The past twelve months has been a busy time for the Sick Doctors Trust. The anticipated changes and developments in service provision for sick doctors which introduced last year's report, are now moving ahead at a quite remarkable pace. It has also been a time of change within the SDT itself.

Dr Jackie Chang, who has been our chair since 2004, stood down having completed a very worthy term of office. Jackie has worked tirelessly for the SDT and led us through some critical times to bring us where we are today. Her reputation as a GP with a special interest in addictions, and campaigner for better services for all addicts/alcoholics (not just sick doctors) has meant that she has been able to be an accomplished ambassador representing the SDT at all levels. What will be less well known are her abilities to chair the group of trustees; she has done this with tact and diplomacy and she will be a hard act to follow. The Sick Doctors Trust is grateful for her contribution. We are also grateful that, although stepping down as chair, she continues with us as a trustee.

Both Dr Michael Wilks and Dr Alasdair Young were proposed for the vacant position of chairman. The deliberations about the chair were happening at a time when the Sick Doctors Trust itself was having to re-evaluate some of it its goals and philosophies in the light of the dramatic new changes that seemed about to take place in service provision. Dr Wilks withdrew due to his other personal and professional commitments, and Dr Young was elected to the chair. Dr Wilks was proposed for and accepted the office of vice-chair.

Dr Bob Brown, who has been our treasurer (and our official address) since 1995 at the inception of the Trust, indicated his wish to retire from that office. He expressed willingness to “12 -step” his successor into the office. Dr Brown was instrumental in introducing Paul Foss to SDT. Paul has previous experience as treasurer of a large recovery related charity and we are delighted that he has now joined us as treasurer and is taking over from Bob. Our thanks go to Bob for all his hard work and enthusiasm. Once again we are delighted that Bob will continue as a trustee with the SDT.

Dr Thelma Bates, another “foundation” trustee, announced her intention to retire. She has been a most faithful member of SDT and I cannot remember her missing a Trustees meeting. We are most grateful for her contribution and will miss her gentle, quiet voice of reason and wisdom. We wish her well.

During this last year two other long standing trustees have also retired: Mr Martin Wells and Dr Chris Hodgson. We are grateful to them both for the important contributions they have made to SDT, and wish them well.

This year also, Dr Douglas Fowlie agreed to become one of our patrons. Dr Fowlie has long been involved, and committed at a personal level, in the provision of services for addicted clinicians in the north of Scotland. His experience in this area is unique and is recognised by those setting up the new services in London (see below). We are delighted to welcome him to SDT.
At the centre of much activity has been the development of a new service for doctors and dentists with health problems, limited to the London area. The National Clinical Assessment Service (NCAS) has been the body taking forward the proposals that stemmed originally from Sir Liam Donaldson's report on medical regulation. During the last year the SDT has been involved in a variety of meetings with Royal Colleges and others organised by NCAS drawing up the proposals for a Doctors Health Programme. Things took a big step forward with the announcement of funding for a pilot study in London. SDT was involved in the NCAS annual conference in January 2007, when Dr Young presented a paper about the activities of SDT and the British Doctors and Dentists groups, and plans for the London pilot study had their first public airing (http://www.ncas.npsa.nhs.uk/trainingandevents/reports/).
Subsequent to that Dr Young (SDT Chair) was invited to join the stakeholder advisory group for the project.
At the same time the project was re-named the London Prototype Practitioner Health Programme; the change from Pilot to Prototype reflecting anticipation that the service would be a model with potential for use outside London and in other clinical disciplines; and the change from Doctors to Practitioners, an indication that the London Programme now included Dental Practitioners. Thus the London Prototype PHP now has great significance and implications for the future.
As stated, the SDT was offered an opportunity to feed directly into shaping the new service, in effect representing the potential users of that service. While not excluding the possibility that trustees, or others involved with the SDT, might choose to become involved (with other parties) in bidding, the Trustees agreed that the SDT would not make a bid, but would seek to ensure that the needs and interests of the sick doctors were heard and met in the new service provision. It also seemed appropriate that the SDT should express willingness to represent the views of the recovering addicted Dentist community, and views from the British Doctors and Dentists Groups. To that end Harry Breen (Dental Practitioner) has been invited to attend SDT meetings.
It had become clear that there was to be an invitation for tenders from interested parties to bid to provide the new service and so SDT had to make an early decision as to where we stood. We could not simultaneously be bidding to provide the service and be a part of drawing up service criteria and requirements of providers. The original dream of SDT had been an emulation of the Sick Dentists Scheme. However as time had passed we had failed to attract the level of funding or universal confidence of the profession necessary to achieve that. Nor was there a strong feeling among the trustees that we ourselves had the ability (stand alone) to bid to provide the London service at this point in time.
Through our involvement with the stakeholder group it has been possible to allow members of BDDG (doctors and dentists) to have direct (anonymous if desired) input to the planning process and NCAS has expressed their gratitude for that.
The successful bidder for the “PHP1” part of the service was announced in early July. The Trustees have discussed the relationship of the Trust with the new service, and have offered expertise to help it meet its responsibilities towards addicted practitioners. In particular, the Trust will emphasise the central importance of an abstinence-based approach to the treatment of addiction, and the strong evidence base that now exists on what represents effective treatment and support in the long-term. In addition, the Trust will continue to be represented on the stakeholder group.
Most of the services that have been provided by SDT will continue unchanged as the provision of a new service affects more those areas where we had not succeeded in making progress, rather than the areas where we are already functioning effectively (see below).
In order to ensure transparency trustees have agreed that they will declare any pecuniary interests they have which might pose a conflict of interest with other SDT activities e.g. employment by a potential or actual service provider, and a register kept.

