My impression is that David Church1 feels isolated and unskilled for the local reasons he describes. And I imagine, along with most other GPs involved in substance misuse, I would feel similarly were it not for the certificate course, a good practice team, a PCT commissioning an enhanced service, and a supportive local specialist service.
The importance of training in this regard, such as the RCGP certificate course, cannot be over-estimated. This is clearly much needed since few of us learned about substance misuse at medical school or during GP training, and yet, even years ago over 50% of the GPs in Strang's2 survey had seen someone with a substance misuse problem in the preceding 4 weeks.
The RCGP substance misuse unit has set up a two stage certificate course to cater for both the generalist (part 1) and specialist GP (part 2 certificate). This course is mapped to the Drug and Alcohol National Occupational Standards (DANOS) for GPs and in order to complete the certificate candidates need to complete the two user friendly substance misuse e-modules on www.doctors.net.uk. To date, 770 GPs have completed the full Part 1 Certificate since its inception June 2004. I wrote in the August 2005 BJGP letters section3 that 4000 of these e-modules had been completed; now it is almost double at over 7500. So there are currently over 2000 more GPs who have completed both of the e-modules (harm reduction and treatment who just need to attend a face-to-face event to be issued with the full Part 1 Certificate. With regard to training in substance misuse, things are getting better.
But, as David highlights, there are often problems at the secondary–primary care interface; hence the need for training of secondary care providers too (particularly A&E and hospital discharge teams). However, it's not just the lack of seamless care when a patient is discharged from hospital that causes problems (especially on a Friday evening it seems), but many patients on a script for substance misuse that need to be admitted to hospital, for example for serious sepsis, are unwilling to go or stay because their script is not maintained at its usual level.
I would also like to emphasise the need for primary care to commission GP and specialist services that are supportive of local populations and care providers so that this valuable work can be further mainstreamed. Perhaps David Church could consider sending a copy of this reply to his local PCO chief executive and director of public health!
- © British Journal of General Practice, 2006.
