Implementing new service models at scale

The Hurley Group is a London-based GP partnership, caring for 120,000 registered patients across 12 practices. The group also provides urgent care and out-of-hours services to 250,000 patients in Bexley and the Practitioner Health Service for GPs in England and Scotland.

Gambling addiction is an increasingly problematic area that is often challenging to uncover in patients. Many of those who gamble do so online and out of sight of even their closest family, and the addiction can have a devastating impact on the individual, their families, and the wider community.

To address these issues and improve the responsiveness of GPs to those with gambling addiction, Hurley Group has established a primary care gambling treatment service (PCGS). The PCGS improves patient outcomes for those with gambling addiction and their affected others and supports the primary care workforce in identifying and supporting them.

Working at scale has allowed Hurley Group to care for a much wider geographical area. What started as a London-based service now works effectively across the UK as a virtual service, receiving referrals from all four of the UK's nations.

Identifying problem gamblers and ensuring they, and affected others, receive treatment

Hurley Group has established a GP-led, community-based, national multidisciplinary treatment service for those who have a problem with gambling and their affected friends and family. This has involved cultivating all aspects of an NHS treatment service, including clinical records, prescribing capabilities, clinical staff and networks, and communication pathways.

Harnessing and demonstrating the potential of system working, a shared care model has been developed. It collaborates with nine third sector organisations to provide expert medical and nursing advice, as well as support and receive patients for assessment and treatment. Working together, they have established governance arrangements, referral pathways and effective, efficient, and safe care pathways. The intermediate, evidence-based treatment service aims to tend to patients' needs holistically, reducing the need for onward referrals for those with problem gambling.

As well as patients having the option to self-refer via its website, referrals are accepted from GPs, voluntary sector organisations, and through word of mouth. The service also supports GPs in improving their identification of patients with gambling disorders.

To help establish the service more widely, the medical lead for PCGS is working closely with the Royal College of General Practitioners (RCGP) to help create a curricular and training programme for primary care to help improve GPs' skills and knowledge of gambling addiction. A competency framework has been created for GPs and primary care staff with RCGP accreditation.

Since the service was launched at the start of the Covid 19 pandemic, waiting times for care have been reduced from 12 months to two weeks, and problem gambling referrals have increased from zero to around 60 per month. The service is expected to expand further, highlighting the opportunity for primary care to treat gambling addiction in the community.