LOW DETECTION RATES, NEGATIVE ATTITUDES AND THE FAILURE TO MEET THE HEALTH OF THE NATION ALCOHOL TARGETS - FINDINGS FROM A NATIONAL SURVEY OF GPS IN ENGLAND AND WALES

The appropriateness of the primary care setting to undertake the healt h promotional activities needed to meet 'Health of the Nation' alcohol targets has been acknowledged in UK government policy and the scienti fic literature. However, the latest data suggest these targets are not being met. A 20% random sample of all general practitioners in Englan d and Wales were surveyed by postal questionnaire to examine their wor k in detecting alcohol misuse and their attitudes towards the work. Fo ur mailing waves produced a 44% response rate. GPs had identified a me an of 3.2 patients per month drinking above recommended 'sensible' gui delines. These patients were mostly male (73%) and above 40 years of a ge (45%), with nearly half (45%) already dependent drinkers. Most GPs perceived alcohol misuse patients as a difficult group with,whom to wo rk. None the less, over half the respondents believed general practice was an appropriate setting for the detection of the problem. However, most did not feel trained or supported in this area of their work. Mo re emphasis needs to be placed on the valuable contribution GPs can ma ke with the larger number of patients who are drinking regularly above 'sensible' levels but not yet suffering adverse affects. Our findings point towards not an unwilling profession, but a profession lacking c onfidence. The provision of support and basic training; are major fact ors in how GPs perceive alcohol misusers and their own role in this wo rk. Twenty years after the Maudsley Alcohol Pilot Project research it is disappointing that, despite greater recognition by GPs of their pot ential impact, lack of training and lack of support are still so centr al to their continued low levels of therapeutic commitment.