T
he first female chair of the Royal College of GPs (RCGP) in more than
50 years, Dr Clare Gerada has been a key figure in the substance
misuse sector, particularly in terms of the role of general practice. As
well as establishing the RCGP’s substance misuse unit, she introduced
the college’s part one and part two certificates in the management of
drug misuse in primary care and has also fought the sector’s corner as a senior
medical advisor to the Department of Health.
A GP for 20 years, she was awarded an MBE for services to medicine and
substance misuse, but it was her work at south London’s Maudsley hospital that
first brought her into contact with drug users. ‘I got really interested in pregnant
drug users in particular and was asked to give a talk about it, as I had sort of the
largest cohort,’ she says. ‘It was only about ten, but more than other people who
were interested – this was pre-internet days, remember.’ From the Maudsley she
went to a walk-in service for drug users who couldn’t access GPs – what was it
that originally got her interested? ‘I just love working with drug users. They’re so
amenable to treatment, so it just grew from there.’
With more than 10,000 GPs having completed the training for the part one
and part two drug misuse management certificates, GPs’ understanding of – and
attitude to – substance issues continues to grow and develop, but delegates at
DDN
’s service user conferences still talk about feeling stigmatised by their GP – or
at least worried that they would be (
DDN
, 7 March 2011, page 10). Does she feel
that situation is improving?
‘When I was starting out there used to be signs saying “no drug users here”
and GP practices with people gouching out in the waiting room – it was so
stigmatised,’ she says. ‘There were a few practices that were seeing large numbers
of drug users, and then the vast majority didn’t want to know. What myself and
others like Chris Ford said was, “look, this is a chronic disease, the same as
diabetes or asthma – just get hold of it”.’
The sector has changed significantly since she came into it, with the 1999
‘orange’ clinical guidelines one of the major developments, she believes. ‘I need to
declare an interest because I was working on them, but the fact that they
recognised the role of GPs and the role of shared care was very significant. Also,
there are the very practical things like instalment prescribing, which meant it
became a lot safer, and – dare I say – I think the primary care movement has been
significant because it shifted the balance of care to general practice, which had a
normalising effect. It meant that GPs became much more involved.’
In the light of all of that, how optimistic does she feel about the future of
treatment provision, given the economic outlook, move to Public Health England
and introduction of payment by results? ‘I’m really worried by payment by results,
i.e.
payment by abstinence – the Russell Brand thing of if you’re not abstinent
then somehow we’re failing our patients,’ she says.
‘With the best will in the world it takes people a long time to achieve abstinence,
if ever, so I’mmuch more in favour of harmminimisation – I grew up in the harm
reduction world. I
am
worried about the place of addiction. I think it’s gone from the
sublime to the ridiculous in that we now have very few specialist addiction services,
and that’s the last thing that myself or any GP leaders would want. I think it’s
imperative that we have specialist addiction services and the next generation of
experts. I’m not an expert – I might be an expert in primary care – but I haven’t done
the sort of things that John Strang and Gerry Stimson have done, for example.
18 |
drinkanddrugsnews
| July 2012
Profile |
Clare Gerada
www.drinkanddrugsnews.com
Chair of council of the Royal College of
GPs, Dr Clare Gerada has helped to shape
substance misuse services as we know
them. She talks to David Gilliver about
what the future might hold
‘I grew up in the harm
reduction world. I
am
worried about the place
of addiction.’
Dr Clare Gerada
What’s