Select Committee on Home Affairs Memoranda


Submitted by Dr Clare Gerada


  I am confining myself in this response to issues that pertain to general practitioners, in particular where changes in the law may or may not impact on the day to day working of GPs. This has been written in my role as Primary Care Lead for Drug Misuse Policy at the Royal College of General Practitioners. The time scale needed to give evidence has negated the opportunity for wide scale discussion, nevertheless this report has been shared with other members of the RCGP, including the Chair, Professor Pringle, and Honorary secretary Dr Maureen Baker and Dr Chris Ford, Chair of the RCGP Sex, Drugs and HIV Task Group.


  There are currently around 35,000 general practitioners in the UK and around 19,000 of them are members of the Royal College of General Practitioners. The RCGP is the Professional body overseeing GPs, the body that represents its interests in relation to terms and condition of work is the General Practitioners Committee, which is a subcommittee of the British Medical Committee. To become a member of the RCGP a doctor first has to undertake a minimum of three years vocational training for general practice and then take and pass the Membership Examination of the Royal College of General Practitioners (MRCGP). Currently almost all doctors entering general practice take the MRCGP.

  General practitioners are in the main independent practitioners, though recent changes in the NHS organisation has meant that increasingly general practitioners are salaried—either by a GP practice, a Primary Care Trust or other organisation—or work as non-principals on sessional payments.

  It would be true to say that there was no consensus view around drug laws amongst GPs, rather as one could not assume a single view from the population at large.


  Over the years the response that GPs have made to the treatment and care of drug users has changed. Whilst a decade ago it would be unusual for general practitioners outside the major conurbations to even come across a drug user, let alone treat one, nowadays, most general practitioners would encounter these patients in their day to day practice.

  General practice is primarily concerned with the improvement of health and harm reduction to drug users, their families and communities. Drug use is a chronic relapsing condition that general practitioners are well placed to deal with, being the point of first contact for many users, families and carers.

  The role of general practitioners has changed; encouraged to a large part by official policy makers in the Department of Health and also by bodies such as the Advisory Committee on the Misuse of Drugs (ACMD). In recent years, the RCGP and the GPC have reinforced government policy (see Annex 1).

  Though strictly speaking general practice has a very flat structure—with all assuming a generalist role, in reality GPs, perhaps because of previous training, location or interest, tend to have special interests, creating increasingly formal levels of expertise within practices, localities and primary care trusts. In the drug misuse field, three levels of expertise are recognised and at the time of writing being delineated. These levels are the generalist, the general practitioner with special interest in drug misuse and the specialist. With respect to drug misuse, all general practitioners will be in the first category, perhaps 500-1000 in the middle and around 20 into the specialist category.

  The RCGP is currently developing a Certificate in Drug Misuse aimed at equipping those GPs with the skills necessary to provide a service to drug users at the GP with Special Interest level.


  The Department of Health has recently given considerable resources to equip GPs with the skills, structures and support necessary to see and treat drug users safely and any new proposed changes in the drug policy needs to be mindful of these changes.

  In addition changes need to mindful that whilst policy may advocate or make certain treatments more avail, this does not mean that they will be delivered by general practitioners. So for example, if heroin were to be made more available as a substitute treatment for opiate addiction, there would be very few general practitioners that would have the skills, facilities or expertise to use this treatment safely.

  In these situations, suggested licensing arrangements being discussed at present which have been proposed by the Home Office, would mean that no general practitioner outside those that have positions in specialist settings, or those that can clearly demonstrate they have the structures needed to reduce diversion of this treatment, would be granted a license to use it for treating addiction.

  Furthermore, the logistics of using heroin as a treatment in a primary care setting (especially as it has been recommended by the 1999 Department of Health Drug Misuse Clinical Guidelines that the provision of daily supervised ingestion for the stabilisation period) would make it a very expensive treatment and one that would have to be considered alongside other more evidence-based, safer, cheaper and easier treatments, such as oral methadone.


  The current Drug Strategy fails in so far as that the majority of resources are directed towards the Criminal—Justice limb of the strategy with remarkably little to effect reductions in demand or treatment. Primary care treatment is as yet still undeveloped and resources are lacking for:

    (a)  sufficient training to equip doctors to play a meaningful and continuous role

    (b)  money for effective prevention strategies at primary care level

    (c)  research into what works most effectively in primary care

    (d)  Mechanisms to reduce diversion, such as effective supervised ingestion schemes.

  Loosening the current drug laws without parallel investment in the above areas would result in an increase in presented drug use problems in primary care with a shortfall in the effective means of addressing these needs.

October 2001

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