexual health and
c) a mental health screening tool
d) Recording any current and/or previous involvement in the Criminal Justice
e) risk assessment
f) domestic violence risk
g) housing needs
h) safeguarding (children and adults) needs
i) emotional needs
j) social networks including family life and relationships
k) personal, life and education, training and employment skills and needs
l) future aspirations and beliefs around recovery
The assessment framework will be used by the Provider to determine the tier of
intervention (tier 2 and up), and develop a recovery plan with the Service User
which will be reviewed and updated, by the Provider and with the Service User, at a
minimum of every three months and according to changing needs and
circumstances of the Service User
Where additional needs are identified, where appropriate and with Service User
consent, the Provider will make a referral and follow up with appropriate onward
All Service Users will have a single recovery plan throughout their recovery journey.
Initial and comprehensive assessments will be updated, but not duplicated as the
Service User moves between different settings/modalities (with Service User
The Provider shall ensure that every Service User receives a full explanation of how
their information will be processed and in what circumstances it may be shared with
other agencies
Where Service Users are not registered with a GP the Providers will support them
in identifying and registering with one
A risk assessment will be completed for every new Service User including their
level of risk awareness. Where risks are identified, the Provider shall develop and
implement a risk and/or vulnerability management plan, linked to the Service User’s
recovery plan. The Provider shall regularly review the plans with the Service User.
Information relating to risk will be shared with other organisations by the Provider
and acted upon according to the local procedures and protocols as notified to the
Provider by the Commissioner
In line with Hidden Harm (children who are affected by living with substance
misusing parents/Carers) and the whole family approach, the assessment will
identify those Service Users who are parents and/or who come into regular contact
with children. For these Service Users, the comprehensive assessment should
identify the needs of the child in relation to the impact of the parent’s substance
misuse. The assessment will capture as a minimum the following information:
the name of the main carer/s for children
the age of children
the name of health visitor if applicable
CAF status (current / previous)
Child in Need status (current / previous) and
Child Protection status (current / previous)
Young person’s capacity to consent (Laming compliancy) where the service
user is a young person in transition
The Provider shall carry out initial, and on-going, assessment of the impact of
substance misuse on parenting capacity - in line with changes to patterns of
misuse/relapse etc - and have mechanisms in place with local Children’s Services
to make appropriate Child In Need/Child Protection referrals. This will be based on
a risk and resilience model, taking into account protective factors
Where it is established that there may be children affected, the Provider shall work
with the Service User to put in place appropriate measures to mitigate risk to
include, for example, safe needle storage, Blood Borne Virus-related factors and
record and review this via the Service User’s Recovery Plan
Where a potential or actual risk to children is identified, the Provider shall have
mechanisms in place to be able to appropriately contribute to the multi-agency
Common Assessment Framework (CAF)
In line with Supporting and Involving Carers, (NTA 2008) the Provider shall give
family members and significant others the option to be involved in assessment,
planning and review, where appropriate and with the consent of the service user.
Assessment will be available in a range of settings, by arrangement with the
relevant individual/organisation, including; specialist services, primary and
secondary care settings, GPs, home (in keeping with identified lone working policy)
and criminal justice settings, to suit the needs of the Service User, their family and
wider strategic priorities
When explaining issues of confidentiality and consent to the Service user, the
Provider shall include reference to the Commissioner’s information requirements
and access to data for audit, service development and performance management
Case Management and Recovery Co-ordination
A single recovery co-ordination and case management process will underpin the
treatment system and will be used to maintain Service User engagement and
facilitate recovery outcomes.
Recovery/Care Planning:
The Provider will ensure that all Service Users accessing structured/specialist
interventions will have a Recovery Plan, signed by both the key worker and the Service
User. This will be developed from the needs identified in the initial and comprehensive
assessments and include as a minimum:
a) Initial Assessment, including child needs/risk assessment (where applicable) –
see Assessment Section;
b) level of drug and/or alcohol use throughout treatment and associated
c) physical health, including injecting and blood borne virus status and sexual
health (including screening and access to contraception);
d) emotional/mental health issues and relevant plans/referrals;
e) on-going risk assessment & associated management plans;
f) current and/or previous involvement in the Criminal Justice System;
g) housing requirements/goals;
h) family/Carer needs, including affected children and referrals for Carers
i) social/support networks including family life and relationships;
j) personal, life and education, training and employment goals;
k) recovery goals and progress;
l) Relapse Prevention Plan and
m) Treatment Exit Plan
The Provider shall undertake a Recovery Plan review for each service User as a
minimum of once every three months
Recovery planning and review will involve the Service User and appropriate
professionals from partner agencies involved in the Service User’s on-going
recovery. This will include the Service User’s family and/or significant others where
appropriate and with Service User consent
Where Service Users are expectant parents/parents/Carers of children, the
Provider will develop appropriate links with safeguarding teams (where required);
maternity services and other relevant services – in line with local safeguarding
The Provider will ensure that a treatment outcome profile (TOP) – as defined by the
National Treatment Agency - is routinely completed for all substance users at
treatment entry, at recovery plan review and on planned exit from treatment. A
minimum threshold of 100% starts, 100% reviews and 98% exit TOPs will be
implemented. A ‘recovery check-up’ will also be completed at a 3 month, post
discharge follow up (subject to client consent).
