Not logged on for a while but don't see any discussion about this..! in the 2 PCT areas I work there has been more or less delay in commissioners and the PCT sorting out the accreditation process... has anyone had any helpful experiences in this respect? I'm particularly interested in whether it is interpeted that all GPs working in GPwSI-run services need accreditation and how the issue of supervision by Addiction Consultants is working out. Also <Implementing Care Closer to Home> (DoH 2007)implies that Young Peoples Services and Services for those with Dual Diagnosis should remain in the "specialist" arena - any comments?

This message has been edited. Last edited by: Simon Tickle (Northampton/London),

hmm. Multi-faceted questions..

In Birmingham we have a system of about 10 GPwSIs and around 100 or so GPIs ("GPs with an Interest") . This is to cover a primary care based prescribing service with patients treated in their own surgeries, practice attached drug workers, spread across more than half of the birmingham practices.

Together with one part-time "lead GP" post, we GPwSIs organise and offer the annual training for other GPs to entitle them to be paid via a LES system which is the same in all the 4 PCTs which make up the bham DAAT.
Each GP who wants to be a "GPI" also has to complete part 1 level RCGP certificate. GPwSIs organise a mentor system so that all prescribing GPIs can and do ring us for discussion about problems and interesting cases. Sig incidents are discussed at bimonthly GPwSI meetings.

I have heard a rumour that all GPwSIs have to be re-accredited during this year, but have no more details.
My annual appraisal was done last year by our "lead GP in substance misuse" and it is suggested that we GPwSIs have a specifically substance use appraisal, every fourth year, and otherwise incorporate it as part of our general GP appraisal each year.. I am a bit vague about revalidation...

As we are a Primary Care based service, we have not looked for "supervision by Addiction Consultants" .

In answer to your question about other GPs who work in GPwSI led clinics, I would think they do not individually need to be GPwSIs themselves, but just GPs with relevent experience and training in the field ..presumably up to part 1 of the RCGP certificate, who can consult with the GPwSI for complex problems. . If they are being employed by secondary care level services, I suppose the services own clinical governance would dictate some level of appraisal or support for people they employ?? and the GPs will of course also individually discuss their drugwork as part of their annual GP appraisal?

Dual Diagnosis: As time has passed, many of the less socially chaotic dual diagnosis patients have moved out from the CDTs to the care of their own GP practice, which seems right if done on a case by case basis, so we do not have any firm rule on this.. just that the person needs to be sufficiently stable to be able to sit in a GP surgery waiting room, and hopefully to attend most appointments without needing outreach work.

Care of Young people we have discussed on these pages now and then. The very young have such a lot of complex needs to be co-ordinated , that i would hope that a specialised young person's service would be available to help them in each area, and if they present to me I try to get them to engage with our local secondary level service. But GPs with particular expertese in this area might sometimes be better able to help than a city centre clinic.

Thanks Judith it is interesting to hear what you have got in B'ham and it seems a very good set-up. It does seem though that the content of "Implementing Care Closer to Home" has not been registered by the Commissioners there.. As I understand it there was an obligation placed on Commissioners by the DoH for GPwSIs AND their services to be newly accredited in a fairly prescriptive process described in that document by 31.3.09 (ref: http://www.dh.gov.uk/en/Public...ndGuidance/DH_074430) Certainly Northampton PCT and City
and Hackney PCTs that I work for have interpreted it in this way and it does I think raise issues about the nature of services likely to be acceptable for GPs to run and the qualifications required of those working in these services which is what I was getting at. If some PCTs/DAATs have ignored the requirements, have others interpreted them in differing ways? I was blissfully unaware of it all until the middle of last month when the Medical Director at City and Hackney contacted me! (But I notice there was a posting referring to it on SMMGP in about May 2007 when the document was published)

Thanks.. that's very useful. As I said, I was aware that GPwSIs all have to be reaccredited this year (not just substance use ones) but I haven't heard anything yet from the local PCTs.still reeling from the QOF I expect.

The rules for re-accrediting in the document don't sound to impossible..

(page 14
Accreditors must ensure the GPwSI or PhwSI prepares a self-assessment that includes:
_ A statistical summary of the service provided
_ Clinical audit data of the work of the individual GPwSI or PhwSI, and resultant actions of
follow up.
_ Data that had been collected to audit patients’ experience of the service
_ A summary of the way in which local people have continued to be involved in the life of
the service.
_ A critical re-appraisal of the way in which the role of the individual GPwSI or PhwSI
within the service had initially been described, with a view to identifying any ways in
which the quality of the clinical service they provide could be further improved in future.
_ A strategy for further improving the quality of the service through the next accreditation
term, identifying explicitly the parameters within which the individual GPwSI or PhwSI
would work.
_ Any additional training or development requirements.

but i suppose all these tick boxes take up time;;;where has all the time gone?

Thanks. I'd be really grateful for comments by others on this topic including the moderators as I feel there are a lot of uncertainties around the issue!