SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

SMMGP History

2011 to Present

Steve Brinksman was appointed as SMMGP Clinical Lead in June 2011, when Chris Ford retired. Steve works part time for the organisation and is supported by a full time Project Manager and a wider team. The team is made up as follows: Elsa Browne, SMMGP Project Manager (responsible amongst other tasks for compiling the Policy Update); Kate Halliday (Policy and Development Manager); Euan Lawson (Clinical Update); and forum moderators Judith Yates and Kevin Ratcliffe. The website is managed by Adam Bull; and Sarah Pengelly is in charge of Membership Administration and is SMMGP's Conference and Events Organiser. In addition we are grateful to colleagues from other disciplines who provide us with assistance and information on occasion as needed. SMMGP also relies on our good relationship with a wide range of other stakeholders and partners who support our work.


During 2010 SMMGP established a Community Interest Company (CIC) to support development initiatives such as training events and conferences. A decision was taken in 2011 to change the status of the CIC to become a charity. The charity was registered in December 2011 and a Board of Trustees was appointed according to the governance requirements of the Charities Commission. Board trustees are: Andre Geel (Chair), Carole Sharma (Vice Chair), Jim Barnard, Sarah Pengelly, Marcus Roberts, April Wareham. Input from the Board is a valuable contribution to our planning and direction.

2009: A New Era

After eight years with the project, Jim Barnard sadly left SMMGP in 2008 but like so many past staff has remained in touch and is still active on website. Elsa Browne was appointed in February 2009 as project manager, to work with the Clinical Lead, Chris Ford, and the Policy and Development Lead, Kate Halliday. Elsa has brought enthusiasm and essential business skills to the project and has a keen interest in the field. Membership administration is outsourced and ably managed by Sarah Pengelly.

SMMGP's website is currently the leading, largest and most used clinical site in this field in the UK and still expertly managed by webmaster Adam Bull. The online discussion forums are lively and receive up to five hundred postings a month. The forums are a major support resource for primary care professionals who often feel isolated in this field. Increasingly, the site is used by pharmacists, nurses and patients and is a vibrant arena for the exchange of information between the professions. The forums are well moderated by a team of people including doctors Nat Wright, Susi Harris and Judith Yates.

Whilst ensuring that the core business such as the Network newsletter and other publications, SMMGP website and forums and the national conference continues apace, the project management team continues to consider new initiatives and explore diverse projects which may enhance and further strengthen SMMGP.

2006: First SMMGP "Development of Services" Conference

As a result of the level of interest regarding the development and coordination of primary care services for drug and alcohol users, SMMGP organised a half day conference in Manchester in 2006, the day prior to the RCGP Management of Drug Users in Primary Care Conference. The aims of this event were to identify good practice in the coordination of shared care schemes, the development of primary care based drug services and to identify and encourage a network of practitioners involved in this area of work. The event drew over 100 individuals from a variety of backgrounds including GPs, managers, commissioners, shared care coordinators and service users. It has since become a lively annual one day conference looking at up-to-date issues for primary care based drug treatment, including different models of delivery, multi-agency working and commissioning.

Back to core business

In 2006 SMMGP had a significant reduction of its core DH funding. This meant that the local advisory service ceased and a return to core business of being a clinical network for primary care. The team reduced to one full-time policy officer (Jim Barnard), one part-time Policy and Development Manager (Kate Halliday) and part-time Clinical Director (Chris Ford).

Supporting publications to the original newsletter (Network) were developed in the form of bi-monthly publications - a Clinical Update and a Policy Update.

A formal free membership scheme, introduced in 2006, has meant that members can consult and inform the field more efficiently and has increased the information resources at our disposal. The large and ever-growing membership gives the organisation a strong presence in informing and responding to the policy makers at the centre. The network and the membership continues to grow and thrive, as does the website.

2004: Regional Advisors Appointed

The project then received further funding from the Department of Health in April 2004 that enabled them to appoint three more Primary Care Advisors. The posts were filled by Kate Halliday (Midlands), Annas Dixon (South West) and Lisa Stanway (London and South East). The new advisors, and Jim Barnard (North) continued to help develop local primary care based drug treatment, advising on local shared care schemes and shared care monitoring groups and services such as supervised consumption and needle exchange, as well as supporting the SMU appointed RCGP Regional Clinical Leads for Drugs. Jean-Claude Barjolin continued as editor of Network and took on the role of Conference Director for the RCGP Managing Drug Users in Primary Care (then in its eighth year and increased in size to over 400 delegates).

