APPENDIX 8
Memorandum submitted by the NHS Alliance
The burgeoning problem of drug misuse and addiction
is exacting an increasing toll on the gatekeepers of the Health
Service, General Practitioners. This is particularly true in the
inner cities where estimates of the users of heroin and cocaine
alone are of the order of 2 per cent of the total population.
Addiction Services have been traditionally an under-resourced
area of an under-resourced speciality (Psychiatry) and the users
on the waiting lists, six months or more in places, are either
left without a service, or are prescribed for by a few willing
GPs with little training, and no resource or remuneration for
this.
Significant new money has been identified and
an integrated strategic direction given to commissioning of care
in this area in the form of the National Treatment Agency and
the Drug Action Teams. Models of GP involvement have been proposed
and are gaining recognition. These basically involve three tiers
of involvement along the lines of the Department of Health Clinical
Guidelines. Involvement at any level from Generalist to Specialist
must remain voluntary for GPs, and must be linked to proper training,
support and remuneration. This is being addressed piecemeal in
various localities, and local sensitivity is necessary to take
account of the variation in need, however a national steer, especially
on remuneration, would be helpful.
It will remain important to address the issues
which will continue to discourage GPs from getting involved in
this work, even when supported by Drugs Workers, and receiving
payment for it. Some of the barriers are mundane in nature, but
nonetheless real while others are pivotal to the success or failure
of the drive to treat these patients.
— The regulations on prescriptions
should be reviewed. It is apparent to many GPs that printed prescriptions
are more secure, less prone to error, and considerably less time
consuming even when dealing with instalment prescribing than handwritten
prescriptions. Errors on prescriptions at best lead to wasted
doctor, pharmacist and patient time, and at worst could be fatal.
It also appears to be an anachronism that Benzodiazepines, one
of the most prevalent drugs of addiction of our times cannot be
prescribed on an instalment prescription, and this also takes
up time.
— GPs and their staff need significant
training of the hands on type to be able to provide this service.
— Drugs Workers need to be recruited
to work in Primary Care in order that GPs are not managing this
case work on their own. The high number of vacancies for drug
workers, demonstrates the necessity of firstly establishing a
national training programme, and secondly of ensuring they are
fairly remunerated for what is very demanding work.
— Premises need to be expanded to house
these services.
— The contractual and remunerative
relationship for providing what are in effect specialist services
needs to be developed, using PMS+ and section 36.
— Prescribing budgets need adjusting
to take substitute prescribing into account.
— The question of different treatment
in prisons needs addressing. It is particularly disheartening
to see patients who were on long-term maintenance go into prison
and come out again on heroin. This is partly due to perception
on behalf of the prisoner, but also to an attitude within the
Prison Service, which tends to ignore evidence that long-term
moderate to high dose methadone is more effective than rapid reduction.
GPs are well placed to provide this care, and
should, if the above issues are addressed, be able to do so to
a high standard. The primary care team, augmented by the Drugs
Worker could provide care where many want it, with much shorter
waist for treatment. This would effectively expand the care that
is currently given by the community Drug Teams.
On the question of the decriminalisation of
Cannabis, GPs have wide and varied views. NHS Alliance believes
that there is a strong case for cannabis to be offered medically
consequent upon evidence showing a case for its prescription.
January 2002
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