All Recovery Plans will be specific, measurable, attainable, relevant and time-bound
and will incorporate the TOP process
The Provider will take particular measures to promote accurate and meaningful
completion of all TOPS treatment questions including those which relate to
The Provider will adopt, where possible, a lead officer (care co-ordinator) approach,
with one allocated key-worker assuming responsibility for co-ordination of all
elements of the Service User’s recovery journey. Every Service User will be
allocated a single key worker/Recovery Manager within 5 working days of
comprehensive assessment, once the appropriate structured intervention is
Where another agency e.g. Probation, Job Centre Plus or Children’s Services, are
involved with the Service User or their children – on either a voluntary or statutory
basis - the Provider shall share relevant information, co-work and attend review
meetings with such agencies as required
The Provider will ensure that the level and frequency of intervention reflects the
Service User’s initial and on-going need and risk assessment
The Provider will allow the PH commissioning team access for anonymised case
file audit purposes at least annually
Treatment Exit Planning:
The Provider will work in partnership with Service Users, Carers and other agencies
to ensure that pro-active exit planning, aftercare and relapse prevention plans are
part of the on-going recovery planning process
To encourage Service Users to achieve a planned exit, and to minimise relapse and
re-presentation into the Service, the Provider will offer a basic level of support
following planned exit from treatment. This will include:
a) links to continued access to positive health and leisure activities and wraparound support where needed e.g. ETE (education, training and employment),
housing etc
b) identification of generic services or other organisations which can continue to
support the Service User in their recovery e.g. mutual aid organisations, Job
Centre Plus, ETE and housing support agencies
c) a three month follow-up contact to identify if the Service User is successfully
continuing in their recovery and/or has any additional needs.
Data Confidentiality and Access Issues
The use of robust case management and information management tools will enable
controlled but wide sharing of information and ensure that the data collected is
accurate, reliable and will support the continual assessment of drug and alcohol
related needs in Doncaster.
The Provider will be expected to supply their own IT system that will support full
NDTMS reporting, or the Provider should utilise DET/DAMS, as available from Public
Health England. The Provider will be responsible for funding any required upgrades
and ensuring compliance with NDTMS requirement – as defined by the PHE – at all
Open Access Interventions
The Service will work to the principle that all interventions are also Public Health
interventions. Open access interventions will provide a gateway into the wider
recovery system providing an initial point of assessment and advice, and where
required referral on into more structured interventions. They will also provide
specific interventions including: Identification and Brief Advice (IBA) and extended
interventions for alcohol; brief and extended interventions for drugs; and harm
The Provider shall provide a single point of access function for screening, advice
and onward referral at a central location in Doncaster Town as a minimum, and
hubs in Bentley, Thorne and Mexborough, with flexible hours to suit the needs and
lifestyles of Service Users. It is recognised that additional delivery hubs based on
need may be developed in agreement with commissioners.
Open access will be a safe space for drug and alcohol users to access information,
support and motivational interventions. The Provider will signpost and refer
individuals into related agencies and appropriate treatment depending on their
needs including advice on areas such as housing access, education, training and
employment and benefits
The Provider will work with partner agencies including Local Authority, Probation,
Police, Citizens Advice Bureau and health Providers to maximise engagement
opportunities across a range of settings; particularly to target hard to reach and
vulnerable groups
The Provider will ensure that all advice and information on treatment options are
offered in a variety of methods and languages according to need
Identification, Brief Advice and Extended Interventions:
An alcohol brief intervention typically occurs and comprises a single 5-15 minute
session, and up to a maximum of four, sessions of engagement with a patient and
the provision of information and advice designed to achieve a reduction in risky
alcohol consumption or alcohol-related problems. A brief intervention has five
essential steps: assessment of drinking behaviour and feedback; negotiation and
agreement of goal for reducing alcohol use; familiarisation of the patient with
behaviour modification techniques; reinforcement with self-help materials; followup telephone support or further visits
The Provider will use AUDIT for identification and brief advice for alcohol, unless
this has been completed by a referring agency. Where a Service User scores 16 –
19 the Provider will offer extended interventions which will comprise a minimum of a
20 minute session and a follow up appointment at three months. Where a Service
User scores 16 – 19 with additional risk factors or 20+ the Service User will be
offered specialist intervention
The Provider shall develop a similar identification, brief advice and extended
interventions structure for those with drug misuse issues. This will include the
targeting of unmet need within the 18-24 years stimulant/party drug/legal high using
priority group
Harm Minimisation:
The Provider will deliver screening/testing for hepatitis B, C and HIV, and will work
in conjunction with Public Health for hepatitis A issues as required.
