The most dramatic events of the last year for SDT have been to do with our involvement at individual, group and corporate level with the planning, commissioning, and now running, of services for doctors and dentists whose performance is at risk of being impaired by issues related to their own health. As noted in last years report, SDT has been a part of the stakeholder advisory group formed by National Clinical Advisory Service (NCAS) to contribute to the prototype Practitioner Health Programme (PHP) for doctors and dentists living or working inside the M25. That service was officially opened in November 2008 and there is a section of this report devoted to PHP, subsequent developments and SDT involvement.

One of SDT’s core functions is the provision of advice and support to individual doctors and medical students suffering from alcohol and drug problems. In order to safeguard our promise of confidentiality to individuals approaching SDT, we keep no formal records and thus detailed statistics are not available. However it is clear that the existence of PHP has not caused any fall in demand for our services by individual doctors. Indeed, if anything, demand has increased. There are a number of possible explanations for this. The publicity surrounding the launch of PHP itself generated increased awareness of the problem, prompting enquiries from not only sick doctors themselves but also from concerned fellow practitioners, family members and employers. An increase in the number of enquiries from medical students may reflect increasing awareness of the role of the General Medical Council (GMC) in ‘policing’ their activities. And, of course, there is the probability that, as the general public increases its use of alcohol and drugs with consequent increase in numbers of those suffering from addictions, doctors and medical students are increasingly likely to suffer themselves.

Also a consequence of increased publicity and awareness is a greater demand for an SDT contribution at conferences and to publications. Particularly gratifying is a greater input to medical schools and to local post-graduate activities.

We are very sad to report the death of Martin Wells in February. It was only in last years report that we bade him farewell as a trustee and acknowledged his contribution to SDT since its founding.

Two more of our longest standing trustees have announced a wish to retire. We are most grateful for their contributions. Their departure emphasises the need for SDT to be seeking new members and looking to the future.

With the launching of PHP and systems now being set up to enable future development of a service to cover all of England, and hopefully the devolved administrations, and possibly a broader group of health practitioners, it is an appropriate time for SDT to consider what role it should or can have in this process. The picture is now beginning to look very different from the situation we had in the mid nineties when SDT was created. New bodies – NCAS, PHP, Doctors for Doctors, Doctors Support Network (DSN) – have been formed. Longstanding bodies – GMC, Royal Colleges – have seen sweeping changes. The British Doctors and Dentists Group (BDDG – www.bddg.org) is bigger and more pro-active and looking ready to be a part of this new world. SDT should be looking at where its role is with regard to these other bodies. A necessary part of examining these things is a re-appraisal of our funding status.

Back in the nineties our vision was that SDT itself would attract sufficient funding to enable it to become an agency providing assessments and access to funding sources and treatment, possibly even itself becoming a treatment provider. Our first step in this direction was the development of the telephone service that Dr Ian Joiner had started. Although we had seen this as a portal of entry to treatment opportunities, it soon became clear that there was a demand for an information, support and networking service with other agencies. A pledge of confidentiality seemed crucial to that service, as was visible independence from the regulatory ‘establishment’. We also saw a role as lobbying and educating others about the plight of, and requirements of, the addicted doctor. Presentations and stalls at conferences and other educational activities, along with written articles in journals, provided the setting where this would happen, and also allow an opportunity for fund raising. It was this increasingly public profile that was to lead to SDT being asked to be a part of the development of future services by the ‘establishment’.

Over the years it has become clear that we were not gaining the sort of financial support that would enable us to become a treatment provider. When the movement to provide some sort of service for sick practitioners was taken up by the establishment and (at least for today) there was a willingness by them to fund the start of such a service, it was clear that SDT was not going to become a treatment provider as such. By this time the need for an independent, confidential help-line had been demonstrated. We also had found a new role, working with the establishment in the NCAS PHP stake-holder group, representing the voice of the sick/recovering doctor community. In that setting SDT was able to forge direct links with other bodies – GMC, NCAS, Royal Colleges and DSN – and those links have shown that there is scope for SDT to relate to those bodies outside the stakeholder group itself. At a crucial stage in PHP development and commissioning SDT was able to facilitate direct contacts between NCAS researchers and the London BDDG group. This in turn enabled contact between PHP and London BDDG. As BDDG itself becomes more pro-active at both local and national level, it is appropriate for BDDG and SDT to consider their roles and futures with respect to each other and the “establishment”.

Dr Bob Brown (trustee and past treasurer) and Professor Malcolm Forsyth (trustee with responsibility for fund raising) have indicated their intention to stand down as trustees. Both have been with us from the start and both have been very active, done much good work, and made an enormous contribution. Their departure as trustees will significantly reduce our workforce. We thank them for their efforts and acknowledge the part they played in the early and crucial years for SDT. We wish them both well.

The retirement of two very active members will have an impact on the other trustees and highlights the necessity for our paying attention to recruiting new members and trustees to SDT. Prof Malcolm Forsyth can not be at the AGM and we still have no-one else carrying a specific responsibility for fund raising.

We should look at areas we need represented in our forum of trustees. Both Public/Community Health and Occupational Health suggest themselves. It may be that the suggested review of our relationships with other bodies will facilitate the introduction of new personnel.

