Journal Information
Journal ID (publisher-id): jgi
ISSN: 1910-7595
Publisher: Centre for Addiction and Mental Health
Article Information
© 1999-2001 The Centre for Addiction and Mental Health
Publication date: June 2011
First Page: 108 Last Page: 112
Publisher Id: jgi.2011.25.8
DOI: 10.4309/jgi.2011.25.8

Continuing Professional Development for General Practitioners in the United Kingdom
Roslyn Corneyaff1
University of Greenwich, London, UK Email: R.H.Corney@greenwich.ac.uk
This manuscript was not peer-reviewed.
Roslyn Corney is Professor of Psychology in the Department of Psychology and Counselling at the University of Greenwich. Her research interests are in the area of mental health and general practice and she has conducted research over a number of years in primary care settings. More recently she has become interested in the area of female internet gambling and how to support men and women at risk of problem gambling.
Competing interests: none declared.
Ethics approval: not required
Funding: RC was funded to undertake this project from the Responsible Gambling Fund, UK.

This article describes the setting up, delivery and impact of general practitioner (GP) postgraduate training sessions on problem gambling in the United Kingdom (UK). Four sessions were delivered in a pilot project conducted in South East England and 140 GPs attended a session of approximately one hour in duration.

Background and Why GPs Were Targeted for Continuing Medical Education

Psychiatric co-morbidity is commonly found in problem gamblers, as well as drug, alcohol problems and other symptoms of ill- health (Morasco, vom Eigen, & Petry, 2006; Petry, 2005; Wardle, Sproston, Orford, Erens, Griffiths, Constantine & Pigott, 2007). However, most problem gamblers do not seek help from specialist services until they reach a crisis and by that time the gambling will have had a major impact on their financial and personal circumstances (Evans & Delfabbro, 2005; Productivity Commission 1999). Identification of problem gamblers by other involved services is therefore difficult, especially as no one particular group can be considered to be at particularly high risk (McMillen, Marshall, Murphy, Lorenzen & Waugh, 2004; Tiffany, Dal Grande & Taylor, 2006; Wardle et al, 2007).

One service that a problem gambler is likely to have visited prior to specific gambling treatment agencies is his or her family doctor or GP (Sullivan, 2000; Sullivan, Arroll, Coster, Abbott & Adams, P, 2000). Symptoms commonly presented include depression, anxiety, stress, headaches and tiredness; gambling may not be mentioned (Goodyear-Smith, Arroll, Kerse, Sullivan, Coupe, Tse, Shepherd, Rossen & Perese, 2006). While GPs may be well placed to identify problem gamblers and to provide support and referral, they do not routinely ask patients about their gambling habits (Setness, 1997).

Encouraging GPs to consider the need to investigate for gambling problems is not straightforward. Just writing to them is not enough as leaflets or documents are unlikely to be read or digested (Tolchard, Lyndall & Battersby, 2007). Literature may also fail to bring about change as it may be necessary to convince GPs that gambling issues merit their involvement (Tolchard et al, 2007).

One way to influence and inform GPs is to provide postgraduate education training on gambling issues. This has been found to be effective in the case of alcohol dependence (Malet, Raynaud, Llorca, & Falissard 2007). Training may have more impact on GPs’ day-to-day practice than supplying information or practice visits.

In the UK, all GPs are required to undergo continuing professional development (CPD) in order to keep up their registration. These training sessions are usually co-coordinated by the GP tutor covering their area, whose role is to arrange a number of relevant speakers.

The Pilot Project

The aims of the pilot project were to find out whether a GP postgraduate session on problem gambling was a feasible way of raising a GP's awareness of problem gambling; encouraging GPs to use a screening measure or probes to measure extent of gambling; and giving information about treatment services.

Sessions were set up by contacting the Postgraduate Deanery in South East England. Three one-hour sessions were arranged as part of a lunch time CPD session arranged for GPs. The fourth was conducted as part of a three day GP refresher course.

