Recent guidance from the National Institute for Health and Care Excellence (NICE) urged GPs to consider asking at-risk patients about gambling during appointments and routine health checks.

A GP involved in developing the guidance has advised how doctors can initiate these discussions with patients and concerned relatives.

Emma Ryan, a GP and clinical lead for the NHS’s Primary Care Gambling Service, which offers confidential advice for adults experiencing harm from gambling, believes the recommendations will help raise awareness of gambling addiction and the impact it can have on people’s lives.

Recognizing the Impact of Gambling Harm

“Gambling has been a hidden addiction where it has previously not been in the forefront of healthcare professionals’ minds,” Ryan explained to Medscape News UK. She has worked in this area for 5 years but previously had little knowledge about gambling addiction. “That’s because we never had it in any of our medical curriculums, so when we have seen patients, we haven’t been thinking about gambling,” said Ryan. “So, the fact that we now have NICE guidance, GPs will see that they do have a role in this.”

To deepen her understanding, Ryan spoke with people who had lived experience of gambling problems. These people had “gone through quite long journeys of either attempting suicide and ending up in intensive care or being arrested and put in prison,” she explained. One sentiment came up repeatedly, she said. “They wish someone had simply asked the question so they could have opened up and received support and treatment.”

Ryan noted: “If we can ask that question early, we can hopefully prevent all the other associated harms that go with gambling.”

Growing Demand for Gambling Support

In England, the North East region has both the highest overall participation in gambling (59%) and the highest prevalence of at-risk gambling (4.9%).

Matt Gaskell, a consultant psychologist and clinical lead for the NHS Northern Gambling Service, noted that demand for support and treatment is growing. “We get a lot of referrals into our service from the North East but also across the north, and usually, it’s within the more urban areas,” he told Medscape News UK. “For example, our cities and bigger towns tend to provide more of the referrals.”

According to Gaskell, the service currently receives “around double the number of referrals that we’re resourced to deal with.” He interprets this as “a sign that gambling harm is escalating and is on the increase across the north of England.”

Gaskell believes that the NICE guidance will help to break down barriers to accessing support, particularly as it recognizes gambling as a significant problem. “What’s good about this guidance is it’s going to normalize help-seeking in this area,” he noted. “It’s also going to normalize patients being asked about gambling, as they are about smoking, alcohol, and drug use. This will give patients more confidence to talk about their gambling problems.”

According to Gaskell, there have been “missed opportunities in the past,” where patients who had tried to speak with their GP about gambling had not received the response they hoped for. He feels this is due to the previous lack of guidance, as well as GPs perhaps being unaware of what they should be asking and what services are available.

“In terms of referrals, there is a ‘no wrong door’ policy, so patients can be referred to NHS gambling services via their GP, or they can self-refer,” he explained. “Currently, the majority we receive do seem to be from self-referrals.”

The Importance of Asking the Question

Early intervention is especially important for people experiencing gambling harm, as the risk for suicide increases with the severity of the addiction.

“As most gambling is now online, it can stay hidden until much later, when there is a crisis point,” said Ryan. “It’s only really at that point that these patients will seek help, and even then, they often don’t see themselves as having an addiction.”

“Whereas with alcohol and drug misuse, these are more commonly seen as an illness. Yet, people affected by gambling are more likely to see it as being their fault that they’re in this position. Consequently, they don’t see the harm it’s doing — so they present late.”

The new recommendations suggest raising the topic with at-risk patients as part of social history questions. How GPs word the question around gambling has deliberately not been advised, Ryan disclosed.

“We discussed this a lot at NICE, and what it came down to was it doesn’t matter how GPs ask the question; it’s just a case of asking it. We debated whether to have a really clear question, but I felt that was going to be a barrier, as if GPs couldn’t remember the exact wording, they perhaps wouldn’t ask.”

Ryan suggested that a question to a potentially at-risk patient could be as simple as “Are you concerned about gambling?” or “Do you gamble?” “If a parent or partner is discussing their concerns about a loved one, healthcare professionals could also ask about gambling in this scenario too,” she said. “For example, ‘Do you think your child or partner is gambling?’ or ‘Could gambling be contributing to how they feel?'”

The exact wording a GP uses is not important, Ryan noted. “Just mention gambling in appropriate consultations. The best way to remember to do this is to ask as you would about drugs, alcohol, and smoking.”

Resources for GPs

For the past 18 months, Ryan has been working with the Royal College of General Practitioners (RCGP) to create its Gambling Harms Hub, a resource for GPs and patients. She’s also the RCGP champion for gambling harms, a resource for GPs and patients.

Ryan, who is also the RCGP’s champion for gambling harms, advises that when a patient signals a problem with gambling, “even if they can’t think of anything else, just signposting them to the National Gambling Helpline will get that person help, as they’ll be assessed and allocated to a support clinic.”

She added: “The requirement for GPs within the NICE guidance is only to ask the question and identify people — and then signpost them for help. It’s meant to be quick and simple, and it could make such a difference.”

Ryan and Gaskell disclosed no relevant financial interests.

Julie Penfold is a freelance journalist specializing in healthcare and medical content. Her work regularly appears in titles such as Medscape Medical News, Doctors.net.uk, and Hospital Healthcare Europe.