The Provider should provide appropriate information for Service Users and their
families around protection from, and reducing the risk of transmitting, BBV and
sexually transmitted infections
The Provider shall supply free condoms to prevent the transmission of BBVs and
It is expected that with the Service User’s consent nurse-led referrals are made to
appropriate services including the Hepatitis Nursing Service for all Service Users
testing positive with hepatitis B or C, and onward referrals for HIV
The Provider will deliver immunisations for hepatitis A and B.
The Provider will deliver advice and support on safer injecting, on reducing
frequency of injecting and on reducing initiation of others into injecting
The provider will deliver advice and support on preventing risk of overdose and
drugs and alcohol related deaths
Harm Reduction
Strategy 2014-15.doc
Wraparound Interventions
Wraparound Interventions should be a ‘core offer’; available for all Service Users,
accessing any type of treatment, and at all stages of recovery, including those
accessing harm minimisation services and those who require abstinence based
support. This should include provision for those who have successfully exited
structured treatment. The Provider should provide a link and broker wraparound
interventions to Service Users as part of the Service and should include, as a
a) access to a range of positive social, art and leisure activities
b) support with Education, Training and Employment
c) support with housing
d) Complementary Therapies
e) developing life skills e.g. parenting, cooking, gardening
support with general healthcare including support with registration and
engagement with dentists, opticians and GPs etc
g) debt advice including links with Citizens Advice Bureau
Psycho-Social Interventions and Counselling:
Psychosocial interventions will form a key part of the Service User’s recovery
journey and will be offered to Service Users in both one to one and group-work
All psychosocial interventions and counselling will be delivered in line with NICE
guidelines and other best practice guidelines
The Provider will offer a range of psychosocial interventions to each Service User
according to need and changing circumstances. These should include as a
a) motivational interviewing
b) solution focused brief therapy
c) international treatment effectiveness project (ITEP)
d) improving access to psychological therapies (IAPT) – referring on to generic
Provider in accordance with any local pathways as notified to the Provider by
the Commissioner from time to time
e) relapse prevention – including the options of 1-2-1 and/or group work in a range
of settings
f) behavioural couples therapy in line with NICE guidance
The Provider shall make available psychosocial interventions to all Service Users at
all stages of their recovery journey including pre-contemplation, contemplation,
active change and relapse prevention and will address drug and alcohol use
including poly/cross use
The specific needs associated with stimulant use are often different to those using
other drugs, so the Provider will ensure that interventions specific to these needs
are available and incorporated into the recovery planning process where
The Provider will make sure that all staff who will deliver group-work are
appropriately qualified and have received appropriate level group-work skills
training and on-going specific support.
Structured Counselling:
The Provider shall provide structured counselling services as part of the Services to
Service Users (where appropriate)
The level and duration of counselling support provided to a Service User will be
based on comprehensive assessment of need. It is anticipated that this will usually
be between six and twelve sessions
Where longer term counselling support is identified in relation to issues such as
childhood trauma, sexual assault and bereavement, the Provider will endeavour to
identify and refer the Service User to an appropriate alternative specialist services
The Provider will utilise both accredited and volunteer counsellors (who are working
towards their accreditation) in delivering the counselling services
The Provider shall have robust systems in place for on-going training and
professional supervision of all Staff involved in the delivery of the counselling
Pharmacological interventions
Medication to support behaviour change and abstinence from alcohol and drugs is a
necessary component of treatment for many. Pharmacological interventions, where
needed, must be fully integrated with harm reduction interventions, evidenced based
psychosocial interventions and in accordance with Drug Misuse and Dependence: UK
Clinical Guidelines for the Management of Substance Misuse and the applicable NICE
Guidelines and Technology Appraisals. A clinical assessment must be completed prior to
prescribing which will build on and contribute to the comprehensive assessment already
undertaken. Such pharmacological interventions will include:
 Opioid substitution therapy.
 Opioid detoxification.
 Stabilisation and withdrawal from illicit benzodiazepines or other prescribed drugs.
 Alcohol detoxification.
 Prescribing to prevent relapse.
In delivering Opioid Substitution Therapy it is expected that the provider will employ
protocols which assure an appropriate and risk managed balance between maintenance
and timely detoxification; these protocols will reflect the key recommendations of Recovery
Orientated Drug treatment- an interim report (NTA, 2011) and Medications in Recovery
(NTA, 2012).
Detoxification will be community based with a number of exceptions such as:
 Several previous unsuccessful formal community detoxification episodes.
 Significant co-morbid physical or mental health requiring medical/nursing care;
 Complex poly detoxification requirements e.g. opioids with alcohol or
 Significant social issues which will limit efficacy;
 For people in acute alcohol withdrawal with, or who are assessed to be at high risk
of developing, alcohol withdrawal seizures or delirium tremens.
