Mental health therapists in GP practices could be the norm

NHS England | August 2018 | Mental health therapists in GP practices could be the norm

New guidance to support GPs, practice managers and commissioners integrate mental health therapists into primary care pathways has been created by NHS England. 

The guidance will enable therapists to become  integrated into primary care teams and focus on common mental health disorders such as anxiety and depression, particularly where this occurs in patients with a long term physical health condition such as diabetes, respiratory or heart problems.

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Evidence suggests 90 per cent of  adults with mental health problems are supported in primary care and broadening the range of services for patients, means local health services are better equipped to deal with patients’ physical and mental health needs (Source: NHS England).

See NHS England  Guidance on co-locating mental health therapists in primary care

NHS England news release Mental health therapists in GP practices could be the norm

In the media:

Pulse NHS England asks GPs to house mental health therapists within practices

GP Online GPs urged to bring mental health therapy services into practices

The Daily Mail Every GP surgery in England should hire a mental health expert to tackle depression that makes physical illnesses worse, experts say

Clinical Pharmacists in General Practice

University of Nottingham | July 2018 |Clinical Pharmacists in General Practice

The University of Nottingham has published its findings into the role of the clinical pharmacist in general practice, it looks at the first stage of the pilot to integrate the role into general practice. Researchers from the university investigated the work of the newly created clinical pharmacist roles from the perspectives of the pharmacists, those working immediately with them in their roles, professional stakeholders and patients. These were evaluated in a range of ways including; observational studies, one to one interviews with staff and patients, patient focus groups and case study site visits.

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The report reveals key focus for the clinical pharmacists was medication reviews, as these often accounted for significant amount of their workload. Clinical pharmacists undertook these on a regular basis, releasing capacity for GP’s and alleviating appointment issues.

As part of these reviews they were able to provide invaluable medicines education and usage advice to patients, in particular those with long term health conditions including; diabetes, asthma and heart disease, which led to increased medication understanding and adherence. Where appropriate they were also able to deprescribe medicines, which has potential for positive health and cost saving benefits.

 

The report also provides many  recommendations including the need to :

  • Manage GP expectations of the clinical pharmacist role capabilities and time for
    return on investment
  •  Manage practice site leads expectations of cost and training commitments
  • Manage local level expectations of wrap around responsibilities for the clinical
    pharmacist role (i.e. clear guidance on senior clinical pharmacist

Dr Keith Ridge, Chief Pharmaceutical Officer at NHS England said “Clinical pharmacists in general practice are playing an important role in the NHS – they are helping GPs to manage demands on their time, they upskill the wider practice team about medicines and crucially, they are providing better outcomes and quality of life for patients, especially elderly patients and those with chronic illnesses. The report’s recommendations are timely and we are confident that the benefits of the programme will continue across more GP practices, as we continue the rollout of the programme.”

Full report: Clinical Pharmacists in General Practice: Pilot scheme Independent Evaluation Report: Full Report 

Executive summary: Clinical Pharmacists in General Practice: Pilot scheme
Independent Evaluation Report: Executive Summary

Celebrating 70 individuals who have made a massive difference to the NHS

Care Quality Commission | July 2018 | Driving improvement – individuals who have made a difference

To mark 70 years of the NHS, the Care Quality Commission (CQC) has published 70 stories underlining individuals who have gone ‘over and above’  and made a significant impact on the care people receive across health and social care services. This collection of 70 case studies highlights the work that individuals – from volunteers, to front line staff to senior leaders – have done to deliver great services in hospitals, care homes, GP practices and elsewhere. (Source: CQC).

Driving improvement
Image source: https://www.cqc.org.uk/sites/default/files/20180629_drivingimprovementnhs70_asc.pdf

 
There are case studies from the following sectors:

The state of care in urgent primary care services

This report presents findings from the Care Quality Commission’s programme of comprehensive inspections of urgent care centres, NHS 111 services and GP out-of-hours services.

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Image source: http://www.cqc.org.uk

Urgent primary care services play a vital role in England’s healthcare system. They are the first step to ensure that people are seen by the professional best suited to deliver the right care and in the most appropriate setting.  A quick, safe and effective response from these services provides a good outcome for patients and takes pressure off other parts of the urgent care system.

This report presents some common themes and characteristics that the Care Quality Commission (CQC) have found from their inspections.

The report found:

  • Urgent care services are an essential part of the healthcare system, particularly in taking pressure off other parts of the NHS at times of peak demand.
  • Urgent primary care services have been able to improve. Overall, the quality is good – although one in 10 services still require some improvement, particularly in initial assessment of people and timeliness of response to urgent needs.
  • Urgent care providers face pressures with staffing and workforce planning. This is compounded by the reality of unsocial working hours and high reliance on self-employed clinicians
  • Many providers experience difficulties in accessing people’s medical records.
  • NHS 111 in particular has the potential to take pressure off the NHS – and provide a better experience for people by giving advice and treatment in one place. However, to achieve this it must be adequately resourced. Commissioners need to support providers, take action if they are not meeting their contracts and integrate services more closely.
  • Many people are not aware of the range of urgent care services available. There is a need for more public information – and consistency of service provision.

Full report: The state of care in urgent primary care services. Findings from CQC’s programme of comprehensive inspections in England

Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

The Nuffield Trust | April 2018 | Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

Health 1000 is a new model of care that aimed to improve quality of life through personalised care delivered by a clinically-led multidisciplinary team, focusing on prevention and early intervention and supported by contributions from the third sector. Individuals eligible in Barking and Dagenham, Havering and Redbridge boroughs were invited to transfer from their primary care practice to Health 1000.

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Image source: nuffieldtrust.org.uk

Using a case-control methodology, where 407 patients registered with Health 1000 were paired with a control who would be registered with another GP in the area. A combination of interviews with patients and staff and surveys were completed by staff of Health 1000 and nearly 50 primary care staff working in the boroughs.
Among the findings were:

  • Staff had reported reductions in unnecessary outpatient referrals and significant improvements to medicines management. They had also referred to the benefits of better care continuity, for example in enabling quicker discharges from hospital and avoiding duplication across the system.
  • However, there is no evidence that the service reduced use of hospital services – whether for all patients, those who satisfied the original eligibility criteria, or those at end of life. However, with the numbers of patients and the period of follow up, it may be too soon to detect any such change.

The report’s key findings and the full details of the evaluation are available from The Nuffield Trust here 

The accompanying report can be downloaded here

Workload in general practice

Ensuring patient safety through control of workload and demand management in general practice | The British Medical Association (BMA)

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General practice in England has seen consultation rates soar by nearly 14 per cent between 2007 and 2014, while the 12 months between 2016-17 saw the total number of full-time equivalent GPs fall by 3.4 per cent.

The BMA suggest that this increase in workload is because of growing patient need (complex multi-morbidity) as well as a result of the widespread recruitment and retention crisis and a lack of long-term investment in general practice. It is argued that the issue of GP workload must be addressed urgently.

This document seeks to address the current challenges in primary care.  It sets out a strategy aimed at improving safety and quality of patient care by recommending the development of agreed workload limits at a local level supported by national guidance.

Full document: Workload Control in General Practice. Ensuring Patient Safety Through Demand Management