2002: Transfer to Trafford

In 2002 SMAS as an organisation ceased to exist. Consequently, management and partnership arrangements were made with the Royal College of General Practitioners, Trafford Substance Misuse Services (where Jim Barnard was employed), and the National Treatment Agency for Substance Misuse. These arrangements ensured that SMMGP remained rooted in primary care while being close to the policy centre.

RCGP certificate developed

After the 1999 Clinical Guidelines were published and through the work of the SMMGP network, it was recognised that standard national training was required for GPs and other primary care workers. Clare Gerada, a member of the Guidelines group from the start, was working at the Department of Health and had a vision about developing appropriate training. She secured funding from DH for the development of the RCGP Certificate in the Management of Drug Misuse. The original funding was earmarked to improve the skills of practitioners already working with drug users in primary care and the first graduates qualified in 2003.

From the outset it was recognised by all involved in this training that there was a need for a more generalist "foundation" course aimed at the less experienced GP who had an interest in working with drug misuse, and in 2003 the RCGP Certificate in Drug Dependency was split into Part 1 and Part 2.

SMMGP was commissioned by the RCGP to develop and run the RCGP Certificate in the Management of Drug Misuse Part 1 and successfully ran five national events and enabled over 300 GPs to obtain the full Part 1 certificate before handing it over to the RCGP to continue in 2004. The course, consisting of two e-modules and a face-to-face day, still runs very successfully in its original format and is seen as an essential qualification for those who work with drug users in primary care. More details on the certificate course Part 1 and Part 2 can be found in the RCGP Training section.

It also became apparent that there was very little guidance written specially for primary care and - working with RCGP Substance Misuse Unit (SMU) and RCGP Sex Drugs & HIV Task Group - SMMGP developed the first guidance document covering the use of buprenorphine in opioid dependence treatment. This has been followed by guidance documents on treatment of cocaine users, Hepatitis A and B immunisation, the use of methadone, and management of hepatitis C. These are all available in the Guidance Documents section.

2000: Increased Funding

Following a successful bid to the Treasury "Invest to Save" budget, the service was further expanded in July 2000. Primary Care Adviser posts, filled by Jean-Claude Barjolin, Jim Barnard, Simon Morton and Christina McArthur and a full-time administrator post (Mark Birtwistle) were established. The advisers were supported by the pooled expertise of a panel of GPs, other healthcare professionals and "expert patients"; a pharmacist; (Martin Bennett); a representative from a drug user organisation - (Alan Joyce from The Alliance) and a psychiatrist (Tom Carnwath). This enabled an expanded advice service to be offered across England. In addition, it allowed electronic means of communication and network building to be developed including an interactive discussion forum on the website.

1999: Further Expansion

It became apparent that this initiative needed administrative support and this led to the appointment of a "Primary Care Development Adviser" in August 1999 to co-ordinate and to develop the network. The post-holder (Jean-Claude Barjolin) was originally based at the Substance Misuse Advisory Service (SMAS) in London. This expansion allowed SMMGP to introduce a national advisory service to directly assist GPs and other practitioners working in primary care to deliver; and commissioners to develop drug treatment in primary care. A telephone, electronic and face-to-face advice system was developed including the creation of the SMMGP web site by Adam Bull.

1996: First Newsletter

This original small group made up of Chris Ford, Brian Whitehead, Clare Gerada, Berry Beaumont, Judy Bury and Jean-Claude Barjolin also identified that there was little literature in the drugs field aimed specifically at general practice and produced the first newsletter in April 1996, before the conference. The group was also the editorial panel for the newsletter. The original newsletter, mailed out to 243 people and distributed at the conference, was well received and it soon developed into a quarterly newsletter entitled Substance Misuse Management in General Practice (SMMGP). The mailing list rapidly increased, reflecting a real need to build a primary care network for sharing ideas and information regarding substance misuse. In the early days the newsletter was written, produced and circulated to practitioners in the whole of the UK without additional resources or finance.

1995: Early Days

In 1995 Chris Ford and Brian Whitehead, who had been working together in general practice treating people who had drug problems, realised that they were managing complex people very much in isolation. They knew of others doing similar work and realised that there may be many more of their colleagues in a similar situation. They called a small group of GPs and other practitioners working with drug users in general practice together to discuss how to support people doing this work. It was decided to hold a conference to share experiences and develop a support network. The first conference entitled "Management of Drug Users in General Practice" was held in 1996 and sold out in a few weeks with 100 delegates attending. It was organised through the Royal College of General Practitioners (RCGP) HIV Working Party (which since 2001 has been renamed RCGP Sex, Drugs & HIV Task Group).