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Teenagers consulting with their GP & practice nurses Dr Maryanne Freer 07960718764 Dr Maryanne Freer 07960718764.

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Presentation on theme: "Teenagers consulting with their GP & practice nurses Dr Maryanne Freer 07960718764 Dr Maryanne Freer 07960718764."— Presentation transcript:

1 Teenagers consulting with their GP & practice nurses Dr Maryanne Freer Dr Maryanne Freer

2 A problem shared is a problem halved Dr Maryanne Freer

3 Introductions- myself Dr Maryanne Freer

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5 Thanks to: Sir Mark and Lady Rachel Waller- CWMT. Dr Dick Churchill - RCGP Adolescent Task Group Dr David Shiers-GP& NIMHE Professor John Spencer & MiC GP tutors- Newcastle Medical School Primary Care Dept Dr Alison Macdonald- Northumbria VTS Director Dr Nicki Williams & Dr Chris Marr – RCGP WBA Professor Chris Drinkwater Dr Maryanne Freer

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7 Quick quiz  Who is the young person’s most favoured health professional & 2 reasons why?  How many young people who see a GP have a diagnosable mental health problem? Dr Maryanne Freer

8 Quick quiz  How many minutes of a GP consultation is spent on a teenagers mental health?  Prior to a young person’s suicide do the number of GP consultations increase or decrease? Dr Maryanne Freer

9 The job of the “favoured” family doctor & practice team  The confidante  Continuity  Cradle to grave  Through physical health management  Family practice  Mum/Dad  Siblings  Early detection & recognition  Urgents/crisis/ out of hours Dr Maryanne Freer

10  Young people see GP’s voluntarily & through their own necessity. E.g contraception needs  GP take a pragmatic, functional approach Dr Maryanne Freer

11 Further information: Freer M, Shiers D, Churchill C. Meeting the Mental Health Needs of Young People: A GP's perspective In: I Goldie (Ed) Public Mental Health: A handbook Brighton: Pavilion. Dr Maryanne Freer

12 Why 10 minutes? Dr Maryanne Freer

13 No mean feat……. Dr Maryanne Freer

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15 Monday morning surgery Psychological or physical? Monday morning surgery Psychological or physical? Tom, 16 – acne Philippa, 36 – crying – mum died suddenly 3 weeks ago Philippa, 36 – crying – mum died suddenly 3 weeks ago Harold, 57 – indigestion and lack of energy Mary, 84 – cannot swallow and losing weight Mary, 84 – cannot swallow and losing weight Rob, 27 – recently diagnosed with schizophrenia – drooling asking if this is a side-effect of new meds Helen, 14 – tired all the time, irritable and sleepless Roger, 20 – diabetic 4 years – poor diabetic control Roger, 20 – diabetic 4 years – poor diabetic control Donald, 29 – sick note + pain-killers for back pain after RTA Parva, 4 – regularly attends: yet another cough and cold Parva, 4 – regularly attends: yet another cough and cold Freda, 77 – depressed, early morning waking, no motivation

16 What GP’s have to know- the “generalist” ESSENTIAL SERVICES; Coronary Vascular Disease, Stroke, Cancer, Diabetes, Hypertension, Mental Health, Asthma, Chronic Obstructive Pulmonary Disease, Epilepsy, Cervical Screening, Child Health Surveillance, Maternity Services, Contraception. ENHANCED SERVICES… Dr Maryanne Freer

17 GP’s main concerns - teenage mental health consultation “ Am I missing some thing ? Is this normal or a diagnosable problem?” “What to do if teenager referred with long wait times and comes back to me with mum saying “do something?” “Will I know if….self harming, suicidal..what to do? ” “ If no cbt, do I prescribe?” GP case- OC Dr Maryanne Freer

18 The GP * practice nurse consultation Dr Maryanne Freer

19 Zoe Zoe Craddock is 15 and brought into see the GP with a sore throat by her mother. Zoe has been having these sore throats for at least 6 months now. She isn’t very happy at home; she seems to get ill very often, and has to have time off school. Her mum isn’t very sympathetic Dr Maryanne Freer

20 What tasks do you see the GP perform? Dr Maryanne Freer

21 Tasks within the GP& practice nurse consultation Initial consultation  Confidentiality  Rapport building  Dealing with parents  Opportunistic screening question Second consultation  Mental Health  Summary  Diagnosis  Risk  Self help - problem Solving  MH Promotion check list

22 Consultation issues Primary care probabilities Watchful waiting Clinical un certainity Management of physical co- morbidity Safety netting Use of continuity & follow up Concordance Dr Maryanne Freer

23 What support do GP’s & practice teams need to mean more young people get the help they require? Dr Maryanne Freer

24 Do you know your GP’s?  Resources  Consultation approaches  Education Dr Maryanne Freer

25 GP * practice team education Initial consultation  Confidentiality  Rapport building  Dealing with parents  Opportunistic screening question Second consultation  Mental Health  Summary  Diagnosis  Risk  Self help - problem Solving  MH Promotion check list

26 GP & practice team education: The patient’s experience. Dr Maryanne Freer

27 GP & practice team education-HEAR DVD Confidentiality Dealing with parents Real cases – GP role models Dr Maryanne Freer

28 Life Situation Altered thinking (ICE) Altered physical Altered emotional symptoms feelings Case:OC/PMT Altered behaviour Dr Maryanne Freer GP & practice team education: Mental Health summary, diagnosis, risk

29 GP & practice team education: Clinical diagnostic & severity tool Dr Maryanne Freer

30 GP & practice team education: Primary & community check list Dr Maryanne Freer

31 Patient feedback on check list options _low_mood/Topic/3672  Young_people_depression_and _low_mood/Topic/3672 Dr Maryanne Freer

32 Resources: Web based self care: Dr Maryanne Freer

33 Web based self care:www.youngminds.org.uk Dr Maryanne Freer

34 GP & practice team education Resource book- CWMT GP toolkit  The theory  Case studies  Self study activities with rationale for each  GP & team consultation tools  Reading material expanding on workshop sessions Dr Maryanne Freer

35 Practical help- what’s around  CWMT supported GP training  Train the trainers sessions ( PMHW)  Training to GP’s on the teenage mental health consultation Dr Maryanne Freer

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37 In summary  GP’s cant be forgotten if we want to help young people with mental health problems  Young people voluntarily see their GP & can do “cradle to grave”  GP’s have critical role in early detection, prevention & functional family approach Dr Maryanne Freer

38 The last word – Jack opic/3673 Dr Maryanne Freer

39 Over to you Any unanswered questions? What next? Dr Maryanne Freer


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