Models of Primary Care for Substance Misusers: the Lothian experience

Introduction: The Community Drug Problem Service (CDPS) was established in 1988 in response to an epidemic of HIV infection among IVDUs in Lothian. It developed a shared-care model of service delivery with GPs. By 1997, this model began to show signs of strain. Method: A self-report questionnaire was sent to every GP in Lothian (N = 530), to get some measure of GP opinion regarding working with drug users, substitute prescribing and their views of the CDPS. A reply paid envelope was included. All data were entered on a database and analyses carried out using SPSS. Results: The response rate was 86%. The GPs were an experienced group. Virtually all were prescribing or had done so in the past. They wanted to get drug users off drugs and were concerned that this was not happening within an acceptable timescale. There were mixed views on who should see and prescribe for drug users. Some GPs would not do this work and others had reached capacity. In terms of CDPS service delivery, top priority for GPs was rapid, good-quality assessment of referrals. Overall, however, there was general satisfaction with the service being provided. Proposed Solutions: The CDPS developed a central Assessment Team to provide an equitable service to all Edinburgh city sectors. A Locality Clinic was piloted in the South-West sector of the city to provide a prescribing service for GPs who chose not to prescribe or had reached capacity.