The Trust has been running for nine years. Our current objective is to raise its profile in order to be more accessible to doctors who may need us. This year we have sought to make both Occupational Health Physicians and medical students more aware of the service we can offer. We now advertise in Pulse and Hospital Doctor in addition to the BMJ. A large part of this year's budget has been spent on advertising and our future depends on our ability to continue to attract sufficient funding to maintain these and future initiatives.

Plans for an office and administrative staff have not been feasible this year. It is very gratifying, however, to see that thanks to the dedication and unstinting efforts of our members, we are still able to fulfil our primary purpose which is to offer a compassionate, prompt, effective and confidential service to doctors suffering from addiction. It is noteworthy that the number of calls we receive increases year by year.

We are extremely grateful to our existing funders for their continuing support. We want to make them aware that many of the doctors and families whom we help express their gratitude to us saying that prior to contacting the SDT they simply did not know how to find a way out of their predicament. It is therefore very clear that the confidential service we offer forms a unique and valuable part of the spectrum of care available to addicted doctors.

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The Trust continues to provide support for physicians, including those in training, who are experiencing problems relating to the inappropriate use of alcohol and/or drugs. This has also included two medical students in the last year.

There is an increasing awareness of the problems both faced and caused by untreated addicted doctors. Trustees are very aware that there is a need for the SDT to be able to provide educational seminars for the Medical Profession. Such events can effectively disseminate knowledge and dispel myths about addiction in doctors. They also provide an opportunity for attracting support and finance for the Trust.

We were pleased to be invited to participate in an Occupational Health Physicians conference in Manchester on the subject of “Fitness to Practise”.

We have also been invited to participate in the scientific meeting of the Society of Occupational Medicine in Manchester in July. The society celebrates the 60 th anniversary of the chair and department of occupational medicine in Manchester.

We have a growing number of opportunities to become involved with the training of medical students concerning addiction in general and we take every opportunity to acquaint them with the work of the SDT. Presentations to medical students are invariably received with great interest and enthusiasm and we feel that this type of training is very worthwhile.

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The newly structured helpline has almost completed its second year, It is manned on a 24 basis by one of six responders, doing an on-call rota for one week at a time. All the responders are doctors and members of the Trust.

During the last year we have continued to receive significant numbers of enquiries – an average of 20 calls per calendar month (range 12-37).

Most of these calls are from the troubled doctors themselves. Some are from relatives or ‘friends', (it is likely that these are sick doctors acting anonymously.) An increasing number are from other doctors acting as colleague and friend, sometimes as part of a formal mentoring or supervising (training) role. It is encouraging that we doctors seem increasingly to regard the welfare of our colleagues to be not only our concern, but also our responsibility.

We have become aware that when answering calls on the helpline, our role is different from that of a doctor in a formal consultation. Thus the interrogation that would form part of a formal examination is not usually appropriate – indeed demanding identifiable personal information could be counterproductive unless such information is volunteered. This means that the collection of potentially useful statistics is very limited.

Nevertheless some trends seem apparent. Callers are getting younger with shorter histories. This is probably to do with starting earlier and having more disposable income, but will also include some factor of greater awareness of not only the problem but also the availability of help. In perhaps too many cases, prosecution or disciplinary action spurs the sick doctor to seek help. Doctors seem to follow the general public in their drug use and choice, a fact consistent with published research. Thus we see a trend of increasing use of cannabis and cocaine (street sources rather than pharmacy), though alcohol remains the single commonest substance reported.

We remain convinced that with greater awareness of the nature and extent of the problem and the availability and excellent results of treatment, many more doctors can be helped before prosecution or disciplinary procedures are invoked. Moreover, early intervention can reduce damage to the doctors health and well being, thereby minimising risk to patients.

The majority of telephone contacts still come through the national helpline as a result of our advertisements in the medical press. A small number come via our website. We believe that the medical press is a very valuable reference point for concerned ‘well' doctors who are seeking help for a sick colleague.

Callers to the helpline often receive suggested strategies to help them with their predicament. These are often very specific and include names, telephone numbers, times and places. Sometimes face–to-face meetings and consultations are arranged and these may include arrangements for admissions, assistance with obtaining funding for treatment and negotiation with the GMC and/or employers.

If we are invited to facilitate these actions, we may become aware of the outcome. We have no right, however, to follow up or to expect to be informed of the outcome. Happily many doctors do choose to keep us informed and we are aware that increasing numbers are able to access a period of in-patient treatment despite the fact that obtaining funding can be a very difficult and lengthy procedure in some areas. It is clear that some authorities are keen and ready to facilitate a doctor getting help swiftly and discretely. Sadly others may lack a policy/procedure and may even be antagonistic and discouraging.

