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National Strategy to Reduce Gambling Harms

Deliver Primary Care Gambling Service pilot including digital signposting to support options, following review of interaction approach during Covid-19 (Hurley Group, NHSE)

Updates

May 2022

We continue to receive referrals via our website, telephone, eConsult and work closely with Gamcare and Gordon Moody.

Patients are being referred in a more timely way from Gamcare and it is has been recognised the need to refer on particularly when complexities are health related.

Other support comes from already established links with the patient's GP and Case Workers.

The funding has been secured for 2022/2023 via GambleAware and there is a planned expansion of the PCGS team 2022/2023.

We are seeing affected others as well as patients seeking help for their own gambling. Since commencement of service and not withstanding Covid, as of 31 March 2022 103 patients have come through the service, and 30 are in active treatment, which consists of a number of different options, such as CBT, psychotherapy, group therapy or residential therapy. A small number of patients have been completely discharged, and others are being followed up at regular intervals to support ongoing recovery. Dr Emma Ryan made a presentation at Pulse Live GP Conference

October 2021

We are in the process of re-defining pathways for care for complex patients and feel there is still a substantial unmet need. We are in discussion with GamCare with regards to this and have developed what we see is a more robust pathway. We have also asked GamCare to look at frequent attenders to consider whether they would benefit from the therapies that the Primary Care Gambling Service are offering.

We have seen very few patients with a ‘pure’ gambling addiction. Our Multi-Disciplinary Team each week is dealing with complex physical and mental health issues which are often undiagnosed and not yet treated. Similarly in those that have a history of relapse we are recognising that they may have an underlying learning disorder or ADHD. We continue to engage with therapists that have expertise in these areas of work.

At the Multi-Disciplinary Team level we are discussing individuals holistically, recognising the importance of supporting and empowering them to address co-addiction, management of their mental illness and to improve their social support. We have recognised that these factors are crucial to prevent relapse.

A further role of our Muli-Disciplinary Team has been to manage the risk these patients present. Our clinical team includes a consultant psychiatrist which gives us confidence that our decisions made at the team around mental health are evidence based and robust.

The Primary Care Gambling Service have recently presented at the Royal College of GPs Conference 2021 and continue to promote the Primary Care Gambling Competency Framework. The interest from primary care is there and this is an area we need to act on in a timely manner. Our funding stream has recently changed and we are keen to secure funding to allow us to progress work on the Competency Framework. The next steps involve the development of a curriculum and the next steps to follow this would be a National training programme. The Competency Framework and its progression is key to raising awareness and engagement of health care workers. This will ultimately lead to more people in treatment.

We now have around 80 patients on our caseload who are being treated with a variety of therapies. We are keeping a tracker with patient demographics and we already have some outcome data. We are working on a paper to present our first 50 patients at Primary Care Gambling Service.

April 2021

Due to Covid -19 the PCGS continues to see patients remotely. We continue to undertake an assessment within a week of contact from the patient and place them into appropriate treatment within two weeks. We receive a number of complex patients from Gamcare on a weekly basis via the joint MDT. In addition, a number of patients are referred direct into the service from General Practice via the online consultation tool.

We are also now working collaboratively with Gordon Moody and have governance in place to refer patients between both services where appropriate. We are working closely with SMMGP who have many years of working with patients with behavioural addictions.

For the first time ever gambling, as an addition, was presented by Dame Clare Gereda at (RCGP and SMMGP) Primary Care Conference in March 2021.

Approximately 50 patients have now been involved with the PCGS and our patient tracker, that has been established from the start of the service, has allowed us to notice common themes in those that present. These include patients not only with undiagnosed mental health problems but also patients with undiagnosed Intellectual Disability and ADHD. Since March 2021 we have engaged with therapists that specifically are trained for this group of patients.

Other themes include, language barriers, unmet needs for different ethnicity and stigma attached to problem gambling

The Gambling Competency Framework has been completed. This document aims to raise awareness of gambling amongst healthcare professionals and to educate them in identifying and managing patients with Gambling-related harm. The document has been submitted and reviewed by the Royal College of General Practitioners. It has been approved and subsequently endorsed by them.

All of the above has been achieved through collaboration and inter-agency working which has proved invaluble in provided high quality patient focused care.

We have engaged with IFFresearch who have undertaken an foundation stage evaluation of PCGS.The aim of the evaluation is to articulate the pilot project, mechanisms for the desired outcomes and to ensure the appropriate evidence is gathered for each of these nechanisms. The PCGS and stakeholders fully engaged in this process with an aim for IFFResearch to undertake a full evaluation at the end of 2021.

November 2020

The Primary Care Gambling Service (PCGS) was due to start seeing patients from March 2020. However, due to the impact of COVID-19 this was delayed until July 2020.

This delay meant the team could further refine the governance arrangements and further develop the policies or structures required to safely and effectively provide a service to patients experiencing harm from gambling.

Since the launch, the PCGS service has had nearly 30 new referrals. The time to first initial assessment in the PCGS is around one week and to ongoing treatment around two weeks.

Weekly meetings between specialists and practitioners take place and all new referrals are reviewed based on an initial assessment and an in-depth mental health assessment, which decides the most appropriate treatment to offer the patient.

The types of therapy or treatment offered include:

  • CBT
  • Psychodynamic Psychotherapy
  • Person Centred Psychotherapy
  • Social Prescribing (including access to art therapy)
  • Peer Support from a staff member with lived experience of gambling harm.

Other support comes from already established links with the patient's GP and Case Workers.

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