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Controlled drugs inspections in practice premises

1 June 2006

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Alan Moore
Medical Group Manager
Retired Police Chief Inspector

Having retired from the police six years ago with the rank of Chief Inspector, Alan’s interest in managing a small business led to his current position of group manager to three practices (two of which are training practices) sharing a centre serving 21,000 patients. Alan spends most of his time defending and promoting the business interests of the partners, as well as trying to smooth the workings of three diverse sets of staff, and he has found steering a way through the new GMS contract a nightmare! Alan has also been selected as a Lay Assessor in the selection process for GP trainees by the local deanery, and he enjoys that side of his work immensely

Proposed government legislation would see the power of inspection currently exercised by the police and the Home Office Drugs Branch – over producers, wholesalers and pharmacies in respect of controlled drugs – extended to GP surgeries. It also proposes to allow “accountable officers” from PCTs to carry out those inspections as well – a group who have not previously been given that power.

As a former police officer who, for several years, was one of those specially trained and authorised to carry out the inspection of controlled drugs systems in pharmacies, I can only assure the conscientious GP that they have probably the least to fear from police inspection. I was trained to exercise my powers with discretion and sensitivity.

On one occasion, these attributes were sorely tested when I found myself having to explain to a highly respected GP that Diconal – the addicts’ prescription drug of choice at that time – was an opiate. He had a notified addict on his practice list who was being treated and prescribed methadone at the local treatment centre. Staff at the treatment centre had written to the GP explaining what they were doing and advising him that he should not prescribe opiates to the addict. This was for several reasons, primarily that addicts can be notoriously duplicitous and will try to supplement their treatment centre prescriptions with additional hard drugs to either sell or use themselves.

It is a criminal offence for the addict to “dual script” in this way. As a result of the regular inspection of controlled drugs registers in the local pharmacies, I had picked this activity up and followed the enquiry through by questioning why the GP had been asked to prescribe Diconal. It turned out that the addict had asked for Diconal as he had “lost” his methadone, which was the usual tale that normally fooled nobody. Regrettably, the drug had been given without question and in complete ignorance of the nature of the substance.

At the very least, this could have proved embarrassing to the GP if it had become public; discretion was clearly appropriate. While the addict was subsequently prosecuted, the GP was left wiser while still providing a service to his patients.

Carelessness and criminality
I could relate many other such examples. For instance, there were doctors who left considerable quantities of controlled drugs in their bags on the back seats of cars while attending house calls in the most crime-ridden of urban areas, and were then surprised when these drugs were found missing on their return. I could also tell of doctors and pharmacists who were addicts and were helping themselves from pharmacy or hospital stocks – and I would have to comment that while those pharmacists were struck off by their professional body, I knew of no doctors who suffered the same fate!

I was in regular contact with officers in other forces in the region who carried out similar work, and the only doctors who caused concern were those whose actions were criminal, rather than doctors who were simply naive. That is why I cannot see a problem in allowing the most scrutinised and regulated professional body charged with investigations to have the necessary access to records that relate to the prescribing, supply and possession of the most harmful substances in society. The problem, however, is that many police forces have reduced this specialist function of the controlled drugs inspection of the medical and pharmaceutical profession, or have stopped it altogether.

Confidentiality is crucial
In many instances, these officers became aware of the medical conditions of members of the public through the controlled drugs they were receiving. They knew of children being prescribed Ritalin – very rare in those days but increasingly common now – and hitting the headlines in the press; of people who were clearly addicted to hard drugs but who were holding down important jobs in the private and public sector; and of doctors who didn’t know what Diconal was! Confidentiality was always the principal idea drummed in at training. I know because I used to train those officers under the auspices of the Home Office Detective Training Schools that once were situated across the country.

Endangered experts
Uncertainty is currently cast over the future of the trained and experienced staff of civil servants who form the Home Office Drugs Branch, and with whom the specialist police officers enjoyed productive working relationships. They have considerable expertise, and still enjoy a great deal of respect for their knowledge, but the service currently looks as if it is being wound down, and their role may eventually be transferred to the Department of Health.

The loss of this group of people, independent of the health sector, would be a serious blow to the prevention of drug misuse and appropriation – exactly the situation that these proposed changes were brought in to strengthen in the post-Shipman era.

Implications of PCT power
The bill, however, has other ramifications for which we should be more concerned. First, it would extend inspection powers to primary care trust (PCT) staff. Current relationships that practices experience with some PCTs already give rise to concerns about the way the trusts manage their affairs. Who would regulate their behaviour? Who would we complain to when they overstepped their powers or exercised them in the wrong way? What controls would there be over information they obtained – about the GPs as well as the patients!

Second, look back at the Shipman case. Having already been discovered some years earlier by the inspection process in relation to the improper use of pethidine, Shipman nonetheless remained in practice – a situation out of the control of either the courts or the police, but firmly with the General Medical Council. Subsequently investigated by a police officer who was clearly inexperienced in, and had little knowledge of, the control of drugs, Shipman was initially cleared of criminal acts. It must be asked why nobody with that knowledge appears to have been involved in the investigation?

My points? First, the inclusion of doctors in the control and inspection process has been brought about by glaring and tragic gaps in the system. In 1971, when the primary legislation was introduced under the Misuse of Drugs Act, there was an absolute belief in the integrity of the medical profession and a conviction that it was able to police itself through the General Medical Council. While this is still largely true today, I would suggest, 30 years on, that public opinion has shifted towards a more questioning approach and there is less acceptance of blind faith.

Secondly, if GPs keep only those controlled drugs that are necessary and in small quantities (and there is a very strong argument that with modern medicines and paramedic availability most GPs need not have them at all), and hold them under secure storage with proper record-keeping, then the inspection process will be very short and painless.

Thirdly, while not perfect, and in the possible absence of the Home Office Drugs Branch, police inspection by trained officers is far preferable to the alternatives.