The number, deployment, activities and attitudes of specialist consultant addiction psychiatrists in England: A national survey

Abstract

Aims: Problematic drug and alcohol use imposes a considerable burden on health and social services in England. Although consultant addiction psychiatrists are considered to play a central role in the provision of treatment services to people with substance misuse problems, little is known about their number, deployment or roles and responsibilities. This study aimed to address this.Methods: This three-stage study comprised a mapping exercise, in-depth interviews and focus groups, and a postal survey of consultant addiction psychiatrists undertaken in March 2005. The latter included questions about working arrangements, views about priorities, attitudes about roles, and retirement intentions.Findings: The mapping exercise identified 126 consultant addiction psychiatrists working in England; this equates to about 117 whole time equivalents (wte). The number is about one quarter of the minimum recommended by the Royal College of Psychiatrists. Rate of recruitment to the specialty is sufficient to maintain numbers at existing levels. Eighty-five consultant addiction psychiatrists responded to the survey (67% of those identified). All but one are members of a multi-disciplinary team. Only 8 consultants (9%) work in a specialist alcohol service. The respondents spent an average of 19 hours per week in direct clinical work and 9 hours on management activities. Many would wish to have more time for teaching, research and clinical audit. Most consultants agree that they should see mainly the most complex cases and that they should lead, and be a resource for, the multi-disciplinary team. Consultants believe that they give higher priority to certain patient groups than do commissioners of services and, in particular, to people with severe alcohol dependence and young people. Nearly three quarters feel under pressure to meet unrealistic performance standards and targets. More than 80% think that addiction psychiatrists, as a professional group, have not been sufficiently involved in setting national policy. Although 92% think that the specialty is a rewarding career for trainees, about one half agree that addiction psychiatrists are an ‘endangered species’.Conclusions: Consultant addiction psychiatrists are playing the clinical role envisaged by the Department of Health and the Royal College of Psychiatrists. Their low numbers, however, mean that they cannot contribute fully to teaching, training, research or service development.