Whither (or wither) Shared Care?

Over a decade ago, there were just a handful of GPs in the UK who were delivering quality prescribing interventions to heroin users. Since the College created the Substance misuse certificate, more than 1,500 have completed the full certificate (PwSI level) and more than 6500 have completed the Part 1 and are actively involved in Shared Care - a fantastic achievement. In the UK today, more patients are getting their opiate replacement therapy from their GP than from a specialist service.....so why my double-entendre with the word "whither"?

I am worried: I feel a very subtle change in GP's attitude to working with drug users. Certainly many of the old prejudices have been allayed: this IS work that GPs can and should do effectively; it is NOT neccessarily a specialist concern; GPs WON'T get swamped or get into trouble; and treatment DOES work, it reduces mortality and morbidity to the individual and the family. These essential messages are now widely accepted and yet I feel it is becoming increasingly difficult to engage GPs in this work - why? well the GP contract has made GPs very well paid, and very busy: it has fostered a very commercial attitude to our profession, which is probably for the most part, a good thing - but more importantly, it has allowed GPs to opt out of areas that although worthy, are just too onerous and not well enough paid - notably out of hours care. And increasing numbers of GPs I fear are taking a similar view to the care of drug users: it's worthy, but just more work than I need - and that is a tough argument to oppose.

So I urge all of you who value this work and who read this column to spread the word - enthuse your colleagues - yes it can be challenging at times, and yes the money is crap compared with other revenue streams - but this work changes lives in ways that almost no other medical intervention can do - it is rewarding in ways that money can never be, and it is bloody good fun. We learn from each other, so get out there and evangelise!