The sessions covered the following areas (see Table 1):

The sessions were supplemented with short details of problem gamblers’ case histories. This was added to provide interest but also to show how serious the problem could become. This included the risks of suicide both during gambling and when trying to give up. Handouts were given with details of the screening instruments and a list of contact details for treatment services.

Evaluation

The 140 GPs filled out a questionnaire before and after the session. They also discussed issues at the end of the session. The findings are shown in Figure 1 below.

Conclusions

GPs in the UK are notoriously difficult to contact by letter or by email. Continuing medical education on gambling may be relatively straightforward to set up and arrange. Most sessions are up to one hour's duration and so there is time to consider a range of relevant issues, including screening, referral and treatment. In addition, a group format may have some advantages. The GPs may not feel under individual pressure, they have time to think about the issue and reflect.

Increased GP awareness might also be supplemented by posters and materials on gambling being displayed in the practice or in the waiting room. Leaflets and posters may give a signal to patients that this is an appropriate issue for discussion with their GP.


References
Evans, L.. Delfabbro, P. H.. ( 2005). Motivators for change and barriers to help-seeking in Australian problem gamblers. Journal of Gambling Studies, 21(2), 133–155.
Goodyear-Smith, F.. Arroll, B.. Kerse, N.. Sullivan, S.. Coupe, N.. Tse, S.. Shepherd, R.. Rossen, F.. Perese, L.. ( 2006). Primary care patients reporting concerns about their gambling frequently have co-occurring lifestyle and mental health issues. BMC Family Practice, 7, 25–30.
Malet, L.. Raynaud, M.. Llorca, P. M.. Falissard, B.. ( 2007). Impact of practitioners training in the management of alcohol dependence: A quasi-experimental 18-month follow-up study. Substance Abuse Treatment Prevention Policy, 14, 1–18.
McMillen, J.. Marshall, D.. Murphy, L.. Lorenzen, S.. Waugh, B.. ( 2004). Help-seeking by problem gamblers, friends and families: A focus on gender and cultural groups. Canberra: Centre for Gambling Research, RegNet, Australian National University.
Morasco, B. J.. vom Eigen, K. A.. Petry, N.. ( 2006). Severity of gambling associated with physical and emotional health in urban primary care patients. General Hospital Psychiatry, 28, 94–100.
Petry, N. M.. ( 2005). Pathological gambling: Etiology, co-morbidity, and treatment. Washington: American Psychological Association.
Productivity Commission ( 1999). Australia's gambling industries: Inquiry report. Melbourne, Vic.: Australian Government Productivity Commission.
Setness, P.A.. ( 1997). Pathological gambling: When do social issues become medical issues?Postgraduate Medicine, 102, 13–18.
Sullivan, S.. ( 2000). Pathological gambling in New Zealand; the role of the GP. New Ethicals Journal, 3, 11–18.
Sullivan, S.. Arroll, B.. Coster, G.. Abbott, M.. Adams, P.. ( 2000). Problem gamblers: Do GPs want to intervene?New Zealand Medical Journal, 113, 204–207.
Tiffany, G.. Dal Grande, E.. Taylor, A. W.. ( 2006). Factors associated with gamblers: A population-based cross-sectional study of South Australian adults. Journal of Gambling Studies, 22(2), 143–164.
Tolchard, B.. Lyndall, T.. Battersby, M.. ( 2007). GPs and problem gambling: Can they help with identification and early intervention. Journal of Gambling Studies, 23:499–506
Wardle, H.. Sproston, K.. Orford, J.. Erens, B.. Griffiths, M.. Constantine, R.. Pigott, S.. ( 2007). British Gambling Prevalence Survey. London, UK.: National Centre for Social Research.

Figures
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Figure 1. 

Findings from general practitioner (GP) questionnaire and subsequent discussion



Tables
Table 1 

Topics covered in the GP training sessions


Click for larger image


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