Basic HTML Version
18 |
drinkanddrugsnews
| July 2014
Profile |
Dr Judith Yates
www.drinkanddrugsnews.com
Dr Judith Yates talks to
David Gilliver
about swapping
the GP surgery for the
international policy arena, and
the vital role of primary care
‘I
do believe that the best care for people who use drugs and alcohol is in
their own GP surgeries where possible,’ says Dr Judith Yates, who –
although retired from her GP practice since 2010 – is far from retired from
the drugs field.
She’d wanted to go into medicine since childhood but dropped out halfway
through medical school to ‘explore the world and myself a bit’, an experience that
helped her decide that it was being a GP – as opposed to other areas of medicine –
that would provide the most interesting challenge. As a young trainee in the late
1970s, and her practice’s only female GP, she soon discovered that the only way to
see male patients was though consultations with those who had drink and drug
problems. ‘At that time the psychiatric addiction services were struggling to find
their way and the heroin was flooding in, and by the ’80s the waiting lists for
treatment by the psychiatrists were rapidly building up,’ she says. ‘People were
falling out of their care and turning up on my doorstep.’
Her other discovery, however, was just how rewarding helping this client group
could be. ‘It just seemed to be something that I could easily do. The rest of general
practice – which I was doing as well, of course – often involves the long-term care
of physical ailments, some of which are quite gloomy, whereas these were young
people with lots of potential who’d struck upon hard times and with a helping
hand could get on with their lives. The transformations could be quite rapid.’
She went on to spend three decades as a Birmingham GP, working in the city’s
first community drug team in the early ’90s at the same time, and after a while the
group of patients at her surgery who used drugs numbered around a hundred.
Clearly, not all practices were – or are – as accommodating. Does she feel that the
stigmatising attitudes of some GPs are starting to change?
‘I think it’s very patchy and postcode-y,’ she says. ‘In Birminghamwe were lucky in
that when all the crime money came in with the NTA all the GPs working in this field –
only about four or five of us – joined the newly formed shared care monitoring group
and managed to use that money to set up probably one of the biggest primary care-
based drug treatment services in the country. It’s been very effectively organised and
managed in that drug workers go out into GP services as opposed to sitting in a centre
somewhere waiting for patients to come to them. Around half the people who are
scripted in Birmingham are treated in primary care, which is good but it does need
proper focus. GPs on their own can’t do it – they need properly organised key workers
coming in because there just isn’t the time in ordinary primary care.’
She still does a weekly clinical session with the community drug team and also
helped to plan and set up a new residential detox and rehab clinic, working there
for two ‘enormously enjoyable’ years after retiring from her surgery. But it’s policy
work that’s been taking up most of her time lately.
‘I had a bit more time to pick my head up from the coalface and look around so
I started to look at ways to reduce drug-related deaths in Birmingham and work on
our take-home naloxone project,’ she says. ‘I thought I’d be able to just put on a
couple of training the trainer sessions and then someone else would take over and
it would run itself, but that didn’t happen. I discovered that you have to chip and
chip away at all these little tiny local barriers that prevent any change.’
It was through the naloxone project that she met Philippe Bonnet (
DDN
,
October 2013, page 16) and started investigating the growing international
evidence base for consumption rooms. Is she confident that the Independent
Consortium on Drug Consumption Rooms (ICDCR) can achieve its aim of
establishing a facility in Birmingham?
‘We’ve been waiting for the Birmingham re-commissioning to finish because –
quite rightly and reasonably – we were asked to not take our plans forward in any
concrete way while all the services were going through this enormously time-
Pr im