Primary care services for problem drug users: PSALT and DrugNet.

Sir, We were pleased to read the editorial by Wilson and colleagues on improving methadone maintenance in general practice for problem drug users (September Journal, p.454). We have followed with interest their previous general practice work with problem drug users in Glasgow, although we are still confused about their budget allocation. In the editorial Wilson and colleagues state that 'the costs to the practice [are] considerable' and have previously reported that each patient receiving methadone maintenance costs the practice approximately £2000 each year.' We have challenged this amount2 as we believe that the actual annual cost is nearer to £1000 per patient. We re-emphasize this point because we share the hope of our colleagues in Glasgow that similar projects in other parts of the United Kingdom will be established. An overestimation of the costs may dissuade other general practitioners or family health services authorities from providing highquality, effective care in general practice to drug-dependent patients. As an extension of this, we would like to outline two initiatives introduced by West Glamorgan Health Authorities. The primary care substance abuse liaison team (PSALT) has been established to offer formal primary care services to problem drug users. PSALT is managed by a project board and primary care is provided by three general practitioners located throughout West Glamorgan. PSALT has a shared-care philosophy and patients eligible for PSALT care can be referred by local drugs projects or by the secondary care sector. It is on this latter point that the second initiative, the DrugNet project, is being developed. Essentially, DrugNet is a computer project and, in the first instance, computers with custom designed software will be installed at the practices of the PSALT general practitioners and three local substance misuse street agencies. Shared care will be supported by a West Glamorgan register and the core system will eventually be expanded to include other partners such as the community drugs team, probation service and social services. The collection of local data will allow the audit of the shared-care model and support the design of proactive strategies against substance misuse. Our initiatives in West Glamorgan support high quality primary/shared care for problem drug users, with a particular emphasis upon service audit. Although both initiatives are still developing, we would be willing to correspond further with anyone who is interested in such initiatives.