Comrades
I am sure that you have all been eagerly devouring the draft new National Guidelines and helpfully feeding back to the Politburo various tweaks and editions. For your edification I pass on my comments which are in no way expert, are completely my personal opinion and not those of the College, and treat the weighty tome with the sort of superficial dismissiveness which you have probably come to expect from me, but at least I have read it….
Overall I have to say that although I was prepared to hate it – in the main it is quite a good document, but at 204 pages, no way can this be called guidance – it is a text book that is comprehensive and draws upon current evidence as presented to NICE, and various other research from home and overseas.
The priorities are very clearly harm reduction – abstinence is noteworthy for being mentioned in the list of priorities, but only after all other avenues of harm reduction. Indeed reading the document you might well wonder if it is ever permissible to discharge a patient from treatment. I think that guidance that clearly steers us away from punitive practices and discourages the harm aggravation of discharge is absolutely necessary, but it should be balanced by guidance on situations (for instance serial non-attendance) where it is unsafe to continue prescribing.
Governance: you might expect (and you would be right) for a section on governance matters to be pretty turgid – but again it is necessary and welcome. I am dismayed by the number of colleagues who are put into positions where they are “over-extended” and neither supervised nor given proper appraisal by someone who understands their work One day something horrible will happen and the wretched doctor will have my blessing if he calls his employers/PCT into the Dock to stand alongside him – because they share the responsibility for his actions.
“Non Medical Prescribing” – a bit of an insult to nurses and pharmacists to call them “Non Medical” but we know what they mean – this is the way forward Comrades – it is high time that all these over paid Prima Donna doctors got their marching orders….............. oh hang on a minute….
Contingency Management – or “inducements”, are vogue at present – NICE saw the American evidence and were impressed, and that has come over into the draft guidance. Excuse me, but isn’t the USA the country where they deny cannabis smokers university grants, but do not extend the same punishment to rapists and armed robbers? Don’t they have more blacks in prison than are at liberty in the whole of Europe? And aren’t welfare payments roughly 40% of what we dish out in the UK? Call me old fashioned, but it is surely flawed to extrapolate that if American drug users attend appointments with their service because they are offered luncheon vouchers (as opposed to being sent down to San Quentin), that the good old British drug user will be similarly impressed? Maybe Contingency measures will be effective in Blighty, and maybe our paymasters will give us a load of money to support this, but I think that we need British evidence first.
As a document of “best practice” this is mostly pretty good in my view. At times it is very biased toward Specialist Service models and offers little to Primary Care with regard to low intervention/long term stable clients. There are a number of worthy although quite unrealistic statements eg: “Drug misusers in the criminal justice system should neither receive higher priority for their treatment, nor should their legal status deny them access to care equivalent to that available in the community.” I hope that the finished article will take account of the feedback that has been sent, and I hope that nothing else is sneaked in at the last minute……!
and the latest NICE Guidance on Psychosocial interventions by clicking:
