The past 12 months has seen a major shift in attitudes towards doctors who suffer from addictions. In his Report, Good doctors, safer patients (July 2006), Recommendation 14, Sir Liam Donaldson, Chief Medical Officer to the Department of Health drew attention to addicted doctors as a source of potential harm to themselves and their patients. He stated that only by identifying and engaging such doctors can such harm can be reduced and that the punitive disciplinary model currently in operation hinders the identification, treatment and support of these doctors. He charged the NHS to commission a specialised addiction treatment service.

A proposal for a Doctors Health Programme is now due for publication and the Sick
Doctors Trust has been included in discussions during its preparation. This proposal
outlines a pathway and a process by which doctors can be identified, managed
and monitored. How doctors will be treated clinically has yet to be discussed. As
a helping organisation with 11 years of expertise in helping addicted doctors to
access effective treatment, we look forward to influencing the development or the
commission of acute clinical treatment services and aftercare. We note that leading
members of the Working Group have examined the Physicians Health Programme in Ottawa and we would very much like to see services in this country develop along Canadian lines. We hope that during the coming months, a system of which we can all be proud and with which we can relate will emerge for the care of the addicted doctor.

The Sick Doctors Trust has identified one very important proviso that is now widely
accepted. Our experience has shown that many doctors seek advice or ask for help
well before the point where harm occurs to themselves or to their patients. We
believe that a confidential and anonymous pathway needs to be identified to allow
such doctors to access help without prejudicing their careers. It is likely that much of our effort will be concentrated on this area in the future.

During the course of the past year, I and the Vice-Chairman have met with officers
of the GMC on two occasions. During our wide ranging discussions, it became
clear that we were in close agreement about the importance of fitness to practise
from the perspective of patient safety. However, in contrast to the GMC, we are also extremely concerned about the provision of treatment services from the perspective of the doctor. We look forward to further discussions with interested parties as to how regulatory or coercive bodies can work with helping organisations to optimise benefits for doctors as well as for patients.

The Sick Doctors Trust has been represented at an increasing number of conferences and some of our trustees have given lectures and have published articles outlining the work we do. Other trustees continue, behind the scenes, with the equally important work of dealing with the day to day management of the charity. Six of our trustees and members continue to man our 24 hour helpline which deals with calls from doctors seeking help for themselves in addition to calls from concerned colleagues,family members and from employing organisations. The Sick Doctors Trust has no paid staff and the success of our organisation depends on the unstinting dedication and hard work provided so generously by our trustees. We are very grateful for the financial support the charity receives from the BMA, some LMCs and from some individual doctors. Without this financial help we could not function and we hope that we shall continue to attract the financial support which is now so necessary not only to provide the service but also to allow us to participate in discussions as the only truly independent organisation representing sick doctors.

I regret to say that my term of office as Chair of the Sick Doctors Trust is soon to
end. I feel extremely privileged to have been involved with this organisation at this level for so long. I hope that my successor will find this role as stimulating and as worthwhile as I have. I would like to extend my thanks to my fellow Trustees and to other members of the Trust who have so generously supported me. I look forward to continuing to work with them under the leadership of our next Chairman.

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The Trust continues to provide support for doctors and medical students who
experience problems in relation to their use of alcohol and/or other drugs whether
prescribed or not.
We have provided a number educational seminars for the medical profession and for
students in training.
We have been exhibitors at the following Conferences where our work has attracted
growing interest and many offers of support from delegates:

• The Annual BMA Students Conference in Nottingham
• The Annual BMA Junior Doctors Conference in London
• UKESAD 2007 in London
• Conference of Local Medical Committees in London
• The BMA ARM in Torquay
• The Annual Conference of Occupational Health Physicians in York

We have had two meeting with senior members of the GMC.

