Home affairsWritten evidence submitted by Royal College of General Practitioners [DFU 05]


Q1. Work which we have done specifically on new psychoactive highs

The RCGP provides training and education for GPs and primary healthcare practitioners wishing to identify and provide interventions for individuals with problem substance misuse (drugs and alcohol).

The assessment and management of individuals taking new psychoactive drugs is considered a specialist competence over and above the generalist competencies. The RCGP Substance Misuse and Associated Health unit, through its network of national and regional champions work to raise awareness of the documented growth in the use of so called legal highs/club drugs working with officials in Public Health England and colleagues in SMMGP (Substance Misuse Management in General Practice).

Basic level awareness and the key principles in the identification and management of patients who misuse legal highs are “touched upon” in our Certificate in the Management of Drug Misuse (Part 1) and further elaborated upon in our Certificate in the Management of Drugs Part 2 course. The latter provides an opportunity for detailed learning supporting practitioners, largely GPs, to gain competencies associated with that of an intermediate practitioner or GP with a Special Interest. RCGP SMAH acknowledges that the current courses which mainly cover recovery oriented treatment of Class A drugs, safe and effective medically assisted withdrawal/detoxification, the principles of safe and effective prescribing for recovery from opiate dependency and the management of poly pharmacy means we are not able to offer in-depth training in psychoactives. We believe this would need and benefit from a dedicated educational programme targeting primary care professionals and supporting practitioners. There is currently no dedicated funding to design and deliver such a course although RCGP SMAH has access to the relevant expertise who would be able to work to develop and disseminate/market such a course.

SMAH has also discussed the option of joining forces with partners such as the primary care network SMMGP to develop targeted CPD such as webinars and/or face-to-face programmes. The RCGP Certificate in Harm Reduction; Health, Recovery and Wellbeing for People using Drugs contains learning materials based on a body of literature and evidence that whilst no longer being run centrally by the college is available as a resource for clinical leads and champions to work with RCGP SMAH to run a local face to face training day in a particular locality/region and individuals wishing to do so can contact the medical director, the certificate programme lead or any of our network of regional leads.

The RCGP and The Centre for Pharmacy Postgraduate Education (CPPE) has launched a new e-learning programme called Addiction, misuse and dependency: A focus on over-the-counter (OTC) and prescribed medicines.

The course which was co-designed by professionals from general practice and also community and specialist pharmacists has been designed to help identify groups of patients who could become dependent on medicines and recognise the treatment interventions that can be used.

More information on this course which is currently only available on the CPPE e-learning platform is available from the CPPE website and GPs are signposted to a link through the SMAH website.

A series of factsheets on the identification, assessment and management of addiction to prescribed medications and over-the-counter drugs has been under development and is currently out to consultation to peer review the content. The fact sheets are aimed at the generalist practitioner and provide useful pointers on who is at risk, red flags, best practice on safe prescribing of drugs commonly associated with iatrogenic dependency and tips on management and signposting to specialist help including patient-led agencies and organisations.

Once ready RCGP SMAH be working with the College to disseminate to the generalist.

In answer to the specific question as to whether the “NHS systems are sufficient to monitor and deter”:

“Doctor shopping.”

Over prescription of potentially addictive drugs.

The numbers of GPs treated through their GPs as opposed to the treatment programmes run through Public Health England.

Personally I do not think there is sufficient emphasis placed on prioritising the analysis and tracking of the prescribing of drugs which are at risk of misuse for example, opiate pain killers such as tramadol and neuro-modulating drugs such as pregabalin and gabapentin.

My understanding is that current GP clinical systems do have the capacity to report on such prescribing.

Similar emphasis could be placed on the need to develop and join up systems of monitoring of such prescription and OTC medicines between GPs and community pharmacists.

RCGP SMAH would welcome greater emphasis and signposting for the treatment of addictions to prescribed medicines through primary care. We believe for this to happen GPs would need adequate hands on support, education and training and guidance on the identification, audit, assessment and management of such problems in the primary care setting. This would require additional resources for dedicated training, continuing development and championship.

RCGP SMAH, with appropriate levels of resource would be well placed to deliver training programmes and support a network of GP champions working in partnership with local public health centre resources, local CCG GP IM and T and medicine management leads.

In our experience training is successfully embedded when championed by local GP and medicine management expertise. In addition, primary care professionals need to be made aware of local information/joint strategic needs assessment data on rates and levels of need and access to local education coupled with targeted support/incentives.

Dr Linda Harris FRCGP
Medical Director, RCGP Substance Misuse and Associated Health

December 2013

Prepared 19th December 2013