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 …