Sue McCutcheon is an Advanced Nurse Practitioner (ANP) working in the substance use field for 30 years. She worked with the Homeless Primary Care Team in Birmingham, England, for 20 years before joining Cranstoun as an ANP. Sue set up and manages the Dynamic-Evolving Model of Outreach in Sandwell.

Drug treatment services in England are typically based at sites where people are expected to attend. The responsibility is placed on the person to turn up for support. For various reasons people may not feel able/wish to engage in this way and thereby are unable to access support. Dynamic Evolving Model of Outreach (DEMO) is a nurse-led outreach model that takes support to people where they are at; geographically and psychologically. No expectation is placed on individuals to attend office appointments or enter formal treatment. It places responsibility of engagement on workers to reach out and build relationships with individuals where they are.

DEMO is delivered in Sandwell, England. It serves those who are homeless or with street-based lifestyles, who use drugs in outdoor spaces, often with complex and unaddressed health needs and little contact with services. It focusses on building relationships and offering health interventions, offering same day prescribing of OST, assessment of general health needs, prescribing of primary care medications, wound care and support to access the wider health care system. The service also delivers harm reduction interventions; injecting equipment, naloxone, safer injecting training, BBV testing, information around emerging drugs threats. Interventions are provided on-street, including in outdoor injecting spaces.

It is funded for 18 months and is being research evaluated. DEMO consists of a nurse and a drug worker. Twelve months from service commencement it has engaged 179 different people; 40% have rough slept for some of this time, 50% use opioids, and numerous health and harm reduction interventions have been delivered. Life-threatening, injecting-related conditions such as sepsis and overdose have been identified and treated. DEMO is committed to ensuring that those individuals with some of the highest level of need and complexity in our community are able to access effective health and harm reduction interventions.