Newsletter No 1 (April 1996)
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Nowadays it is perceived as accepted practice that GPs and practice staff do have a role, and will be involved in providing health promotion, general medical services, and specific interventions to patients who engage in compulsive and addictive behaviours, whether that be smoking, drinking or eating. During one year many patients with such problems are likely to be in contact with their GP. Once again it is the practitioner who is the primary contact and who needs to be equipped with the competencies to raise the possibility of a problem with the patient, to talk matters through and to give immediate advice and support.
Some years ago, to have suggested a similar approach with heroin and other substance users would have appeared to many professionals to be fool-hardy. It was the acknowledged wisdom that drug dependence was the province and responsibility of Drug Dependency Units, and General Practitioners were strongly advised to leave these patients to the hospital, and the specialists. Over the last few years it has become apparent not only that drug dependency units have insufficient resources to deal with the surge in numbers, but also that the primary health team is very much the appropriate front-line for early detection and response. A recent report suggested that family doctors overall are seeing about 40,000 heroin users over a 12 month period, and an increasing number of GPs are becoming involved in this work, to meet this need. Often working a rear-guard action General Practice is demonstrating that it does have a highly important contribution to make to the management of drug users, without taking the drug user out of the community. De facto, General Practice is recognised as having a role.
The determinates of precisely what that role is, and should be, are unclear. There is a large and wide range of prescribing and care packages being demonstrated in general practice around the country. Local demographics and specialist service provision clearly have some impact upon the GP in formulating their role. But what works, and is best suited to general practice remains unclear. Having accepted that general practice is an appropriate site for managing drug users, GP needs to address what function it has in managing drug users, and future discussion should focus on the task of managing drug users, and how it can be most effectively achieved. Which drug users are best suited to be managed in general practice, and how should they be managed?, Who should not be managed in general practice?, What is the relationship of general practice to specialist services?
GPs working with this client group may often experience frustration and confusion about their task and their skills. Working with drug users can be an isolating experience, both in terms of relationships with partners, and separation from other local services. Having experience GPs talking about working with drug users it is clear that it can be at once rewarding and frustrating, but often isolating. In an attempt to bridge this gap the Substance Misuse Management Project in Brent and Harrow and East London and City Drug Services are producing a newsletter; Substance Misuse Management in General Practice, by general practice. It is the intention to run this newsletter 2-3 months addressing issues relevant to GP. We need to know who would be interested in subscribing to this newsletter and who would be willing to provide contributions, and brief articles to encourage debate?
Topics for the newsletter already suggested include:
- Prescribing of injectables.
- What is shared care and how do we do it?
- Value of substitute prescribing drugs other than methadone.
- How to do an assessment in a GP consultation.
- Urine testing.
- Audit and research.
Fancy writing any of these?
We hope it will go out to all GPs in some areas through the local FHSA mailings.
This Newsletter was originally created by:
- Chris Ford
- Brian Whitehead