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A national newsletter on substance misuse management in primary care NETWORK


Whether you have the DES or a LES, use of GP targeting skills can lead to greater gains. If, for example, 10-20% of those screened are higher risk drinkers and knowing 1 in 8 see reductions in their drinking as a result of brief interventions, then in an untargeted approach 40-80 patients need to be screened for 1 patient to reduce their consumption to low-risk drinking as a result brief advice from their GP. But if GPs target screening and two thirds of those talked to about alcohol are drinking above safe levels, only 12 patients need to be screened and given brief advice where appropriate for 1 patient to reduce their consumption to low-risk drinking.


If more training is what you need then why not try the online module on the alcohol learning website (www.alcohollearningcentre.org. uk) or sign up for the RCGP certificate course which can often be run in your area if there is sufficient interest (or find a good local alternative). However as a first step, you could just try talking about alcohol more in your consultations – you will be surprised how many people are willing to discuss it, and you will get used to talking about alcohol until it becomes ingrained as a habit.


4 Not our problem


We may argue that because the key levers of alcohol pricing and advertising are operated beyond primary care that our efforts are futile. It’s true that these high level changes have the potential to turn the tide in a similar way to the smoking ban in public places, and as key opinion leaders in the community we can play a part – who knows, the government may even listen to us if we have a strong enough voice.


Whilst the drinks industry generates £30bn and one million jobs, calls for them to behave responsibly are not given sufficient clout by the government. Evidence suggests that in the UK a minimum pricing of 50p per unit would gradually reduce alcohol-related admissions in NHS Nottingham City by up to 500 a year (calculated on a reduction of around 150 per 100,000 of the population15


).


A University of Sheffield report commissioned by the Department of Health found that policies which lead to price increases reduce alcohol consumption16


. In the US, it has been calculated that


doubling the alcohol tax would reduce alcohol-related mortality by an average of 35%, traffic crash deaths by 11%, sexually transmitted disease by 6%, violence by 2%, and crime by 1.4%. The authors’ conclusion is that these studies establish beyond reasonable doubt that alcohol taxes and prices are inversely associated with health across a population17


. And yet our own government is reluctant to


support any level of minimum pricing that would actually make a difference to even the cheap strong ciders/beers that mean it is all too affordable to become dependent.


Conclusion


In primary care it is widely accepted we do see most people (about 78%) on our list every year and there is evidence that drinkers attend twice as often. Have we got our antenna up to spot those windows of opportunity when people are ready to make a life saving change? As over 70% of accident and emergency attendances at night are alcohol related, can we engineer the teachable moment to spur movement on the cycle of change? I think it is counterproductive (and often hypocritical!) to be anti-alcohol but we need to learn how to balance a harm reduction approach with encouraging sensible drinking, both on an individual level with the patient in front of us and with an eye for campaigning for alcohol related health policy in the brave new world of alcohol services being commissioned by public health and/or GP consortia.


Stephen Willott, Clinical Lead for Drug Misuse and Alcohol, NHS Nottingham City


15 http://www.nottinghaminsight.org.uk/insight/jsna/jsna-home.aspx


16 Booth, A., O’Reilly, D., Stockwell, T., Sutton, A., Wilkinson, A., and Wong, R. (2008) Independent review of the effects of alcohol pricing and promotion: Part B modelling the potential impact of pricing and promotion for alcohol in England: results from the Sheffield Alcohol Policy Model Version 2008 (1-1), Sheffield, University of Sheffield for Department for Health.


17 Wagenaar A.C., Tobler A.L., Komro K.A. (2010) Effects of alcohol tax and price poli- cies on morbidity and mortality: a systematic review”. American Journal of Public Health: 2010, 100(11), p2270-2278


3


Chris Ford retires as SMMGP


Clinical Director Chris Ford is retiring as SMMGP Clinical Director. Chris has worked tirelessly in the role from the moment she set up the organisation in 1996. She has an amazing ability to work across many levels, from writing guidance and training, and working strategically, to working at her ‘real job’ as a GP in a busy London practice. It is impossible to list all her achievements during her time with SMMGP, but here are just some of them:


■ Establishing and chairing the Royal College of General Practitioners working with drug and alcohol users in primary care conference, now in its 16th


year. This has become the second largest conference the RCGP hosts (the largest being the RCGP annual conference).


■ Instigating and co-writing a suite of RCGP guidance for primary care clinicians, including guidance on crack cocaine, opioid substitute medications, hepatitis C, and most recently a draft guidance for benzodiazepines.


■ Being pivotal in developing RCGP Certificate courses for the management of drug misuse, sexual health, harm reduction, and hepatitis B and C in primary care.


■ Establishing Network Newsletter in 1996 and being Clinical Editor since its inception.


■ Providing unerring and ongoing advice, encouragement and support to primary care clinicians to increase the accessibility, capacity and quality of treatment for drug and alcohol users in primary care.


■ Supporting a number of other agencies including helping to set up and being the first chair of The Alliance, being a founder member of UK Harm Reduction Alliance (UKHRA), being on the board of Release, and being a member and former chair of the RCGP Sex, Drugs and HIV Group.


■ Securing funding for International Doctors for Healthy Drug Policies (IDHDP) to establish a network of doctors across the world who work in the field of drugs and alcohol.


Throughout every aspect of her work runs a deep commitment to treating patients using drugs and alcohol as individuals with a range of needs, rather than reducing them to the substance they happen to be using − her mantra is “treat the patient, not the drug!” − and a belief that primary care is the perfect place to treat drug and alcohol users and their families. Chris has always insisted on involving service users in the development of new projects to ensure they remain at the heart of the services she provides.


Chris has had an enormous influence on the drug and alcohol treatment field and it is unlikely that there would be the range and quality of treatment available in primary care without her work over the years. She leaves a healthy and thriving organisation and a legacy which will continue long into the future. We admire Chris’ infectious enthusiasm, her awesome drive, her magnificent leadership skills which are coupled with the ability to be a team player, her creativity, and the strong value base that underpins every aspect of her work. All of these are expressed in an unparalleled capacity for hard work – followed by an equal investment in having fun! We will strive to continue to honour these attributes in all aspects of SMMGP’s future work. However, we are pleased that this is ‘fare thee well’ rather than ‘goodbye’ as Chris will continue to be ‘on call’ for SMMGP’s burgeoning range of projects.


She will continue to work for the next couple of years as a partner at the Lonsdale Medical Practice, where she has worked for the past 25 years and where her interest in working with people who use drugs and alcohol began. She has always enjoyed this work seeing it as a privilege, and says she has learnt all she knows from her patients. She has recently become Clinical Director of IDHDP, and we wish her every success, and will work closely with her in this important work to develop healthy drug policies internationally1


.


SMMGP team 1 For more information see www.idhdp.com


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