Prescribing to substance misusers

I must strongly disagree with Stephen Willott's opinion1 that it is ‘good news’ that there has been an almost threefold increase in the number of GPs seeing opiate users.

If there had been an increase in the proportion of substance misusers seeing GPs and having specific treatment (from someone) that would be good news.

The possibility of a real increase in the number of misusers would most definitely be bad news, whether or not they were seeing their GP!

Again, increase in proportion treated (regardless of numbers) would be good news, but that they are treated by inexperienced non-specialists would not necessarily.

An increase in the number of GPs seeing these patients, even if the total patients stays the same, would imply that they are being more thinly spread across non-specialist care, and this suggests to me that their care is being dumped on inexperienced GPs who do not have the support to manage them well.

This would most definitely not be good news for the patients or the community.

It is also quite possible that they are indeed being dumped without the provision of any local enhanced service support, and this would be bad news for the GPs involved, who are doing it for free, as well as without support.

I don't know where Stephen works, but here in our part of Wales we have very poor availability of service, partly related to rurality, but the hospitals do tend to discharge such patients with instructions to get scripts from their GPs for tomorrow's doses, with no thought as to the effects of this on GP services or quality of care, and the fact that we have no contract to provide such services. Furthermore, when informed of their duty to continue prescribing, the hospital staff seem to think it is okay just to dump it for GPs to sort out, when we don't even have access to a suitable dispensing chemist for some of these drugs nearby, let alone education and an LES for the service.

Could Dr Willott influence this service provision problem at all to improve care of these patients?

• © British Journal of General Practice, 2005.