SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
The joys of the GP (Mar 2006)

General practice is an odd wonderful place where we see people of all ages and all walks of life. Over 98% of you are registered with us and you come and see us on average about 5 times a year! You come with everything from boils, to bunions through to heartache (both physical and psychological). All you have to do is live in the practice area, register and away we go. There is no fee to join and you don't have to confirm motivation to attend. We are good at listening, not so good on curing but great at managing chronic conditions, such as diabetes, asthma, drug dependence, heart disease etc. We also have our part to play in the whole care of patients with HIV and other blood borne viruses such as Hep B and C.

A systematic review of quality of care in general practice concluded that the published research in the field presents an incomplete picture of the quality of clinical care. But a substantial number of well-designed studies exist comparing care by GPs to that of specialists, which show "no significant difference in quality of care and health outcome for care delivered by GPs even when substituted for secondary care specialists" and "Primary care physicians are more likely than specialists to provide continuity and comprehensive care resulting in improved health outcomes".

We see the whole range of people and are able to provide care for the person not their condition. We are a model of patient centred care, working pragmatically with risk assessment and harm reduction. We don't always cure, but we care and reduce harm. What is so different about caring for drug users? Why should treatment care and access to general practice be any different with people who have a drug problem? Well, increasingly it isn't! The national average for practices being involved in drug treatment has increased from 20% in 2002 to over 40% in 2006.

People who use drugs, present to general practice in a variety of shapes and sizes. The last two new patients with drug problems we accepted on to the list were typical of the range of people who chose to present to general practice.

First was an woman of 67 years who was obviously nervous and said she had specifically asked to see me as her friend had informed her that I might be able to help. She stated she had two problems: 1) she had for several months increasing constipation and 2) she was receiving a prescription for injectable methadone from a private doctor and could no longer afford to pay his bills. Seeing this woman in the street you would not have guessed that she had been using drugs for over 40 years and had settled with a private prescription for the past 10 years, having been discharged from several NHS facilities for a variety of reasons, but the commonest was requesting injectables. She had not received health care beyond her prescription from any of these facilities or her private prescriber.

Her drug prescription seemed the easy part and after a full assessment, checking with her current prescriber and observing her taking her regular dose, we took over her drug treatment. Her constipation was caused by bowel cancer, which has since been treated.

Secondly was a young man of 22 years who wanted to be reassured that I would not tell his parents before he began to discuss his heroin and crack problem. He has settled well on substitute prescribing and is beginning to understand and manage his crack use with counselling. His plan is at sometime to stop but at the moment he is able to receive treatment and continue his college course.

Both can sit and wait in the waiting room without anyone knowing why they have come to see the doctor, or other members of the health care team. Both are receiving help with their drug problem, their physical health and their psychological problems and both will continue to be registered with us wherever they are on their treatment journey.

- Dr Chris Ford