Clinics will be arranged to facilitate rapid access to prescribing, on the same day where
needed and appropriate, and within a maximum 2 – 5 working days. For service users who
are released in a planned or unplanned way from prison on a maintenance prescription,
the prescribing programme shall continue without any interruptions to the service user.
Prescribing interventions shall have clear protocols around prescribing regimes and
reviewed at the earliest opportunity to ensure that they are contributing towards overall
recovery plan goals.
Prescribed drug selection, dose and dispensing frequency for each service user must
remain a clinical decision based on service user need and risk. However, Providers shall
need to evidence within this, that prescribing is carried out in a cost effective manner and
in line with local guidelines.
Prescribing Costs
The provider will be responsible for the prescribing budget and will be expected to manage
the total cost of prescribing for the service
Supervised Dispensing
The Provider will be responsible for facilitating arrangements with all participating
pharmacies for the supervised consumption of medication for opioid substitution therapy
and detoxification. This includes all relevant costs associated with the provision of this
service. Doncaster Commissioners wish to promote a model of delivery which maximises
local geographical access of supervised consumption pharmacy outlets for clients.
The provider will supply methadone safe storage boxes to clients.
Drug Testing
The Provider must ensure local protocols and appropriate facilities are in place for
biological testing and service users are provided with sufficient information about the uses
of drug testing, including how it is used to inform the treatment they receive, so that an up
to date picture of any illicit drug use is maintained.
The Provider will be responsible for all costs related to drug testing including the purchase,
testing and disposal of equipment.
GP/NMP Shared Care Clinics
The Provider will manage and deliver a system of shared care key workers to complement
General Practitioner/Non Medical Prescriber led Shared Care clinics in a Doncaster Town,
Thorne, Bentley and Mexborough. The provider may wish to deploy GPs, NMPs or both to
deliver the prescribing component of the shared care clinics. The Provider and
Commissioner will keep the capacity and location of these clinics under constant review in
order to respond to changing patterns of drug and alcohol use and demographics across
the Borough.
During 2015-16 the GPs providing substance misuse shared care services are: Drs P.
Hurley, W. Barker, M. Coleman, S. Arif, E. Njoku and A. Paul.
Primary care based locally commissioned services for alcohol screening, brief
interventions and referral
The provider will manage contracts for and further develop provision of primary care based
locally commissioned services for alcohol. A specification for the delivery of these services
was developed during 2014-15 and the commissioner is seeking to further develop and
extend the provision in order to adopt an ‘upstream’ approach to alcohol interventions, via
the delivery of screening and brief interventions in primary care settings.
Access to services for criminal justice clients
Referral systems will be agreed with staff based in, or working in the custody suite, i.e. an
arrest referral function will be provided. The intention is that all prisoners held within police
cells will be offered the service, i.e. being given to those who test positive as a result of the
drug testing procedure. Referral pathways are as follows:
All custody staff will refer proactively where appropriate;
Those staff involved with drug testing of detainees will refer proactively, and ensure
that all those with positive tests are referred under the Drugs Act 2005;
Those staff involved in cell sweeps will refer proactively;
Those clients who could not be seen whilst in custody will be offered a domiciliary
visit or an appointment at a convenient time and place;
Referrals from courts under bail restrictions;
Referrals from prison CARAT and Health Care teams (as per locally agreed
pathways); a prison liaison function will be provided between the service and local
prison establishments
Referrals from Direct Access;
Referrals from other partner agencies such as National Probation
Service/Community Rehabilitation Company or the IOM;
Referrals from any relevant MDT forum and individual service providers, for
outreach, throughcare and aftercare support where appropriate.
Work in a complementary fashion with schemes such as Liaison and Diversion
Drug Rehabilitation Requirements/Alcohol Treatment Requirements:
The Provider will work in partnership with the National Probation Service/CRC to
support the delivery of Drug Rehabilitation Requirements (DRR) and Alcohol
Treatment Requirements (ATR) in Doncaster. NPS/CRC will care coordinate
Service Users on DRRs and ATRs; the Provider will participate, as required,
including involvement in three-way care plan reviews
The Provider will assess all offenders referred for a DRR/ATR for suitability
according to a comprehensive assessment of need. Where offenders are assessed
as not suitable, appropriate information will be provided to the offender to
encourage voluntary referrals into the Service
The Provider will work with all suitable offenders to prepare and co-ordinate a
recovery-focused treatment plan based on their assessment of need and where
possible Service User choice.
The Provider will support delivery in line with local NPS/CRC DRR and ATR targets
The Provider will report to the NPS/CRC or court as required on the progress and
compliance of Service Users subject to a DRR or ATR including, where appropriate,
supplying evidence to support breach or revocation proceedings
Binge Drinkers group work: the provider will support NPS/CRC with local
initiatives such as the development of binge drinkers groups for NPS/CRC clients.
