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GPs should routinely ask patients about gambling, proposes new NICE guideline

GPs should routinely ask patients about gambling, proposes new NICE guideline

GPs should ask people about gambling during consultations, in the same way they ask about smoking or alcohol use, NICE has recommended in draft guidance.

Patients should be asked during health checks, but also when they present with a mental health problem, including depression and anxiety, or with an addiction, because they may be at increased risk of harm, the recommendations now out for consultation advise.

Those who are experiencing homelessness or financial concerns may also be particularly at risk from gambling. Domestic abuse or safeguarding concerns should also flag the need to ask about gambling, NICE said.

GPs should also consider asking about gambling for patients taking some medicines including for Parkinson’s disease or psychosis or if they have a neurological condition or brain injury.

Some occupations including armed forces personnel, veterans, people working in the gambling or financial industry and sports professionals can also be more vulnerable and having multiple risk factors can have a cumulative effect.

An NHS questionnaire can be used by the patient to assess the severity of their gambling problem where a score of 8 or above indicates they may need support from a specialist gambling treatment service.

Depending on the extent of a person’s gambling problem, healthcare professionals can discuss with people whether they can use blocking software or tools to limit their online gambling or ways to restrict their access to money as well as signposting them to local support services.

If a person experiencing gambling-related harms presents considerable or immediate risk to themselves or others, they should be referred urgently to specialist mental health services, NICE said.

The guidance also notes that cognitive behavioural therapy (CBT) should be a treatment option as research shows it can be effective. 

The Public Health England gambling-related harms evidence review estimated that around 300,000 adults experience ‘problem gambling’.  

NHS England has opened 12 gambling treatment clinics across England since 2019, with a further three due to open in the coming months, it said.  

Professor Jonathan Benger, chief medical officer and interim director of the centre or guidelines said: ‘Harmful gambling causes immense misery to all those who experience it.

‘We want those needing help or who are at risk to be identified sooner and receive appropriate help.’

NHS England mental health director, Claire Murdoch, said: ‘Gambling addiction is a cruel disease that destroys people’s lives, and the NHS is already playing its part in treating it with four new specialist clinics opening in recent months and a further three opening later this year, so if you’re struggling, please come forward for help.’

She added: ‘We will work with NICE on this consultation process and while this new guidance will ensure the NHS can help even more people struggling with gambling addiction to receive evidenced-based treatment, it is vital that the billion-pound industry also takes action in line with the government’s white paper to stop people coming to harm in the first place.’

RCGP chair Professor Kamila Hawthorne welcomed the focus on the ‘growing problem’ of gambling addiction, with an ‘increasing number of people, including children’ turning to GPs for help.

As such, she said it was ‘important that GP teams are able to deliver appropriate advice and care, including signposting them to other services, to help them change their habits and reduce the associated harms’.

But she added that ‘expecting GPs to pro-actively ask patients about gambling habits as part of every mental health consultation could prove counterproductive’.

‘Some patients might choose not to disclose their gambling problems until they have built up a trusting relationship with their GP or member of the practice team over time, and any attempt to make them have these conversations before they are ready could make them more vulnerable. Patients must not feel they are being interrogated when we ask them about their lifestyles as part of a mental health assessment.

‘With the current workforce and workload pressures in general practice, it’s also hard to see how hard-pressed GPs could fit this into the standard 10-minute consultation when it is already too short and unfit for purpose.’

Instead GPs should be able to ‘ely on their clinical judgement about when it is appropriate to discuss particular issues, based on their assessment of the individual patient in front of them’, she argued.

The consultation harmful gambling: identification, assessment and management is open until 15 November.  

NICE draft guidance: Harmful gambling: identification, assessment and management

1.1.1  Consider asking people about gambling when asking them about smoking, alcohol consumption or use of other substances (for example, as part of a holistic assessment or health check, when registering for a service such as with a GP or on first contact with social services)
1.1.2  Consider asking people about gambling when asking them about smoking, alcohol consumption or use of other substances (for example, as part of a holistic assessment or health check, when registering for a service such as with a GP or on first contact with social services).
Ask people about gambling in the following situations, because they may be at increased risk of harm:
  • when they present in any setting with a mental health problem or concern, in particular depression, anxiety, psychosis, post-traumatic stress disorder (PTSD), personality disorder, attention deficit hyperactivity disorder (ADHD), or thoughts about self-harm or suicide at each new contact with the criminal justice system (for example, with the police, liaison and diversion services, probation services, courts and prisons)
  • when they present in any setting with an addiction (for example, alcohol or drug misuse, in particular use of cocaine)
  • when they are at risk of or experiencing homelessness
  • when they share that they have financial concerns
  • when there are concerns about safeguarding issues or violence, including domestic abuse
  • when they share that there is a family history of gambling or other addictions
1.1.3   Consider asking people about gambling if they may be at increased risk because of:
  • a medication, for example, people taking dopamine agonists for Parkinson’s disease, or aripiprazole for psychosis
  • a neurological condition or acquired brain injury
  • their current or past occupation, for example, armed forces personnel,
  • veterans, people working in the gambling or financial industry and sports professionals.
1.1.4  Take into account that having multiple risk factors may have a cumulative effect and further increase the person’s chances of experiencing gambling-related harms.
1.1.5  Use direct questions to ask people about gambling, such as: ‘Do you gamble?’ and ‘Are you worried about your own or another person’s gambling?’
1.1.6  Encourage people to assess the severity of their gambling by completing the questionnaire available on the NHS website. This is based on the problem gambling severity index (PGSI). Advise them that a score of 8 or above indicates that they may need to seek support and treatment from an NHS-commissioned specialist gambling treatment service.
Source: NICE