From our observations, we are certain that availability of assured funding is a real help in persuading a frightened and ambivalent doctor to accept help, whereas the absence of funding is the commonest reason for a doctor to decline to pursue treatment.

It would be an enormous help to have an independent fund to prime treatment and a universal willingness to permit retrospective reclaim of treatment costs from health authorities and trusts after a patient has been admitted.

A small number of calls to the helpline are concerned with mental health/employment problems rather than with addiction. It is pleasing to be able to report a growing relationship with The Doctors Support Network (DSN – www.dsn.org.uk) The main aim of this organisation is to help doctors with mental health problems other than addiction alone. We continue to liaise with the DSN over matters of mutual information and support.

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Trustees are, to a certain extent, all involved in raising the awareness of doctors as to how addicted colleagues may present and be best managed.

This is frequently done ad hoc when the need arises by trustees known individually to hospital doctors, GPs, trainers, primary care authorities and other relevant medical professionals.

An educational day on addiction for the Association of Anaesthetists' seminar programme (November 3rd 2005 in London) is being organised by Dr Mayall, who will also set up a series of talks on addiction as part of the 3rd year medical students teaching programme in Manchester.

In July 2004 Dr Young presented a paper to the Royal College of Psychiatrists in Harrogate entitled ‘Support for the addicted doctor – a national and international perspective'. This paper included an account of the origins, functions and structure of the SDT.

Dr Brown gave a presentation to first year medical students at Leicester University about chemical dependency and its effects. He outlined how doctors can recognise the illness in themselves and colleagues and access help.

On 30 th November 2004 Dr Young participated in a one day workshop in Edinburgh organised by the GMC, looking at ideas for identifying and assessing impaired doctors.

In April 05 the SDT jointly with the Doctors Support Network had a stall at the Careers Fair organised by the BMA in co-operation with the Scottish Executive. There was considerable interest from employers, employees, medical students and academics.

In April 2005 Dr Young delivered a paper to the CARES Conference in Dundee on the history and origins of the Minnesota Model of treatment of addictions. He was able to talk about the work of the SDT.

Dr Young addressed the Royal College of Psychiatrists in Edinburgh in June 2005 on ‘The sick doctor - whose responsibility is it?'

Further invitations have been extended to Dr Young to speak to medical students in Edinburgh and Glasgow during the coming year.

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This remains a high priority. We plan to hold more training sessions for Trustees and also have started to develop a Family Helpline system. Conference materials have also been upgraded.

Telephone responders met together in London in April to exchange information and share thoughts about the manning of the helpline.

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We continue to advertise in both the Clinical and General Practitioner issues of the BMJ. We have also taken out advertising space in Pulse and Hospital Doctor. A number of recovering doctors who received help from us advised us to advertise more widely. We have distributed over one thousand copies of our pamphlet at various medical conferences..

We contacted Primary Care Trusts (PCTs) and Hospital Trusts with information about ourselves and also asked for details of their occupational health services for doctors. The response was patchy but the exercise enabled us to let these services know about the SDT. The response from medical schools has been better and it is to be hoped that we may be able to have some input into teaching. One medical school e-mailed all the medical students with a copy of our leaflet and a letter from one of the trustees.

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The Medical Council on Alcohol (MCA)

We maintain a good working relationship with the MCA, who occasionally receive calls from doctors asking for help or advice. They now refer such callers to the SDT helpline. Several referrals have come to our attention this way over the past year. Dr Ruth Mayall and Dr Alasdair Young are members of the MCA Executive Committee.

NCAA (National Clinical Assessment Authority)

This body has now been integrated into the NPAS (National Patient Advisory Service). We have been invited to attend meetings with advisory input.

CHITS (Clinicians' Health Intervention, Treatment and Support)

We are represented on CHITS and this organisation has applied to the Department of Health for monies to fund treatment for health care professionals. Unfortunately funding has not yet been made available for this purpose.

BDDG(British Doctors & Dentists Group)

The members of the BDDG are doctors and dentists in recovery. Eleven groups of the BDDG meet monthly throughout the country offering regular long term support to sick doctors. There are also attached family groups. The Sick Doctors Trust always refers doctors to these groups. We were able to assist the BDDG with a grant of £1,000 towards the cost of the academic day at the annual convention held in Harrogate, thus supporting education in the field of addiction.

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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 its launch – this includes 1154 in the last year.

Dr Wilson is currently in the process of upgrading the website.

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We are extremely grateful to the BMA for their generous annual grant of £10,000 from their Charities Fund.

We also extend our gratitude to the following LMCs: Kent, Leicestershire & Rutland, Londonwide LMCs, Manchester, Norfolk, Shropshire, Somerset and Walsall - their combined donations totalling over £9,000.

We heavily rely on such donations, to enable us to continue our activities.

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