Socially Supported Detoxification
Social care model: the provider will deliver four beds of CQC registered social model inpatient provision offering a 14 /21 day community based detox or stabilisation (based on
individual assessment on an exceptions basis) from illicit drug and alcohol use within a
supported environment, including regular testing, key working, activities and daily chemist
runs. The remit for this provision excludes more complex cases such as heavy
benzodiazepine use. The treatment provision should also have capacity to look at rapid
intake if voids occur and possible extensions to the 14 day experience depending on
spaces. The provision should offer an extended treatment interface for clients leaving
medical model in- patient detox if needed. There is an assumption that all clients would
aim to engage in Structured Day Programme post detox.
In patient detoxification and Residential rehabilitation
The Provider will deliver or will contract 2 beds of medical model in-patient detoxification
capacity for drugs and alcohol. This should be delivered / contracted from an appropriate
facility, which is CQC registered and with an appropriate level of clinical cover.
The Provider is required to provide assessment and care coordination for access to
planned in-patient detoxification. Ensuring continuity of care for service users is
particularly important with respect to unplanned discharges.
The care co-ordinator will still remain responsible for tracking the service users progress
on their treatment journey whilst they are in residential rehabilitation including TOPs
recording and other data collection and recording.
Residential rehabilitative treatment provides a safe environment, a daily structure, multiple
interventions and can support recovery in some people with substance misuse problems
who have not benefitted from other clinical interventions or recovery options. For people
with substance misuse problems to make an informed choice about residential
rehabilitative treatment, taking into account personal preferences, it is important they are
aware of the NICE eligibility criteria (Clinical Guideline 51).
The Provider will offer access to residential rehabilitation in line with the requirements of
the NHS and Community Care Act (1990). This will require additional assessment and
care co-ordination. A residential rehabilitation pathway will be produced by a Provider
which will be available to service users, carers and other agencies, in liaison with the Local
Structured Day Care/Structured Day Programme
Structured Day Programme
The provider will deliver a 12-18 week rolling programme based on cognitive restructuring
within a therapeutic environment (including outreach projects) offering a range of
therapeutic groups and 1-1 interventions, workshops, life skills, diversionary activities and
qualifications. Clients will have an individually tailored recovery plan drawn up on the
outset and reviews each 4 weeks. A rolling programme will be delivered and clients will be
illicit drug free on the day of presentation, and expected to work towards detoxification
from prescribed medications during the Structured Day Programme. Screening will take
place regularly. The timetable will be client centred through the care/recovery plan, though
core groups need to be attended.
The Provider will work with the commissioner and other Providers to develop a stepped
recovery pathway for drug and alcohol clients, which encompasses a progression as well
as a step down from the structured day programme, into the structured day care/social
space activities.
Six week aftercare component
A 6 week aftercare programme of the SDP will be designed to offer both therapeutic and
practical life skills to enable clients to move through the transition stage towards
independent living. Using lower tiered interventions and IAPT, shared care and other such
appropriate support networks. The aftercare will focus very much on securing meaningful
exit strategies whilst supporting individuals in this process addressing job applications,
budgeting etc. These will take the format of 1 group per week alongside 1-1 work and key
working. This group is not exclusive for people completing the first 12-18 weeks of the
SDP programme and will be run on an evening so there will be inclusion for those who
Completion & discharge planning including suitable aftercare arrangements,
including external, post SDP support:
Clients will have successfully completed a SDP intervention and confirmed attendance in a
suitable aftercare, structured support or follow-up. These are likely to include, but are not
restricted to
Residential housing support
Floating support
Another suitable statutory and/or non- statutory service
Structured day care/social space provision
The provider will develop a social space provision where clients can drop in and socialise,
with a structured day care approach, which incorporates activity and interest groups. This
provision with act as a step up or step down from the Structured Day Programme.
Dual Diagnosis
For the purposes of this specification, dual diagnosis is defined as being:
‘Individuals with both diagnosed severe and enduring mental health illness and
problematic drug and/or alcohol use. This includes any drug use which is seen to
be either, exacerbating the symptoms of a mental illness, or, interfering with an
effective treatment response.
The Provider shall work alongside generic mental health services to provide an
integrated and inclusive treatment response for Service Users presenting with a
dual diagnosis need
The Provider will ensure that Provider Staff have appropriate training and
competencies to address dual diagnosis
The Provider will provide screening, assessment and establish links with mental
health services to address the identified issues via existing pathways
The Provider will promote and facilitate joint recovery planning and risk assessment
for Service Users with Dual Diagnosis as identified by mental health services
The Provider will regularly review care pathways and operational protocols
Joint Working With Hospital Liaison Worker
The Provider will ensure close working relationships with the Drug and Alcohol Nurse
Specialist based at Doncaster Hospital, in order to maintain care pathway arrangements
between the hospital and community settings.
Targeted Services for Vulnerable People
The Provider will deliver targeted drug treatment services and intensive social support to
drug and alcohol misusers from vulnerable groups and hard to reach groups, with chaotic
and complex lifestyles who may be marginalised from and find difficulty accessing other
generic services.
