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National Strategy to Reduce Gambling Harms

Pilot embedding questions about gambling harm into online triage platforms, accessed by patients for GP response. (Hurley Group/NHSE)


May 2022

The eConsult question is on every practice system that has eConsult and therefore the practice will have a record of all patients that have identified themselves as suffering from gambling harm. It is recognised that more education is required in terms of healthcare professional recognising and identifying gamble harm and the referral pathways.

Dr Emma Ryan has written a Competency Framework for GPs and HC professionals with a view to this being rolled out to GPs and practice teams across the country. We have attended a further national conference aimed at primary care in April 2022. We ran a stall and undertook a presentation raising the awareness of gambling harms to primary care.

The PCGS are undertaking an initial assessment within 10days of referral and time to treatment is 2-3 weeks.

Since Covid we have found that patients prefer the use of technology for on-line consultations. Choice is always offered to patients. At the moment the preferred option is Zoom, telephone and Teams.

October 2021

Patients are now being seen face to face and virtually.

Despite not receiving direct referrals from GPs during the covid period we have received referrals directly from patients through the online consultation tool eConsult. Throughout the pandemic the NHS has developed a “digital front door" and the use of eConsult has supported this. Instead of calling or going to the surgery patients have sent in details of their medical problems online to the GP. We have worked closely with eConsult and they have placed a gambling screening question on their mental health questionnaires. If our patients click yes to the screening question we have been able to reach out to them and offer support. This question appears on the eConsult system across the country. Because of governance issues we still cannot access other practices' data but we continue to make contact with the 110,000 patients registered at the Hurley Clinic.

There is also an ongoing discussion with EMIS (a web-based primary care software system) to add a question to their online consultation product.

April 2021

Covid -19 has continued to prevent us meeting colleagues directly to promote gambling harms and has continued to reduce the number of patients seen in a face to face consultation. General practice has therefore continued to use a digital front door. The Gambling screening question on the online questionnaire has been asked in the six month period between October 2020 and March 2021 3,381,503 times. In the same period 21,000 patients answered “yes”. This suggests that 0.6% of the people who saw the gambling question clicked “yes”. These patients continue to be signposted to the National Gambling Helpline.

In addition, the Hurley Group that consists of 100,000 patients is contacting patients that tick “yes” to the Gambling Screening question directly by telephone to offer help. This is possible as they are Hurley Group patients. Data privacy only allows the patients own GP to contact the patient. These patients are less complex and we are able to manage them with brief intervention and signposting where appropriate.

A further update in this area is that we are in consultation with EMIS health which is one of the largest electronic patient record systems used in primary care. We are working with them in a number of ways to raise awareness of Gambling harms within primary care. These include: • Establishing a code for Gambling Harm so that it can be placed in the clinical record akin with other medical conditions. • Establishing an alert that will be triggered to the healthcare worker to ask a Gambling screening question if the patient is suffering with any of the following: Mood/Anxiety Disorder, ADHD, Suicidal ideation/self-harm, Sleep disorder/insomnia, Obesity, Domestic violence, Financial stress/debt, Nicotine dependence and Alcohol use disorder. • Establishing patient information and electronic links the health care worker can access to inform and signpost the patient. An important part of our work has included engagement with the wider gambling community and promoting the PCGS.

We have undertaken workshops and presented at: -Gamcare - presented on the management of depression -Pulse live - presentation with Tony Parente (lived experience expert patient) -GambleAware educational film promoting accessibility to services -GambleAware 8th Annual Conference

  • Gambling Awareness presentation to Psychiatrists
  • Member of the trigger question advisory board by Kings College London
  • Invitation to Ministerial Round Table
  • Intial discusssion with Lloyd's Bank"-Gamcare - presented on the management of depression
  • Pulse live - presentation with Tony Parente (lived experience expert patient)
  • GambleAware educational film promoting accessibility to services
  • GambleAware 8th Annual Conference
  • Gambling Awareness presentation to Psychiatrists
  • Member of the trigger question advisory board by Kings College London
  • Invitation to Ministerial Round Table

November 2020

"The Primary Care Gambling Service pilot being delivered by the Hurley Group has embedded a new question alongside other lifestyle questions and within the depression/anxiety template. eConsult is an online triage platform that allows patients to access their own GP online. They answer a series of questions relating to their condition, which get passed through to their GP for a response by the end of the next working day. Everyone is now asked : “In the last year, have you bet more than you could afford to lose? Or has someone in your household bet more than they could afford to lose?”. Answer “Yes” or “No”. Since the question went live in early October 2020, it has been asked >500,000 times. And 3,500 people have responded “Yes” – they are then sent a link explaining how to access help via both Gamcare and the Primary Care Gambling Service."

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