The last year has seen several changes both in the structure and function of the SDT.
1. Ian Joiner stood down as Chief Executive Officer in June. Both Trustees and all the doctors he has helped owe him immeasurable gratitude. He worked both tirelessly and enthusiastically as founder of the Trust in 1996 and as CEO during it's first seven years of operation. This was often not easy and he received some resistance from professional bodies, with which he dealt diplomatically. His involvement with the sick doctor has helped to raise awareness amongst healthcare professionals of addictive illness in the physician and possibly due to our close alliance with the BDDG (British Doctors & Dentists Group), helped towards the GMC now putting attendance at these groups as a voluntary undertaking during their assessment and monitoring procedures.
Dr Joiner remains with the SDT as a Trustee.

2. The helpline has been reorganised thanks to the hard work of Dr Alasdair Young. Since August 2003, the helpline has been manned, still on a 24 hour basis by one of six responders, doing an ‘on-call' rota for one week at a time.

The number of calls has risen since the Shipman Enquiry commenced and often calls are from doctors with psychiatric problems who are experiencing problems getting back to work.
Since its inception, the Trust has received over 400 referrals and we are seeing an increasing demand on our services.
We continue to improve our ability to offer assistance to a growing number of physicians with addictive illnesses and often to their families also. For these reasons we strive to increase our activity in the educational field.
We have now completed our eighth year of running the Trust. During the last year we have again achieved our main target, namely maintaining the number of doctors admitted into treatment centres. Over the last year, 40 doctors were admitted out of a total of x calls received by the helpline.

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The SDT trustees realise more than ever the need for more work in the form of educational seminars. These are essential in order to persuade the Medical Profession to support and finance the Sick Doctors Trust. This will inevitably involve funding. It is hoped that following our report and the Shipman Enquiry's public hearing on Medical Regulatory Bodies that our activities will be noted and at least attract more referrals if not more funding.

Unfortunately the majority of charities approached have not been able to support us in the last year.
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It is important to stress the role of the BMA charities who have been extremely generous in making regular donations of £5000.Whether this will continue in 2004-5 will not be known until the BMA review their position in September.

John Ashton, the Secretary of the Kent LMCs, has also donated on behalf of Kent LMCs the same amount over the past four years on a yearly basis. More recently Somerset LMCs has donated £2000 a year for the past two years. Last year Hampshire, consisting of five amalgamated LMCs donated £15000. All LMCs were sent a letter of thanks.

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The aim of the SDT is to provide support for physicians, including those in training who are experiencing problems related to the inappropriate use of alcohol and/or drugs.
Lectures to healthcare groups.

A lecture on the subject of sick doctors was delivered by Dr Joiner to a group of seventy GPs in Hampshire.

Dr Young spoke at a meeting of The Royal College of Physicians and Surgeons (Glasgow) on ‘Clinicians In Crisis'

We were represented at one of the Public Hearing Days of the Shipman Inquiry by Rory O'Connor from Birdsgrove House & Dr Ruth Mayall from the SDT. This was held in Manchester in January 2004.
The invitation to attend followed a written response requested by the Enquiry in answer to many questions which were being raised regarding the management of addicted physicians.

An article on the work of the Trust is being prepared for submission to the BMJ Careers section by Dr Ruth Mayall by invitation of the editor, Rhona Macdonald.

All Trustees to a certain extent are involved in raising the awareness of physicians general as to the ways in which addiction may present in a colleague and how it is best managed. This is usually done in our own workplaces, for example speaking regularly to House Officers and other trainees at ‘in-house' tutorials. However, one of our main aims in the next year is to hold more formal seminars and raise awareness in the Royal Colleges. This is obviously reliant on funding which can be specifically allocated to this venture. Dr Mayall is currently organising a seminar day at the Royal College of Anaesthetists on addiction.

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This remains a high priority.
A very successful day was spent at Birdsgrove House in August discussing the new helpline structure and ways of responding to helpline calls.
We plan to hold more intervention training sessions for trustees and also to develop a Family Helpline system.

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We are still represented at meetings of the NCAA (National Clinical Assessment Authority), but have advisory input only as stakeholders.
Membership does help in raising awareness of the work of the SDT, which is now widely known in the profession and future membership must be maintained.

The CHITS Committee (Clinicians' Health Intervention,Treatment and Support) has met on three occasions, culminating in an application for a considerable sum of money. A management plan has been accepted by the Department of Health who appeared to receive it favourably. The outcome will not be known until September 2004.

We were able to assist the BDDG (British Doctors & Dentists Group) with a grant of £2000 towards the cost of the scientific day for the convention, held in Exeter and hope to be able to repeat this on an annual basis. We are thus continuing to support education in the field of addiction.

No intervention in the form of a visit to the home or work place has been carried out in the period covered by the report. We still find that the majority of the potential patients requiring admission are willing to be assessed on a formal basis. Direct referrals to the treatment centres by Consultant Psychiatrists, and self-referrals continue to increase. Birdsgrove House continues to have a high reputation in the addiction field.

It is unfortunate that Foxleigh Grove had to close as an inpatient facility. Consequently it has often been difficult for doctors who call the helpline but live in southern England to both travel to Birdsgrove for assessment and also to make arrangements for a four or five week in-patient stay.
Accordingly, we are currently drawing up a list of treatment centres all over the country, who offer similar in-patient facilities to Birdsgrove – i.e. a programme based on the Minnesota method and an introduction to AA, NA and the BDDG. This combination approach is used in American and Canadian centres for addicted physicians with excellent results.

The majority of the contacts still come through the national help line and as a result of our advertisement in the Careers section of the BMJ.

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We continue to liaise with the Medical Benevolent Societies.

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We continue to advertise in both the Clinical and General Practitioner issues of the BMJ.

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1. The Medical Council on Alcohol
We maintain a good working relationship with the MCA, who now refer callers to the SDT helpline. Several referrals have come to attention this way over the past year.

2. Liaison with the BMA.
The BMA has continued to support us with an annual grant of £5000 from their Charities Fund for which we are most grateful.
The BMA's ‘Doctor's for Doctor's' service has been very helpful in cases of employment disputes involving doctors who have been in treatment.

3. The National Health Executive
We still maintain contact with DOH through our representation on CHITS.

4. Liaison with the BMA Counselling Service, National Counselling Service and the Medical Council on Alcohol.
We still maintain a good relationship with these organisations.

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The Trust Web Site remains under the management of Dr Chris Wilson. The web address is www.sick-doctors-trust.co.uk. We have received 2904 hits since it's launch to April 30th 2004 – this includes 1154 in the last year

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Since we have failed to attract sufficient funding, many aspects of our five year plan are now in abeyance. There is little prospect of secretarial staff or premises in the foreseeable future. We can only await the outcome of the CHITS application for funding from the DOH.

However, we still have a healthy bank balance and thanks to the hard work and dedication of our members, there is no doubt that we can continue indefinitely to provide an intervention service for doctors with alcohol and drug problems.

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