We do not forget that our single most important function is the provision of a confidential service of friendship, support, information and advice, direct to the individual sick doctor. All our other activities are either aimed at facilitating and advertising that resource (help line, publications, conferences etc.) or stem from it, as above.

The help line 0870 444 5163, is our most obvious access point for the sick doctor or concerned other. The help line is manned 24/7 by trained volunteers, themselves doctors and in recovery from addictions. The help line promises absolute confidentiality to any enquirer and to this end we do not demand personal identity of an enquirer, nor do we keep any central records of help line activity. Only with the agreement of the enquirer is any personal identification detail taken, and then only sufficient to enable further agreed action, e.g. arranging contact with a local SDT contact or BDDG group, or referral to a treatment provider. Increasingly, as networks build, we are successful at enabling enquirers to rapidly access local support resources to them, BDDG groups being a most important part of that network.
In the absence of personal identification, hard statistics are unavailable; however we estimate that there have been in the region of 50-60 “new” contacts over the last year through the help line. We also have a strong impression that there is an increasing trend for local addiction services, Occupational Health services and Psychiatrists treating sick doctors to be aware of SDT members and BDDG groups in their own area and making or facilitating direct contact at a personal level without involving the SDT at help line/national level.
As before the help line continues to receive requests for information from the media and we help or suggest other resources as seems appropriate.
There is also an impression that we are receiving an increased number of enquiries from individuals with alcohol/addiction problems, who are not doctors (or dentists). We are happy to give non-specific advice to these e.g. contact details for AA, NA and CA. Some of these calls are from other health practitioners, commonly nurses, so our experience may be relevant to them.
The SDT as an organisation would be happy to share our experience with members of other clinical groups, if asked, to help them create resources for themselves. Our present limited resources and our role and function must be dedicated to serving the sick doctor.

We continue to advertise in the BMJ regularly. This is expensive and we have no way of assessing how effective that expenditure is. The sick and struggling clinician has often stopped subscribing to the BMA or reading the small print; but a regular entry in a main line journal is perhaps like an entry in yellow pages. It lends an aura of enduring presence and reliability which may attract the attention of a concerned colleague, even if missed by the sick doctor.
We are grateful to other organisations and publications who give us advertising space. The Medical Council on Alcohol (MCA) deserves a special mention here.
SDT members are now involved in presentations to medical students about addiction (and recovery!) among doctors and medical students, as part of the curriculum, in medical schools. We have in the past year (often in association with MCA) made presentations in Glasgow, Edinburgh, Sussex/Brighton and Swansea

The SDT continues to field a strong presence at a number of conferences and academic gatherings. Mention has already been made of the strong SDT presence and participation in the NCAS conference in January 2008 Overdue Business – Supporting the health of health practitioners.

