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NETWORK A national newsletter on substance misuse management in primary care
Hepatitis C
In this issue
The Adelaide Street NES
Guidance Launched
Michael Taylor tells the refreshing story of how
he managed to realise his dream of providing
high quality care for drug using patients in
his practice. He has done this purely based
Guidance for the prevention, testing, treatment and management of
on NES monies which have been invested in
staffing for the scheme. A true tale of proactive
Hepatitis C in Primary Care
development of services, robust responses to
hep C guidance v4 29/05/2007 11:13 am Page 1
critical incidents and forward planning. Page 5
Royal College of General Practitioners
The following is a summarised excerpt from the The results of an SMMGP member’s questionnaire
recently produced Guidance for the prevention, testing,
are reported by Jim Barnard. What do you really
Guidance for the
think about the NICE guidance supporting a
prevention, testing,
treatment and management of Hepatitis C in Primary contingency management approach in drug
treatment and
management of
Care. RCGP SMU and Sex, Drugs & HIV Task Group,
treatment? Page 6
hepatitis C
in primary care SMMGP, Hepatitis C Trust, UK Hepatitis C Resource
Another successful MDUPC conference was help
in Birmingham in April. Here is the consensus
Includes appendices on: hepatitis A and B vaccination guidance, hepatitis B and HIV
RCGP Substance Misuse Unit Centre & Release. Ed
RCGP Sex, Drugs & HIV Task Group statement from the conference, and we are
Substance Misuse Management in General Practice
Hepatitis C Trust
UK Hepatitis C Resource Centre
Release already planning for the next conference in
1st Edition 2007
Brighton! Page 8
The full guidance and others in the series are available
Working Party:
Chris Ford, Kate Halliday, Jean-Claude Barjolin reports on the results
Graham Foster, Charles Gore,
Kate Jack, Nicola Rowan,
Carola Sander-Hess, online at and
Sebastian Saville, Brian Thomson,
Stephen Willott, Nat Wright
and David Young of the SMMGP Network reader survey, which
produced some positive feedback and good
This guidance has been produced to aid medical practitioners and others in the
suggestions for future Newsletter articles.
Page 8
management of hepatitis C infection in Primary Care. Hepatitis C virus (HCV) was first
identified in 1989 and rapidly emerged as a significant world public health problem.

Vivienne Evans, Chief Executive of Adfam,
brings us up to date on the impact of Hidden
Every general practitioner is likely to have between 8 to 18 infected individuals, with
Harm four years on. Agencies have begun to
an average list size of 1,800, partly depending on local population demographics.
improve services for children of drug using
However, many of these patients may go undiagnosed. In a majority of people
parents, and responses to pregnant drug users
have improved. However, we must not forget the
hepatitis C is a curable disease and therapy is recommended by the National Institute complexity of working with dependency and
for Clinical Excellence.
. However treatment rates in the UK remain low despite the
parenting, improve at working with the family
as a whole and still address issues of child
on-going patient awareness campaigns, NICE recommendations and pressure from
protection. Page 9
informed clinicians and their patients. Diagnosed individuals in France are 6 to 12
With the ups and downs of substance misuse
times more likely to enter treatment programmes.
It seems the lack of awareness
work, why do we do it in the first place? We
in primary care contributes to the low treatment rates in the UK and the purpose of know it’s much needed work, but Dr Nicolas
this guidance is to provide clinical information about the management of hepatitis C
Smith reminds us all why working with users and
substance misuse is enjoyable and ultimately
infection in primary care that, hopefully, will lead to increased prevention of HCV
very rewarding. Page 12
transmission along with improved testing, diagnosis and treatment for patients who
Narcotics Anonymous (NA) provide us with a
are already infected. It has been shown that general practice has an important role
very useful and clear outline of the organization,
in the care of people at risk of hepatitis C and when appropriately supported can
its traditions and insight into its philosophy and
effectively implement current best practice.
workings. No doubt an organization that more
clinicians could do well to recognize. Certainly
…continued on page 10 for many it provides a life changing and powerful
opportunity for recovery. Page 13
Dr Fixit Chris Ford addresses questions on
Snowballing: Combined
managing dependence on over the counter
medication Page 14, and Graham Foster
provides answers to the treatment of hepatitis
C Page 15. Catch up with the lates news on the
Heroin and Crack Injection
bulliten board Page 16.
We hope you enjoy this issue.
Danny Morris and Claire Robbins take us through the basics of snowballing,
the injecting of heroin and crack cocaine together, a form of drug use that is
increasing in the UK. They highlight the complexity of harms associated with
Don’t forget to become a free
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the practice, and the need for a broad range of harm reduction interventions and policy updates - the newsletter can also be
when working with people who are snowballing. Ed
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continued overleaf
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