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Our national helpline is manned on a 24 basis by one of six responders. All the
responders are doctors and members of the Trust. We receive an average of 20 calls
per month. There is a seasonal variation in the number of calls with an increase in
January and a decrease in peak holiday periods.
Most of these calls are from doctors who are concerned about the amount of alcohol
they are drinking or about their use of drugs. Some call because they have been
suspended by their employing authorities or by the GMC. Our first task as telephone
responders is to build a trusting relationship with the caller while engaging him
or her in the helping process. We have become aware that our role here is totally
different from that of a doctor in a formal consultation. We do not ask for personal
information that would identify the doctor as to do this would be inappropriate
unless volunteered. This means that the collection of potentially useful statistics is
limited.
Telephone referrals also come through from medical and non medical colleagues
acting as concerned fellow professionals. Sometimes the callers are acting in a more
formal mentoring, training or supervising role. LMC members often seek advice
from us about constituent members, as do officers from Primary Care Trusts and
other employing organisations. Spouses, parents, children and friends of doctors
also contact us and we welcome these calls and find that working closely with caring
relatives can be a very effective way of helping the doctor to change and become
well.
We have noticed that doctors with drink and drug problems are presenting for help
at a younger age and with shorter histories. We are also very willing and pleased to
help medical students who approach us.
An initial call to our helpline often results in the formation of a long standing helping
relationship. We approach the problem in a very tentative way, offering as much help
as the caller will accept. Having formed a relationship of trust, we try to assess the
severity of the situation and the degree of risk to the doctor and to his or her patients.
In some cases it is very clear that the doctor requires admission for detoxification
and intensive therapy. As the result of our experience over the past eleven years,
we have confidence in a number of residential treatment centres that provide an
abstinence orientated service with a good understanding of the special needs of
addicted doctors. We believe very strongly that abstinence has to be the goal for
doctors who wish to continue to practise clinical medicine. In common with pilots
and train drivers, they belong to a group to which the public entrust their lives.
Some of our callers do not require immediate admission. Their needs are often better
served by affiliation with community based mutual help groups. Eighteen branches of
the British Doctors and Dentists Groups BDDG meet regularly in various locations
around the country. Many doctors find it very helpful to meet other doctors with
similar problems and the BDDG groups usually offer groups for families at the same
time as the main groups. Healthcare Professional groups also provide a network of
help but are open to a wider range of health workers such as nurses, pharmacists and
others. We also encourage doctors to attend Alcoholics Anonymous and Narcotics
Anonymous whose regular groups and support help them to find happiness and
a new way of living in the abstinent state. We always emphasise the importance
of group support and affiliation because we recognise that doctors become very
isolated as their addiction progresses and they tend to lose faith in other people,
finally trusting only their drug of choice to get them through each day. However we
also recognise that doctors may require one to one counselling in addition and we
can make referrals to suitably qualified people when necessary.

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All trustees are involved in raising awareness about drug and alcohol misuse and
dependence in doctors and how an individual doctor can be helped. This is often
done on an ad hoc basis when individuals seek advice about a specific problem. It is
also done through articles in the medical press, at medical conferences and through
any formal opportunities for training that present to individual members.
The Trust was very pleased to be asked to participate in a training session for GMC
psychiatrists, newly appointed as medical examiners and supervisors.
Dr Mayall provided lectures and talks to 4th year medical students in Manchester,
to anaesthetists in Nottingham and to North West ICU trainees. She is involved in
welfare provision for medical students at Manchester University and at the Association
of Anaesthetists. She participates in the regular in house tutorial programme for
Foundation Year 1 within the Pennine Acute Hospitals Trust and she recorded a
podcast on addicted doctors for Doctors.net. She also wrote an article in the BMJ
Career Focus 2006; 333:125 on the work of the Sick Doctors Trust.
Dr Williams presented his regular annual training session for medical students at
the Brighton and Sussex medical school. As in previous years this training was very
highly rated by the participating students.
Dr Young is currently in the process of designing a research proposal looking at
recovery related issues in members of the BDDG. He has provided lectures and talks
to the following groups:

• Third year students at Edinburgh University
• Medical Students at Aberdeen University
• Post-graduate Diploma in Addiction students at Glasgow University
• Third year medical students at Glasgow University
• An open meeting of the Royal Society of Medicine
• The AGM and study day of the Medical Council on Alcohol
• A study day at the Lothian and Edinburgh Abstinence Programme
• The 6th National CARES Conference in Dundee