Target client groups will include but not be limited to:
BME groups/asylum seekers
Female substance misusers especially sex workers
Homeless substance misusers
Stimulant/NPS users
Steroid users
LGBT clients
Clients with a learning disability or learning difficulty
The full range of open access and structured interventions will be available to these
groups, taking account of vulnerability factors such as the need for the use of interpreters,
or the need for an assertive approach due to chaotic lifestyles.
Mutual Aid Support
The Commissioner is committed to the development of recovery networks to
provide a diverse and comprehensive range of support to those in recovery – in
treatment and beyond.
The Provider will utilise the emerging evidence base around recovery and work with
recovering drug and/or alcohol users to support the development of non- clinical,
non- professional support groups across the borough
The Provider shall ensure information about and pathways into these groups are
accessible for all Service Users through-out the treatment system
The Provider will support the identification and development of recovery champions
to promote the peer-led recovery agenda locally
The Provider will develop working links with Narcotics Anonymous, Alcoholics
Anonymous and SMART recovery to ensure that a variety of meetings are easily
accessible for all Service Users
The Provider will work with mutual aid organisations to ensure that assertive linkage
and onward referral are available into mutual aid and peer support for all Service
Users engaging in or leaving treatment, including residential rehabilitation.
Peer Mentoring and Volunteering
 The Provider will develop and co-ordinate an effective volunteering and peer
mentoring system, including the delivery of regular accredited mentoring training,
developing and maintaining links with Doncaster CVS. The peer mentors, who will
themselves be in recovery, and volunteers, shall be supported to become recovery
champions and have a growing visible presence within the whole system, helping to
motivate and support others to take steps towards recovery and avoid relapse
 The Provider will provide appropriate supported placement opportunities for
volunteers and mentors throughout the system
Mentoring of Offenders
The Provider will offer support and guidance to offenders, resident within the Doncaster
area, identified as IMPACT Offender status, and who either are or not subject to statutory
supervision by the South Yorkshire probation service to :
Contribute to the reduction in the incidence of re-offending by the IMPACT
Offenders identified, registered and reviewed by the Doncaster Local Offender
Management Panel
Assist IMPACT nominals to access accommodation services
Assist IMPACT nominals to access drug and alcohol advice and treatment
Assist IMPACT nominals to access education, training and employment services
Provide support to IMPACT nominals to help them resolve personal, social and
family relationships
Individuals will be referred via the National Probation Service/CRC, and engaged into a
mentoring arrangement and a range of support services which will assist them to resettle,
access accommodation, medical care, and suitable training and employment
opportunities. Support with addressing personal and emotional issues will also be provided
with the objective of reducing the risk of re-offending.
Training to Professionals
The provider will offer a comprehensive range of drug and alcohol training to local non22
specialist agencies in order to increase knowledge of substance misuse issues, and
enhance local referral and care pathways.
12 training sessions will be conducted per annum on localised request.
Public Information
The provider will ensure that electronic and paper information about services is available,
e.g. websites, to meet the needs of local populations.
Public Health Campaigns
Periodically the Public Health team may require the assistance of the provider in the
delivery of specific local or national campaigns. This will not exceed 4 campaigns per year.
Hosting of Specialist Substance Misuse Midwife
The Provider will host the Specialist Substance Misuse Midwife post employed by DBHFT,
in order to deliver a seamless service for pregnant substance misusing women.
50% of the cost of the post will be borne by the provider, and a formal arrangement will be
made as such with DBHFT.
Service User and Family/Carer Involvement
The Commissioner encourages Service Users, ex-Service Users and families
/Carers to be given the opportunity to be involved in the design and delivery of local
services at all levels.
The Provider will ensure all Service Users and family members/Carers if
appropriate, are aware of their rights and responsibilities at the point of engagement
with the Services, specifically around information sharing and consent
The Provider will ensue there are mechanisms which allow anonymous feedback
from Service Users and informal Carers
The Provider will have a clear Dangerous Patients’ policy which will govern the
decision making process for excluding a Service User from the Services (including
consultation with the Commissioner) and managing associated risk. This policy will
promote risk-assessed on-going contact with Service Users who may have been
excluded from certain locations.
The Provider will support the involvement of Service Users and families/Carers
within local strategic planning by active links with Doncaster PH commissioning
The Provider will encourage the recruitment of, and provide support for, Service
User representatives across the service
The Provider will develop a range of volunteer and peer opportunities within the
service. The Provider will ensure there is a clear policy governing the recruitment of
ex-Service Users both as paid staff and volunteers, including CRB check issues
The Provider will promote regular consultation with Service Users and Carers in
order for their views and experiences to be used as a tool for performance
monitoring and continuous service improvement.
Family Interventions and support for Carers
Evidence clearly shows that Service Users have a much greater likelihood of
achieving and sustaining recovery where protective factors and recovery networks,
such as close family/Carer involvement, are in place. Equally, evidence shows that
the people surrounding a substance misuser are also more likely to have
issues/complex needs to address. In order to ensure recovery of the client, the
Provider must, therefore, also provide support to the family/Carers.
