Tier 1 GPs.

The large majority of GPs will remain in tier 1. Such GPs will be expected to provide all usual services to substance misusing patients, as they would for any other patient. As described above in Section A4, page 13 (making a referral to specialist services), all patients for whom opioid substitute prescribing is being considered should in any case be referred to specialist services for an initial assessment, and if indicated induction onto substitute medication. Equally all clients for whom opiate or alcohol detoxification is being considered, should be referred to specialist services for assessment and potential joint working.

Patients with complex needs such as pregnancy, poly-substance misuse etc. may be provided with a prescribing service by the local specialist service. However, once such complications have resolved and the patient's substance misusing behaviour has stabilised, the GP may be asked to take primary responsibility for the prescribing needs of the patient.

Tier 2 GPs.

Specialist teams will be expected to form close links with tier 2 GPs through workers who provide services on-site at surgeries.

Tier 3 GPs.

Such GPs will act as a local specialist resource for tier 1 and 2 GPs. Otherwise they will function in the role of a tier 2 GP.

Tier 4 GPs.

Such GPs will take an additional strategic role in the local development of shared-care services.

Any general practitioner treating a patient with a substance misuse problem is advised to refer to the DoH's clinical guidelines:'Drug Misuse and Dependence - Guidelines on Clinical Management' (Drug Misuse and Dependence - Guidelines on Clinical Management, 1999). All GPs who prescribe controlled drugs for the purpose of treating addiction will be asked to attend annual training events.