We have been in discussion with Jonathan Goodliffe, a lawyer and a founder of the lawyers support group (now Lawcare – www.lawcare.org.uk). He has expressed a willingness to consider becoming one of our trustees.

Direct support for the suffering doctor remains our primary purpose. We need to continually examine and restate our commitment to providing confidential individual support and advice to the suffering practitioner. The telephone helpline and website remain our principle contact points, supported by our growing network of recovering/experienced practitioners. In support of this we are active in providing speakers, poster displays etc in a variety of educational settings from undergraduate through to post-graduate as well as outside the profession itself in the broader healthcare environment. As observed earlier, the existence of the new PHP service has if anything increased the number of enquiries we have received.

The development of PHP by the establishment, however funded, increases the importance of an independent advisory service able to make the needs of the sick doctor, rather than the needs of patients or state, its first priority (although, in our experience hitherto, conflict has been rare).

We are conscious that we are unique in our promise of unconditional confidentiality to those approaching our service. However we need to constantly reappraise that promise in the light of changing attitudes by regulators and legislators. It may be that future changes could impact on those volunteer doctors who provide services through SDT to suffering practitioners. We believe that the existence of our confidential service enables significant numbers of suffering doctors, who might otherwise be too frightened to seek help, to access appropriate support and treatment.

The demand for SDT involvement appears to be increasing at a national and local level. Often in association with Medical Council on Alcohol (MCA) and BDDG, we have been a part of presentations to medical students at an increased number of medical schools. MCA are keen to try to cover every medical school in the country.

In the past year SDT has had a stall or presentations at the BMA medical students conference, the American Medical Association/BMA/Canadian Medical Association Conference ‘Doctors’ Health Matters – Finding The Balance’, the annual Local Medical Committees Conference, the annual meeting of the Society of Occupational Medicine, the annual meeting of the Association of Anaesthetists of Great Britain and Ireland, the BMA Birmingham Careers Fair and the annual meeting of the Faculty of Addictions of the Royal College of Psychiatrists. One of our trustees delivered a talk as part of the CME stream of the International Doctors in Alcoholics Anonymous (IDAA : www.idaa.org/) annual conference which described the activities of SDT. Much of the BDDG annual convention academic day was taken up with presentations about PHP and SDT’s involvement. There have also been a number of presentations made at a variety of locally organised postgraduate exercises involving a variety of different specialties. These latter are too numerous to mention individually, but represent a very welcome new trend, leading inevitably to more locally based initiatives to assist sick doctors. In collaboration with Glasgow BDDG, SDT will be contributing to the Royal College of General Practitioners annual convention in October in Glasgow.

By almost any criteria PHP has been a runaway success. Numbers of Doctors using the service has exceeded all predictions. Feedback from Doctors who use PHP suggests that the quality of service is second to none. There is now a clear wish from the profession and the ‘establishment’ to extend the service. Planning has started to extend across all England, though as yet, funding has not been defined. We still wait for a response from the devolved administrations!

One interesting consequence of PHP is the realisation that the group of practitioners with psychiatric problems other than addictions has, so far, been slightly larger than the group with addictions. (Addictions remain the largest single diagnostic group and alcohol still by far our commonest drug of choice.) Alongside this, the Doctors Support Network (DSN – www.dsn.org.uk), incorporating the Doctors Support Line (DSL), has re-organised itself to do for that group of practitioners what we do for those with addictions and has developed a network of support and a helpline that parallels our own.

An important spin-off initiative is the consideration by Royal College of General Practitioners (RCGP) of some sort of register of doctors who have special skills and abilities that enable them to assess and treat sick colleagues. SDT has contributed to initial discussions and would seek to continue to be involved.

We also observe that in the last two or three years the administration of BDDG has become more structured, with the Annual Meeting of Secretaries of BDDG groups incorporating the Convenors and Treasurer of the BDDG Convention, and looking increasingly like an AGM. There is thus now a structure that could enable BDDG as a whole to relate to SDT and other organisations.

We continue to enjoy an close relationship with the MCA, who have always supported us and two of our trustees and a Patron sit on their executive committee. MCA is the profession’s forum for those from a variety of medical disciplines who have an interest in alcohol and alcoholism as it affects us in the UK, but has also always had a special interest in how alcohol (and other substances) impact on medical practitioners themselves. The MCA is our only channel to the medical Royal Colleges, apart from any allegiances that individual trustees may have.

With all this change it is desirable that SDT considers its place and looks forward and that, as a theme for the coming year, we consider how we relate to other organisations and bodies.

We need to actively safeguard our ability to continue to provide a confidential service to the sick doctor with local and national networks, the phone-line and the website.

We have demonstrated our ability to co-operate with other organisations – so looking ahead:

• Following on the blueprint for the creation of the London PHP, we have been asked to contribute towards the planning of its expansion.

• We are re-examining our relationship with DSN and MCA, to see if we can maximise our effectiveness by closer collaboration.

• Dialogue has started with BDDG with a view to more effective cooperation.

• We continue in dialogue with other bodies – GMC, Royal Colleges, Department of Health and others – and consider how we might respond to anticipated developments.

• We need to address recruitment to the “work-force” of SDT itself, from both the recovering doctor community and other concerned and influential members of our profession.