This document reflects the findings of a working group set up
jointly by the Royal College of Psychiatrists and the Royal College
of General Practitioners. The group had the support of the National
Treatment Agency (NTA) for Substance Misuse and the Department of
Health. It is intended as a resource for commissioners, service
providers and doctors, and seeks to clarify some of the issues
surrounding the employment of doctors and deciding which doctors
have the appropriate competencies to carry out various tasks in the
treatment system.
There has been a large increase in the number of doctors from a
range of professional backgrounds working with substance misusers.
This increase has mainly been in primary care, as there are
shortages of addiction psychiatrists and other experts in secondary
care. The expansion in the numbers of general practitioners (GPs)
involved has resulted in individual doctors working in different
ways, with a variety of competencies. Titles now used include
‘general practitioners with a special interest’ and ‘primary care
specialists in substance use’. The new General Medical Services
contract has defined locally and nationally enhanced services,
which allow a degree of clarity in terms of the services a GP would
be expected to provide to a drug misuser.
All organisations employing doctors need a robust clinical
governance structure that addresses issues of education and
supervision. The report recommends that appraisal must be carried
out by a trained appraiser with experience of the clinical area.
Supervision could be carried across different employing and
specialty areas, so for example a consultant addiction psychiatrist
could supervise a GP with special clinical interest working in
their geographical area. Royal College of General Practitioners’
regional leads are another potential source of support. In most
circumstances, however, training-grade practitioners should be
supervised by practitioners from the same discipline.
In some parts of the country, GPs are working as primary care
addiction specialists. There is currently no recognised pathway for
these individuals to obtain specialist qualifications, but draft
criteria are suggested.
This document defines the following professional groups:
- Psychiatrists: consultants in addiction psychiatry, consultants
in general psychiatry with a special interest in addiction,
consultants in general psychiatry.
- GPs: GPs with a special clinical interest, GPs providing
enhanced services, GPs providing core services.
- Other specialists: substance misuse specialists (in primary
care), substance misuse specialists (from other professional
backgrounds), other doctors on the specialist register, associate
specialists, senior clinical medical officers, staff grades.
The competencies expected of each group are .summarised. It is
acknowledged that individuals will have a range of competencies and
skills.
Doctors work within treatment systems and therefore may provide
services over a range of National Treatment Agency Models of Care
tiers. However, doctors with higher levels of competencies are
generally more likely to be working in services that provide Tier 3
and Tier 4 interventions and to be more involved in management and
strategic activities. In a treatment system there is a need for
services at all levels, with input from GPs and specialists (either
addiction psychiatrists or other specialists).