The Provider will have in place appropriate mechanisms to identify and respond to
the safeguarding of children and vulnerable adults at all times through-out delivery
of the Services
The Services will operate within the context of the substance misuse section of
Doncaster’s safeguarding procedures, between adult drug/alcohol services and
Children’s Services. Staff will be trained to level 3.
The Services will collect a minimum dataset on Service Users with families and
those living with children – see Assessment Section
The Services will offer specific interventions for parents based on the impact of drug
and/or alcohol use on parenting, the role of social services, positive parenting and
the safe storage of medication. The provider will ensure staff are available to
participate in the local delivery of MPACT (Moving Parents and Children Together)
training and interventions to families, funding and facilitating up to 4 cohorts per
The Provider will assess the needs of Service Users who are parents and
encourage and support them to access and utilise mainstream family services. This
will include the development of referral pathways with Sure Start and other
mainstream Providers. Where a Service User is pregnant, the Provider will flag with
maternity services to ensure post-natal follow up e.g. in respect of potential
neonatal abstinence or foetal alcohol syndrome
The Provider will collaborate fully with Doncaster’s Stronger Families programme.
The Provider will develop working links with community health services including
health visitors, parenting support workers and school nurses
Where Service Users are identified as living with children, or in regular contact with
children, supportive home visits will be offered. This will where possible be in
partnership with appropriate community services. Home visits must be made in the
context of a lone working policy and appropriate risk assessment procedures
The Provider will provide Carers’ Assessments and onward referral into generic
Carers’ services in Doncaster
The Provider will support the development of parent and carer support groups as
required by local needs
Reducing Drug and Alcohol Related Deaths
Key to the reduction of drug and alcohol related deaths are:
 Robust information sharing systems, care co-ordination and the delivery of
integrated pathways
 Staff training and commitment to ensure that service users have access to the
appropriate harm minimisation advice and support
 Service delivery that focuses on recovery focussed engagement
 Appropriate risk assessments and risk management processes
 Provision of take home naloxone
Moving in and out of the criminal justice service and following detoxification and
rehabilitation are high risk periods to which the Provider shall pay particular attention.
The Provider shall assist in the development and implementation of any plans to reduce
drug or alcohol related deaths, following any recommendations highlighted to clinical
governance leads from confidential enquiry panels. The provider will fully co-operate with
supplying information to the PH commissioning team regarding any service user or former
service user death or critical incident, and will attend the DRD steering group.
3.3 Population covered
The services cover the geographical area of Doncaster Metropolitan Borough Council and
are for Doncaster GP registered clients. However it is recognised that some Doncaster
area clients may be homeless/in insecure accommodation, or not registered with a GP.
3.4 Any acceptance and exclusion criteria and thresholds
The NHS Zero Tolerance guidance (DOH circular, 1999) describes a process where
service users can be excluded for behaviour which breaches acceptable rules and
standards but within a structure of user’s rights and responsibilities which should be made
clear to clients from the outset.
However given the situation where there is limited choice for drug services within the
Borough, decisions to exclude clients from all or some aspects of the treatment system
should only be made by the service manager/ clinical lead, and this decision and the
reasons for it should be communicated within 24 hours to the commissioner in order that
consideration can be given for ongoing care of the individual.
The service is for clients age 18 and over, and the Provider will develop a transition policy
with the Young People’s risk taking behaviour service.
3.5 Interdependencies with other services
The Provider shall:
involve Service Users and develop strong working relationships with mutual aid and
peer support groups
develop links with other relevant services e.g. maternity services and
safeguarding/children’s services
develop interdependencies with ETE Providers e.g. Job Centre Plus and other
wraparound provision e.g. CAB services
make appropriate links with community-based criminal justice agencies to ensure coordination of work with substance misusing offenders
The Provider shall attend key partner agency groups that facilitate recovery coordination, such as task and steering groups and forums, to ensure that the
Services meet objectives. Through attendance at these meetings and partnership
working the Provider will demonstrate the Services relationship to the whole
treatment system including strategic relevance, meeting local needs, originality and
impact of the Service, how the Provider manages resource effectively, working with
diversity and its financial management to meet outcomes set.
The Provider shall develop specific links with other elements of the treatment
system including:
Provision of a clinical intervention service that will work in close partnership with
community mental health teams, palliative care, sexual health, hepatology/BBV nursing
service and other specialist services to ensure a seamless and holistic service for
Service Users
Provision of a clinical intervention service that will work in close liaison with prison
medical services to ensure defined and accessible pathways between prison and
community treatment services for prisoners on release. The Provider, in conjunction
with the prison service, will ensure that mechanisms will be in place to ensure those
who are prescribed substitute medication from prison receive seamless continuity of
care into community services
working with established acute health care services to ensure clear effective pathways
between acute health care and community drug/alcohol treatment services
developing working relationships with local community pharmacists, utilising existing
protocols around supervised consumption
pathways to In-patient services
developing Psycho-social Interventions on interdependencies with Providers of
specialist and/or generic counselling services (other than substance misuse specific)
e.g. IAPT pathways
links with Primary Care services and on-going development of GP Shared Care clinics
as required
3.6 Workplace Health
Providers are expected to demonstrate a commitment to the health and
wellbeing of their employees by working towards the standards set out in the
Workplace Wellbeing Charter: National Award for England. This may include
adopting tobacco control, healthy catering policies and active travel plans.
