GambleAware’s Anna Hargrave on how GPs can play a more central role in tackling patients presenting with harms from gambling
James had reached the end of the road and was desperate for help. He was spending more than £50 per day on gambling – mainly online betting. He was now £10,000 in debt and his life was collapsing as he couldn’t pay his bills. He felt he should die and had walked along the embankment ready to jump into water. But something stopped him, and instead he returned home and contacted his doctor who referred him to the Primary Care Gambling Service.
He is not alone. In Great Britain, up to 1 in 10 adults are estimated to be at risk of gambling harms, and nearly 1% of 11-16 year-olds are classed as problem gamblers. This can have disastrous consequences on the finances and health, mental and physical, of those affected. For men such as James, gambling is a major contributor to high rates of suicide.
New NHS figures show referrals for gambling treatment were up 42% between April and September in 2021. Put simply, harmful gambling is a growing public health issue.
So what more can be done? Of course, there is no single prescription – the issue is multi-faceted and complex. But putting aside for one moment the elephant in the room, the Government’s delayed Gambling White Paper, what role are GPs currently playing? And is there scope to expand it?
Although there are pockets of excellence for treatment around the country, such as the National Gambling Treatment Service, resources for those affected are sparse. Currently, the NHS provides just nine specialist gambling treatment centres in Great Britain, a drop in the ocean compared to similar institutions for drug and alcohol dependency. Although GPs and other health professionals can refer patients to these services, many patients are self-referred.
However, we also know being treated in primary care settings is highly valued. There is also evidence that many who experience harmful gambling are in contact with their GP, but don’t necessarily talk about their gambling.
This was the catalyst for the first ever Primary Care Gambling Service, which opened in 2019 in south London by Dame Clare Gerada – ‘a service which I’m proud to lead with wonderful support from a multidisciplinary team of mental health nurses, GPs, treatment practitioners and therapists’.
Commissioned by GambleAware, the first evaluation of this pilot programme has just been published. It’s revealed some intriguing and important insight on how GPs view the treatment of harmful gambling, referral barriers and the patient user journey.
Encouragingly, out of more than 150 GPs practising in England surveyed, 82% recognised the need for a service like the PCGS, with 92% agreeing that if they were aware of one in their local region, they would likely to refer patients to it. However, only a quarter of GPs reported being aware of gambling harm treatment and prevention services in their area.
Perhaps of more concern is that fewer than half (40%) recognised signs of gambling harms amongst patients, and a third thought helping patients with gambling harms was a low priority given other NHS pressures. More than 60% of GPs were not confident in initiating conversations about gambling harms.
Early findings suggest that patients had a positive experience when using the service, with users praising how quickly they were contacted after being referred, the speed of patient access to support and treatment, and the personalised and welcoming approach. Further encouragement can be taken from early evidence that psychological stress had reduced for patients who engaged with the service, but it’s too early to make any firm conclusions.
The evaluation has reinforced that GPs can play a more central role in tackling patients presenting with harms from gambling. In busy GP clinics healthcare professionals can identify those suffering with gambling harm and then refer on to the Primary Care Gambling Service. Here a holistic approach is taken. First line treatment for this behavioural addiction is CBT but the PCGS also stresses the importance of treating associated co-morbidities, co-addictions and social problems that co-exist with gambling.
Empowering GPs to become more confident in identifying those suffering gambling harms, along with better understanding of the nuances and the health and social care complexities involved in harmful gambling, is important. Treatment should be seen with a 360 lens, not in silos. This training will have a dual benefit. Ensuring the fastest access to the most effective treatment will improve public health and reduce the burden on the NHS down the line.
There is no magic bullet to the crisis. The current regulatory framework is out of date, and we must hope the White Paper is published soon and outlines new reform that is so urgently required. This should begin tipping the odds in favour of those tackling, preventing and experiencing gambling harms.
Anna Hargrave is chief commissioning officer at GambleAware, which funds the Primary Care Gambling Service
