Drug misuse and primary care in the new NHS

For years Central Government policy has been to involve general practitione rs (GPs) in the care of drug misusers. High morbidity and mortality rates m ake it particularly important that drug misusers make contact with treatmen t services, yet this group is regularly denied effective and evidence-based treatment by the National Health Service (perhaps the only group of patien ts that this applies to). For many well-rehearsed reasons GPs have been rel uctant to become involved in the care of drug misusers. In order to get GPs to undertake this work secondary services must adapt their services so as to enable shared care which is easily accessible and flexible enough to acc ommodate the differing skills of the GP and the Primary Health Care Team. C hanges in delivery, payment and organization of health care services with t he formation of Primary Care Groups (PCG), and future Primary Care Trusts, means that services can be adapted to meet the needs of patients (and clini cians). This paper describes, from a predominantly English primary care vie w point, the changing face of primary care, its altered relationship to sec ondary care and how primary care can best act to provide a service to patie nts with substance-related problems. It also attempts to guide the reader t hrough some of the key policy changes that have occurred that could have re levance in planning and delivering services to substance misusers.