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Issue 6 October 2003
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SMMGP
SUBSTANCE MISUSE
MANAGEMENT IN
GENERAL PRACTICE
A national newsletter on substance misuse management in primary care
What does the new
GMS contract mean for
patients and GPs?
A personal view from Dr Clare Gerada, RCGP lead in drug misuse
So the new GMS contract (nGMS) has finally been
The new GMS contract. The new GMS divides our
accepted and will be implemented from April 1st 2004. As
work into 3 main parts:
the RCGP lead in drug misuse I am often asked to give my
views on ‘what it means for us’. I do know that I am
Core work – acute illness and terminal care which all GPs
unhappy about placing drug use and therefore drug users
must provide.
in a special category in nationally enhanced services (an
opt-in service) rather than additional services (an opt-out
Additional services – chronic disease management,
service).This places a dowry on drug users heads and
vaccinations, contraception – all GPs must provide unless
removes their care away from mainstream general
they can give the local PCO a very good reason to opt out.
practice, something that for years, myself and many
Nationally enhanced services (NES) - which need to be
others involved in leading primary care drug misuse have
provided in each locality but not by every GP – this is very
fought against. The drug strategy aimed to involve all
much an opt in service and includes many specialist
general practitioners in the care of drug users, something
services and drug misuse, alcohol and sexual health
that the new GMS contract undermines. We now have a
services, all which I would argue should be mainstream
situation, where prescribing will be separated from care
and not only provided by a few!
and GPs can legitimately refuse to manage these patients.
What does it mean for our patients?
So let me take you through what I think the new GMS
contract means. I must stress that these are my thoughts, Advantages out-weighed by disadvantages? The
not those of the RCGP. The practicalities of the new advantages may be better care, delivered by more
contract, or how it is to be funded, monitored and other committed and better-trained professionals – paid to
process issues have yet to be fully understood. deliver evidence based care. However, I fear the
disadvantages, if not properly addressed, may out-weigh
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the potential gains. I have stated my first anxiety – making
drug users different worries me as it marginalizes them,
making the care of drug users fragmented and separated
IN THIS ISSUE
from mainstream GMS. I feel this is a retrograde step
Services in Gateshead – GP perspective 3
leading to reduced patient access and choice as there may
not be such a spread of services, and reduced access to
Naltrexone tablets or implants? 4-5
general health care and normalised settings.
Paper review - buprenorphine in primary care,
I entered this work at a time that most drug users were
tolerance and overdose after detox,
looked after by a very small number of GPs – the statistics
benzodiazepine dependence
6
being 50% of users by 5% of GPs – this meant that those
who did look after drug users risked being overwhelmed
Dr Fixit – Naltrexone following detox 6
and burn-out. This could apply again within NES which
Dr Fixit – Going on holiday 7
once again places drug users in a special category.
Bulletin board – conferences 8 My second anxiety is the money. Like the rest of you I want
to earn an honest living, and many of us have been doing
Viewpoint – Injectable heroin guidance 8
this for nearly two decades. We know the work does take
www.smmgp.co.uk
time and should be valued, but did the negotiators price it
so high so PCOs could not afford it? Should not the care
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