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Please note, only GPs are permitted to add comments to articles

Mr Marvellous 5 October, 2023 10:39 am

Does anyone else feel like NICE is trolling us?

Maybe they should also release their guideline on boiler checking.

Also I’m pretty handy with a drill – could we have a Shelf Hanging LES?

David Turner 5 October, 2023 11:10 am

Based on recent events we should also be asking them if they own an XL Bully dog

and while we are at it we could ask if they rise a motorbike or enjoy in rock climbing, caving or scuba diving

Angela Parker 5 October, 2023 11:39 am

Another lovely Score with an 8 as a trigger point . Harking back to the “one over the 8 “ saying !!
Why not get the gambling industry to do these as part of licensing law ?Same could apply to alcohol
– Supermarkets and other outlets, loyalty schemes must have all that individualised data easily to hand – Why are GPs being pushed into this public health role ?
Please could somone compile a list of the numbers or letter for the scores you need to collect before you can treat a patient for what they perceive as a problem?

Liam Topham 5 October, 2023 11:43 am

If the NHS was doing a fantastic job of looking after sick people I would fully endorse an expansion of our remit

Liam Topham 5 October, 2023 12:16 pm

it’s got all the hallmarks of something dreamt up during a meeting on teams, involving lots of people working from home

Dave Haddock 5 October, 2023 12:55 pm

Another useless parasitic organisation, generating pointless activity to justify it’s existence.

Robert James Andrew Mackenzie Koefman 5 October, 2023 1:22 pm

Maybe we should flip this on it’s head and the gambling companies should be asking clients the questions about their mental health etc before allowing them to gamble and taking their money !

David Banner 5 October, 2023 1:40 pm

I bet we won’t……..

Ian King 5 October, 2023 2:27 pm

There is really no point when there are no sensible services to refer into

A Non 5 October, 2023 2:54 pm

GPs should routinely screen for depression, self harm, suicidal ideation, domestic violence, child abuse, elder abuse, risky sexual behaviour, drug misuse, alcohol abuse, smoking, poor dietary habits, gender identity concerns, housing difficulties, financial difficulties, memory problems, carer distress, misuse of fire arms, concerns regarding ability to drive a car, eligibility for benefits, fitness to be at work, tiredness resulting from sleep apnoea, misattributed symptoms resulting from menopause and errr “illness”. 23 items there..10 minutes. Thats 26 seconds per issue. Oh forgot make it 25. They booked in for their own actual unrelated reason??? Oh wow..patients do that? No time sorry, got to make sure I don’t get sued by a pressure group quoting NICE when I fail to screen for one of these buggers. You’ll have to book another appointment, but they might need to screen you again. Sorry no choice, GPs aren’t allowed to think. We just have to follow guidelines out of fear of getting sued

A Non 5 October, 2023 2:58 pm an illness? Sorry its just become too risky to treat you here. Go to a&e

Darren Tymens 5 October, 2023 3:54 pm

I’d be quite keen for someone to screen NICE employees for drug and alcohol use, based on their most recent ideas.

Meanwhile, General Practice is on its knees, and secondary care cannot even manage basic functions safely.

DOH/NHSE/GMC/NICE/CQC all need to engage with reality and get a clearer sense of appropriate priorities for the service.

David jenkins 5 October, 2023 11:02 pm

gambling, and drinking, and smoking, and drugs, and sex, and being trans, or being hated etc etc etc etc.

don’t worry about drug side effects – leave that to proper doctors in the posh building……………………

Turn out The Lights 6 October, 2023 8:03 am

Do you have a tip for the 3.15 at Sandown?

Not on your Nelly 6 October, 2023 11:05 am

NICE have yet again lost the plot and need a reality check. Also try and get some people who work in day-to-day general practice on these panels, rather than the out-of-touch, retired or now working people. Gambling needs to be a self-referral service for patients signposted at the front of every casino, prior to starting any gambling app or at the front end and exit for anywhere gambling takes place. The BMA and the RCGP need to be clear “GPs are not best placed to be a part of this and will have nothing to do with this”.

Keith M Laycock 7 October, 2023 4:43 pm

I’ll wager that’s non-starter.