Interactive E-mail Groups – Giving GPs What They Ask For

Guest blogger Laurie Windsor explains how an interactive e-mail group can help support GPs in a bid to increase the number of patients with substance misuse in shared care…

My name is Laurie Windsor and I’m a psychiatry higher trainee (Spr) who worked in the Substance Misuse service in North Devon up until August 2013. I wanted to draw your attention and perhaps stimulate debate about the different methods that I tried to increase engagement in shared care whilst I was there. There are a particularly low percentage of clients prescribed within shared care in North Devon (4%). I have written an article (available on the SMMGP web site) which discusses the different surveys and methods that I completed that helped to find out the reasons for this. The survey found that the main factors that might persuade GPs to get involved were easy contact with a psychiatrist, increased training and information, an ability to refer back easily to specialist services and increased funding.

Unfortunately in this climate I wasn’t able to offer increased funding! However I did begin a trial of an interactive email group that we thought might help with the other factors. It also helped maintain the training of the GPs who struggled to make the six monthly sessions provided locally. The difficulty attending was partly due to the relative isolation in this rural area and partly due to the time pressures that affect all GPs.

The Interactive Email Group is based on a systematic literature search that I completed on educational interventions for GPs in shared care. The main factors that were backed by evidence were good communication, sharing patient narratives and positive outcomes as well as maintaining skills, education and training by psychiatrists. I’m aware there are national on-line forums but experience in other areas, such as Recovery, has shown that local relationships and local training can have a significant added benefit.

The advantages of the Interactive Email Group can be summarised as:

  • Quick responses from Consultant Psychiatrists and members of the drug team
  • GPs can share experiences of clinical but also administrative problems
  • Strengthen relationships between local GPs in shared care
  • An easy place to offer and advertise further training

My experience shows that shared care works well when GPs communicate well with and feel supported by the secondary services. I wonder whether this could be an approach that might work well elsewhere. I also hope that my article will encourage practitioners to share what else has been tried and what has worked.

I hope people will read my article which will aim to shed some light on the factors that affect why GPs choose to get involved in shared care in substance misuse. Please contact me on l.windsor@nhs.net if you wish to have further information.

– Laurie Windsor

See Laurie’s full article here
See Laurie’s related article in Network 36 here

Dry January and different strokes for different folks (A tale of two drinkers)

Dr Steve Brinksman writes the regular “Post-its from Practice” articles for Drink & Drugs News (DDN) Magazine. The most recent Post-it (Feb-2014) appears below with kind permission from DDN.

As the role alcohol plays in ill health and social dysfunction is increasingly in the spotlight, the whole SMMGP team decided to support Alcohol Concern by taking part in Dry January. It would be fair to say that it was anticipated that it would be harder some of us (i.e. me) than some of the others.

I decided that the best approach for me would be to tell as many people as possible that I was taking part, thus feeling compelled to complete it. One of the knock-on effects was that one of my GP partners and his wife decided to join in, I also had several interesting conversations with patients including one with an older lady who said “Oh, I didn’t realise you were an alcoholic and needed to dry out”. Hopefully she now understands a little more about the concept of dependence!

Frank had an appointment about his high blood pressure, he was taking medication for this and we were discussing adding in another tablet. He is a self-employed plumber and has always admitted to drinking “a lot” at weekends and “a few” during the week. That said when work was busy he would sometimes go 3 or even 4 days without a drink. Now in his mid 40’s he had watched his weight go up with his blood pressure, especially after he stopped smoking 3 years ago. He was surprised when I suggested he consider Dry January but faced with the prospect of more medication he somewhat begrudgingly agreed it might be worth a go.

Linda on the other hand brought her plan to participate in Dry January up with me. She told me a friend at work was intending to sign up to the campaign and she thought she would too. She had a stressful job with a firm of solicitors, had lost her driving licence due to drink driving 12 months ago and had been seeing the local CBT counselling service for anxiety and depression over the past few months.

This led to a deeper exploration of her drinking habits: she arrived home from work and immediately had a large glass of wine, followed by a couple more during the working week and probably twice this at the weekend.

She had gone a couple of days without a drink earlier in the year when she had flu but said she felt really ill and had been retching and shaky which she blamed on the virus.

An AUDIT score of 28 supported my view that she probably had a degree of physical dependence and after some persuasion she agreed to see our alcohol counsellor rather than attempt Dry January. She has done well and over the course of January she has cut back to about half a bottle of wine a day and towards the end of the month has even managed a couple of dry days, she is now focussed on getting her licence back and is starting to think that her life might be better without alcohol.

As for Frank he came in looking great, he had lost 4kgs in weight and his BP was back under control, I had thought he might struggle but he told me he had stopped going to the pub and started going for a run: “I’d like to do a marathon Doc, it’s quite addictive this running, you know”.

– Dr Steve Brinksman
Birmingham GP, SMMGP Clinical Director, RCGP Regional Lead in Substance Misuse for the West Midlands

Note: Previous Post-its from Practice can be found in the Resource Library on the main SMMGP web site.