Drug misuse and primary care in the new NHS

For years Central Government policy has been to involve general practitioners (GPs) in the care of drug misusers. High morbidity and mortality rates make it particularly important that drug misusers make contact with treatment services, yet this group is regularly denied effective and evidence-based treatment by the National Health Service (perhaps the only group of patients that this applies to). For many well-rehearsed reasons GPs have been reluctant to become involved in the care of drug misusers. In order to get GPs to undertake this work secondary services must adapt their services so as to enable shared care which is easily accessible and flexible enough to accommodate the differing skills of the GP and the Primary Health Care Team. Changes in delivery, payment and organization of health care services with the formation of Primary Care Groups (PCG), and future Primary Care Trusts, means that services can be adapted to meet the needs of patients (and clinicians). This paper describes, from a predominantly English primary care view point, the changing face of primary care, its altered relationship to secondary care and how primary care can best act to provide a service to patients with substance-related problems. It also attempts to guide the reader through some of the key policy changes that have occurred that could have relevance in planning and delivering services to substance misusers.