3. The role of Primary Care in the prevention of drug-related deaths: Patient and family member perspectives

Drug-related deaths (DRDs) cluster disproportionally in the most deprived areas of Scotland. Primary Care, in particular ‘Deep End’ GP practices serving the most deprived communities, are natural hubs of local health systems but represent a small part of the complex system of care for people at risk of DRD. This paper explores the current, and potential, role of Primary Care in the prevention of DRDs from the perspective of patients and family members.

Underpinned by complex systems thinking and a case study approach, semi-structured interviews (n=26) and focus groups (n=4) were conducted in two Deep End GP practices with patients, affected family members, GPs and other local health and social care professionals. Each system and model of care was ‘mapped’ using Kumu software. Thematic and framework analysis was conducted using NVivo.

People experiencing drug use problems, and affected family members, seek available, accessible, holistic, non-stigmatising, needs-led services based on continuity of care and relationship based practice. People experienced significant barriers to care including the navigation of a complex fragmented system of service provision and inflexible, hard to reach services. Primary Care offers unique opportunities for addressing their multiple and complex health and social care needs.

System complexity, differentiation in policy and practice, services’ values and ethos, and the internalisation of stigma and responsibilisation affected people’s experience of care. The broader social and structural determinants of health require systems of care to focus on treating the physical, mental and social care needs of people not just their addiction.

This work was supported by a research grant from the Scottish Government’s Drug Deaths Task Force.