Select Committee on Home Affairs Appendices to the Minutes of Evidence


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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