The SDT had a manned stall at the Association of Anaesthetists of Great Britain and Ireland in Dublin in September 2007 which attracted a number of enquiries. An SDT stand was manned at the BMA Conference of Local Medical Committees (LMC) in London, the BMA Annual Representative Meeting in Torquay, the Junior Doctors Conference in London, the Medical Students Conference in Nottingham and the Society of Occupational Medicine Annual Scientific Meeting (SOMASM) in York in July 2007. The latter is very interested in our work and provide our stand free of charge for which we are grateful. In April 2008 we attended the BMA Medical Students Conference in Cambridge and were impressed by the knowledge and interest displayed. We are attending the Senior Hospital Doctors Conference in June of this year as well as the LMC conference and the 2008 SOMASM.

We are delighted to be able to draw attention to our new website: http://www.sick-doctors-trust.co.uk/ We are grateful to all those who helped us with advice and to Dr Chris Wilson, in particular, for arranging quotations, getting expert opinions and ultimately commissioning the new site.
We perceive the website as one of the most important portals of entry for the sick doctor and/or concerned colleague to access SDT services.
The new site will enable us to more readily keep it up to date and relevant.

Medical Council on Alcohol.
The SDT continues its longstanding association with the MCA and two of our trustees and a patron serve on their executive committee. This relationship allows many opportunities for both informal and formal networking and mutual assistance.

General Medical Council.
We continue to have both formal and informal communication with the GMC. The presence of representatives from the SDT and GMC on the PHP stakeholder group, along with BMA, BDA, GDC and Royal Colleges has proved to be very worthwhile forum , where with our focus clearly on the both the needs of the sick doctor and the protection of patients, we can explore practical ways of working together. It has been gratifying to hear colleagues not specifically involved with addicted doctors in their other activities, speaking up strongly to ensure protection of confidentiality for the sick doctor.

Professor Malcolm Forsyth continues as or Trustee with special responsibility for fund-raising. He has fulfilled this responsibility for a number of years and continues to do so despite the fact that he indicated a wish to retire from that post a year ago. At present we have no willing available successor and he has graciously agreed to continue until a successor is found. We continue to receive support from BMA Charities, a number of Local Medical Committees and a not insignificant number of individual grateful doctors.

At present, with all SDT activity and works being carried out by Trustees, members and Doctor Volunteers, we have no salaries to pay. As mentioned in the opening paragraphs, there is no immediate prospect of SDT becoming a “major league” treatment agency/provider and our funds adequately provide cover for the out of pocket expenses of those performing SDT activities and serving the sick doctor, the helpline and our presence at conferences and other educational activities.

It is appropriate to record that Trustees and others give considerable amounts of time and their own personal resources to these activities.

The future funding and shape of services to treat and support the addicted physician (& other clinicians) in the UK are likely to be influenced by the success of the prototype PHP. Whatever the outcome, all those involved, including the SDT, have worked hard to improve future services, but the SDT has to be able to continue to serve the sick doctor and champion his/her rights. There will probably always be doctors who seek to achieve recovery through other than “establishment” pathways – there always have been a substantial proportion of such individuals and a majority are successful. They continue to deserve SDT support.

No matter how “good” the state service may become, there will always be a place, we believe, for the independent voice of the sick/recovering doctor community. Indeed we would maintain that the presence of that voice will be necessary to maintain the standard of any service.

There will too, remain many areas where support and practical help - material, moral and spiritual – for the sick/recovering doctor and family, can only be delivered through a caring community of fellow (recovering) practitioners. Thus the SDT continues to depend to a very large extent on BDDG and the other recovery groups in order to survive at both an individual and corporate level.

We need a continuing flow of “youngsters” coming into the SDT – from BDDG largely – to go on and get better. We also need the continuing presence of “concerned others” from the profession – doctors, not themselves having suffered alcoholism/addictions – to help and work with us.

We live in a society increasingly damaged by the prevalence and consequences of drug and alcohol use. The establishment, belatedly aware of the severity of the problem, struggles to find a suitable response. Many will be watching to see how we as a profession deal with that reality among our own.