Employment policies should facilitate stop smoking and promote abstinence
including no smoking policies during paid working hours. Staff with service user
contact should not be identifiable as smokers i.e. they should not smell of
tobacco smoke or smoke whilst wearing provider identification.
The Provider will work with Public Health to support workplaces across the Borough
towards standards set out in the Workplace Wellbeing Charter: National Award for
England. This will include providing support and advice relating to actively
promoting an environment and culture which supports healthy choices, including
identifying existing training which is delivered across the Borough to support and
enhance where appropriate, to avoid duplication and ensure consistent messages
across a number of arenas.
4. Applicable Service Standards
4.1 Applicable national standards eg NICE
The Provider must deliver the service in accordance with national guidance including (but
not limited to):
 Medications in Recovery: Re-orientating Drug Dependence Treatment (NTA, 2012):
 Medications in recovery: Best practice in reviewing treatment. Supplementary
advice from the Recovery Orientated Drug Treatment Expert Group (PHE, 2013):
 Clinical Governance in Drug Treatment: A good practice guide for providers and
commissioners (NTA, 2009):
 Drug Misuse and Dependence: UK guidelines on Clinical Management (DH, 2007):
 NICE Guideline CG51: Drug Misuse – Psychosocial Interventions (2007):
 NICE Guideline CG52: Drug Misuse – Opioid Detoxification (2007):
 Routes to Recovery: Psychosocial Interventions for drug Misuse. A framework and
toolkit for implementing NICE recommended treatment interventions; the National
Treatment Agency for Substance Misuse (NTA, 2010):
 NICE Technological Appraisal TA114: Drug Misuse – Methadone and
Buprenorphine for the management of opioid dependence (2007):
 NICE Technological Appraisal TA115: Drug Misuse – Naltrexone for the
management of opioid dependence (2007):
NICE Guideline CG110: Pregnancy and Complex Social Factors: A model for
service provision for pregnant women with complex social factors (2010):
NICE Public Health Guidance PH18: Needle and Syringe Programmes (2009):
Towards successful treatment completion: A good practice guide (NTA, 2009):
Reducing Drug Related Deaths: Guidance for drug treatment providers (NTA,
Supporting and Involving Carers: A guide for commissioners and providers (NTA,
Joint Guidance on Development of Local Protocols between Drug and
Alcohol Treatment Services and Local Safeguarding and Family Services
(DCSF/DH/NTA, 2009):
Parents with drug problems: How treatment helps families (NTA, 2012):
Working Together to Safeguard Children: A guide to inter-agency working to
safeguard and promote the welfare of children, 2013:
NICE Guideline CG115: Alcohol Use Disorders: diagnosis, assessment and
management of harmful drinking and alcohol dependence (2011):
NICE Guideline CG100: Alcohol Use Disorders: Diagnosis and clinical
management of alcohol-related physical complications (2010):
NICE Public Health Guidance PH24: Alcohol-use disorders – preventing the
development of hazardous and harmful drinking (2010):
Review of the effectiveness of treatment for alcohol problems (NTA, 2006):
Supporting information for the development of joint local protocols between drug
and alcohol partnerships, children and family services (NTA, 2011):
Turning Evidence into Practice: Biological testing in drug and alcohol treatment
(PHE, 2013):
Turning Evidence into Practice: Optimising opioid substitution treatment (PHE,
Facilitating access to mutual aid: Three essential stages for helping clients access
appropriate mutual aid support (PHE, 2013):
Good Practice in Harm Reduction (2008,NTA):
Drugs and Alcohol National Occupational Standards (DANOS):
General Healthcare Assessment (NTA, 2006):
Care Planning Practice Guide (NTA, 2006):
Employment and Recovery: a good practice guide (NTA, 2012):
The Joint-Working Protocol Between Jobcentre Plus and Treatment Providers
(NTA, 2010):
Club drugs: Emerging Trends and Risks (NTA, 2012):[0].pdf
The Role of Residential Rehab in an Integrated Treatment System (NTA, 2012):
The Provider will be expected to accept and adopt relevant updates to existing guidance
as well as new guidelines as and when issued.
5. Location of Provider Premises
The Provider will source their own premises as per the structure outlined in this
specification and include the full accommodation costs within their own budgets.
For details of potential available DMBC properties please contact
[email protected] (Property Manager)
01302 737363

1B. Section One Part B - Service Specification FINAL