Dr Emma Ryan trained at Kings College London and is currently a GP and Clinical Director of a Primary Care Network which provides care for 45,000 patients. She is actively involved in the education and training of General Practitioners and has been a lead GP at the Primary Gambling Service from its inception.

Background

The Primary Care Gambling Service was set up in 2019 by Dame Clare Gerada and exists as an intermediate shared care service sitting between primary care (General Practitioners) and the voluntary and specialist services. This service is based on the successful NHS drug and alcohol shared care service developed by the Hurley Clinic in the 1990s – which persists today and is now the model of shared care across England.

In the UK 90% of the population see the GP every year and 99% every three years, with over 300 million appointments per annum. Despite this, patients suffering with gambling harms still go unrecognised. The reasons for this are complex but health care worker’s poor awareness of gambling and its harms is a factor.  Even when the existence of gambling-related harm is identified, health care professionals often regard this as a personal or ‘social’ problem, rather than a health issue, meaning that the needs of relevant individuals are largely unaddressed.

Aims and Structure

The Primary Care Gambling Service was established to address the above and has two main aims:

1. Education:

Raising awareness of the physical, mental and wider implications of gambling on individuals and their families, such that health care professionals can identify those that are suffering from gambling harms.

This has been underpinned by a Gambling Competency Framework which defines the core skills, knowledge and attitude individuals need to acquire to be in a position to help patients. There are seven competencies within the framework which represent the different understanding and depth of knowledge an individual working in primary care might need depending on their role.

2. The Treatment Service:

Patients are currently being referred into the service via various routes including:

• Directly from the GP via a question on an online consultation (a mode of consulting during lockdown);
• Referrals from GamCare of complex patients with medical problems;
• Via a self-referral to the www.primarycaregamblingservice.co.uk

Once referral is received a mental health assessment is undertaken within seven days and the patient is discussed at a multidisciplinary meeting. The core team consists of a Director of operations, GPs, a consultant psychiatrist, a lead mental health nurse and a peer support worker. The patient is assessed holistically and then placed into treatment. All aspects of the patient’s situation are assessed. Common themes that are emerging amongst those being assessed include undiagnosed mental illness or learning disability; poor control of chronic disease, for example, diabetes; co-addictions; and the need for an offer of support for chaotic lifestyles.

We continue to adapt and be flexible to the patients and the restraints that Covid -19 has imposed on the service and look forward to the next step in the journey once restrictions are lifted.