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1. BDDG.
We maintain very strong links with the British Doctors and Dentists Groups.
Meetings are held regularly around the country and family support groups are often
linked to each group. We recommend participation in BDDG groups to all doctors
who contact us for help. The Sick Doctors Trust assisted the Annual Conference
of the BDDG with a grant towards the cost of its academic day, thus supporting
education in the field of addiction.
2. MCA
The SDT maintains a good working relationship with the Medical Council on
Alcohol. We encourage them to make referrals to us where appropriate and two of
our Trustees are members of the MCA Executive Committee.
3. NCAS
In response to the CMO Sir Liam Donaldson's report on medical regulation Good
doctors, safer patients, (July 2006), NCAS was given the responsibility of developing
assessment services for doctors with mental health and addiction problems. The
NHS was also charged to commission a specialised addiction treatment service. A
number of stakeholders came together in a Working Group to produce a proposal
for a Doctors' Health Programme (June 2007). NCAS has now submitted this report
to the Government and we are awaiting the response. Dr Wilks represented the BMA
Representative Body and the Sick Doctors Trust on the Working Group and when
an Addictions Sub-group was set up, he arranged the participation of two further
Trustees in the process. The Sick Doctors Trust made a very significant contribution
to the wording of the proposal which describes how a service can function in terms
of identifying, assessing, managing and monitoring the addicted doctor. Because
of our unique expertise developed over the years, we hope to be equally involved in
helping to define and set up the actual clinical care. The SDT was also represented at an NCAS day conference on the impaired clinician.
4. GMC
The SDT had 2 important meetings with senior members of the GMC. These
meetings came about following last year's groundbreaking conference in
Edinburgh, The GMC, The Profession & Addicted Doctors initiated and
organised by Dr Young. The Trust was later invited by the GMC to participate
in a training day for psychiatrists newly appointed as medical examiners and
supervisors. Our brief was to provide information about the organisational
structure of the SDT and our presentation consisted of a short talk followed by
a question and answer session. We are very pleased to work with the GMC in
this way. The GMC, as the regulatory body, is primarily concerned with patient
safety. We are concerned with both the provision of good care for the doctor
and patient safety. Indeed, we feel strongly that the former greatly enhances
the latter. We look forward to continued co-operation with the GMC.

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We advertise in both the Clinical and General Practitioner issues of the BMJ.
Such advertisements form a major part of our expenditure. A number of
LMCs have included adverts, articles and case studies by us in their regular
newsletters. The MCA includes our details in their newsletter Alcoholis. The
editor of Addiction Today has offered to publish our details. We are extremely
grateful to organisations and journals providing us with such free publicity.
Delegates at the BMA Medical Students Conference offered to display
information for us on notice boards in halls of residence and other areas
frequented by students.
We plan to be more pro-active in seeking out ways of promoting the Trust in
this and other ways at minimal financial cost.
This year we have updated our pamphlets and our conference posters. We
have also purchased ball point pens inscribed with details of how to contact
us. These are proving to be popular at conferences.

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The Trusts website (www.sick-doctors-trust.co.uk ) remains under the
management of Dr Chris Wilson. It is accessible using the major search engines
and via links from the sites of organisations with related aims and objectives.
It receives an average of 1400 visits per month. Contact with our helpline
responders by phone or email is encouraged and it provides information
about the Trust – its personnel, activities and development plans. The personal story of a doctor recovering from addiction is published and there is an archive of articles, reports and synopses of talks on topics of interest. The Donaldson report and the Government's White Paper on the regulation of health professionals are noted and links to sources of further information provided. It will offer updates on relevant developments.

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We are extremely grateful to the BMA for their generous annual grant of £10,000.
We wish to thank the following LMCs for helping to support us financially:
• Kent LMC
• Londonwide LMCs
• Manchester LMCs
• Norfolk LMC
• Shropshire LMC
• Walsall LMC
At the Conference of LMCs in June, our stand was visited by a large number of LMC officer delegates. We were gratified by the interest shown in the work we do. We shall continue to ask LMCs to consider us as a deserving Charity when they allocate their budgets. We are grateful to individual officers for suggestions about placing advertisements and articles in their regular newsletters.
We also extend our thanks to the growing number of individual Gift Aid donors who have so generously supported us over the years. We welcome and encourage such donations. An email to treasurer@sick-doctors-trust.co.uk will enable our treasurer, Dr Bob Brown to send information and forms to would-be donors. Details can also be found on our website.
We rely entirely on the generosity of our donors to enable us to continue our activities.

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