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I became
interested in
working with
people who
develop
problems due
to their drug
and alcohol use
very early in my
GP career.
However a significant number of GPs do not
work with people who use drugs and alcohol.
On the one hand there are practices like
ours, in which all of us regard this work as a
priority and where a few years ago our list
was closed, unless the person had a drug
problem! This compares with others where,
from the outset, it is clear that ‘your sort’
isn’t wanted. Why the difference?
Medical education plays a significant part
in attitudes – as undergraduates we receive
very little teaching on drug and alcohol
problems. Although this has improved a
little over the past few years, there is still a
great deal more that could be delivered, as
evidence suggests that young doctors are
quite happy to engage in this role.
At a postgraduate level it is fairly hit and
miss. I was fortunate to have a GP
postgraduate tutor, Dr Ian Fletcher, who
passionately believed in primary care
‘substance misuse services’ as we called it
then. He arranged a session for the West
Midland GP registrars and one of his
patients agreed to come along and share his
experiences with us. This was a real eye
opener to me, allowing me to see drug use
not as a self-inflicted problem but as an
attempt by some individuals to try and deal
with the trauma they face or experience as
they go through life.
Dr Clare Gerada, the current chair of the
RCGP council, has been a leading light in
encouraging primary care to provide good
quality care around substance use. She is also
keen to increase the length of GP
postgraduate training from three to four or
even to five years. This would provide an ideal
opportunity for the RCGP drug dependence
and alcohol training – currently optional for
both GP registrars and established GPs – to
be a part of the core curriculum.
Another problem relates to GP contracts.
The vast majority of GP practices have either
GMS (General Medical Services) contracts
which apply across the country and do not
include or specify providing treatment for
drug or alcohol problems; or PMS (Personal
Medical Services) contracts which are locally
agreed for a range of other services above
and beyond GMS – but again, many would
not have a specific substance misuse
category. This doesn’t mean GPs can ignore
the physical or mental health problems of
people with drug and alcohol problems but
they are not obliged to offer OST, community
alcohol detoxifications etc unless they have
signed up to specific local contracts.
There also remains a cohort of (often
older) GPs in practice who trained at a time
when GPs were actively discouraged from
getting involved in this field. I hope that as
time goes by they are being replaced by
more receptive GPs and that it will become
as normal to work with those with drug and
alcohol problems, as it is to treat someone
with diabetes or hypertension.
For this to occur the training needs to be
right, the support structures from
commissioners, drug workers, and the more
experienced GPs need to be in place and the
current investment in services needs to be
maintained. Given this, my aspiration is that
in time, the maverick GPs will be those that
are not involved in working with drug and
alcohol patients. Until then, I will continue
to educate and inform all GPs about
providing primary care treatment to this
interesting group of patients, giving them
the chance to recover from problematic drug
and alcohol use in their own communities.
For more information about the RCGP
Substance Misuse and Allied Health
certificate courses in the management of
drug and alcohol misuse, see
http://www.smmgp.org.uk/html/rcgp.php
Steve Brinksman is a GP in Birmingham,
clinical lead of SMMGP, www.smmgp.org.uk,
and RCGP regional lead in substance misuse
for the West Midlands.
Post-its from Practice
‘Somedo, somedon’t…’
All GPs should see involvement in drug and alcohol
treatment as the norm, says
Dr Steve Brinksman
MEDIASAVVY
WHO’S BEEN SAYINGWHAT..?
Have you been stopped and searched by the police recently? If
you are a white, middle-class resident of, say, Tenterden or
Totnes, then almost certainly not. If you are a hoodie-wearing
black teenager, often to be found out on the streets after
midnight in Tottenham, then the chances are pretty high that
you have. So, is this a function of ethnicity or of relative crime
rates? Common sense would suggest the latter.
Philip Johnston,
Telegraph
, 1 July
Azelle Rodney was a violent drug dealer on his way to rob a rival
gang at gunpoint when he was shot dead by police. Oh dear,
how sad, never mind. …Naturally, the usual suspects are lining
up to turn this vile little gangster into the latest cause célèbre to
bash the Old Bill. BBC London, Channel 4 and the Guardianistas
are filling their boots… In his line of work, getting shot is an
occupational hazard. If it hadn’t been the Old Bill, it may well
have been a Colombian hitman. Or one of his closest associates,
off his face on heroin.
Richard Littlejohn,
Mail
, 8 July
Why Theresa [May] takes advice on drugs at all is a mystery. I
suppose it’s nice to get out and have some meetings with
experts, even if their input is superfluous.
Grace Dent,
Independent
, 3 July
While tabloid coverage of the mephedrone craze focused mainly
on the risk of death, the less extreme side of the story – that
people who wouldn’t have touched illicit chemicals began
hoovering up legal ones with gusto – went largely unreported…
Perhaps legalisation remains the best solution for society as a
whole – but, at least through my anecdotal periscope, it won’t
result in nirvana. British people like to boogie, and aren’t too
good at stopping.
Memphis Barker,
Independent
, 1 July
In a complete inversion of morality, modern welfare punishes
the diligent and rewards the feckless. That profound unfairness
is why the coalition has been so right to embark on a major
programme of welfare reform under the combative Iain Duncan
Smith, through sanctions on the workshy, limits to housing
benefit claims and the withdrawal of subsidies for spare
bedrooms.
Leo McKinstry,
Express
, 18 July
Criminals will not stop their crimes, change course and become
honest tax-paying citizens if drugs were legalised. Although
there may be freedom of choice to use dangerous substances
there can be no freedom from the consequences. International
drug control is working; fewer than 6 per cent of people globally
use drugs regularly and legalisation is not the answer.
Ian Oliver,
Herald Scotland
, 16 July
How many times do we keep trying to save people who don’t
want to be saved? Howmany times do we bring them back from
the brink to show them what a decent life is, only for them to
vomit all over it after yet another bottle of gin?
Carole Malone,
Mirror
, 14 July
August 2013 |
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| 7
www.drinkanddrugsnews.com
Media savvy |
Post-its