Presentation on theme: "NIMHE, Primary Care Programme"— Presentation transcript:
1NIMHE, Primary Care Programme nGMS and Mental HealthNIMHE, Primary Care Programme
2Where does Mental Health fit? Quality and Outcome FrameworkNational Enhanced Service for DepressionPatient satisfaction questionnaireMedicine ManagementSignificant Event Monitoring
3Quality and Outcome Framework 41 points of 550 are related to severe mental illnessDifferent to other clinical domains – patient has to agree to be includedThree parts:Develop a registerMonitor physical healthManage lithium appropriately
4The Q & O Domain Indicator Points Payment Stages Register of people with a severe long term mental illness7Percentage of patients with a review recorded in the last 15 months2325 – 90%Percentage of patients on lithium with a record of lithium in last 6 months3Percentage of patients on lithium with a record of renal and thyroid functionPercentage of patients on lithium with a recorded lithium within therapeutic range25 – 70%
5Develop a register Who to include? What to call it? People with schizophrenia and bipolar affective disorderOn a case by case basis for others with significant mentalhealth and physical health needsWhat to call it?Be aware that registers ( e.g.like supervision registers) meansomething different to users
6How? Search by diagnosis Search by therapeutic category Ask the PHCT Schizophrenia Eu 20.0Bipolar disorder Eu 31.0Search by therapeutic categoryAsk the PHCTAsk the CMHTLabel with 9H8Label those who do not wish to be included 9H7
7Why do it? SMR for schizophrenia and bi-polar disorder is about 200 Cardiovascular and respiratory disease SMR is 400Diabetes is 5 times as common90% of people who have schizophrenia smoke (30% of people with bipolar disorder)Drug and alcohol misuseHIV is 8 times as commonHCV is (perhaps) 15 times as common
8What to do? Physical health review Medication review Communication review
9Physical Health Cardiovascular disease Diabetes and obesity BPHistory of arrhythmiasDiabetes and obesityUrine analysis or blood glucose?Respiratory diseasePeak flowHealth PromotionSmokingSubstance/alcohol misuseCervical cytologyInfluenza?HIV/HCV?
10Medication Review – 8B3SReview what medication (all) is supposed to be prescribedWhat is the patient actually taking?Is the patient taking any OTC medication?Review side-effects, interactions etcReview concordanceConsider referral to CMHT if medication has not been reviewed in the last 5 years by psychiatrist
11Communication Review Name of Key worker (if known to CMHT) Contact details for key worker in office hours and in emergencies/OOHContact details for carer (if the patient has nominated a carer)
12Lithium ReviewProportion that have had their lithium level checked in the last six monthsSerum lithium 44W8%Proportion that have had their renal and thyroid function tested in the last six monthsThyroid function tests 442%Serum Creatinine 44J3%Proportion that have their lithium level within the therapeutic range
13NES for DepressionWhat is it?How much will it cost?Who can do it?
14NES Depression – What is it? Essential or additional services delivered to a higher specified standardCommissioned by PCTsGenerally placed with GMS/PMS providers but need not be [2.15(iv)]Can be provided by the PCT itself [2.38 – 2.43]
15NES Depression – What is it? Aim: To meet main recommendations of Defeat Depression Campaign.Definition of Depression: Clinical judgement and evidence based diagnostic skillsService Outline:Register of patientsMulti-disciplinary approachUse CBTUse screening proceduresUndertake trainingMaintain personal health plansMake referrals/enquiriesReview and feedback
16NES Depression – ££££ ? For a PCT population: Use ONS data for prevalenceCalculate % of patients between 16 – 65Weight the target population by the DH Mental health indexAssume only 50% identifiedAssume that 90% will be treated in primary careMultiply that total by £100.00Light the blue touch paper and retire!
17NES Depression – Who can do it? GMS/PMS primary health care teamsMental health providersVoluntary Sector organisationsPCO itself [2.44 – 2.46]
18Patient Satisfaction Questionnaire Length of consultation10 min booked, 8 min open surgery30 pointsUndertaken an approved survey annually40 pointsUndertaken the survey and reflected on changes if appropriate15 pointsUndertaken approved survey, discussed results as a team, an d with patient group of NED of PCT, and proposed changes with some evidence that some had been enacted
19Patient Satisfaction Questionnaire There is no approved questionnaire that is specific to mental healthYetNIMHE Primary care programme is developing such a questionnaire, which will need to be tested for face validity etc, and then approved by the National Panel.Available in 12 months?
20Medicine Management 10 indicators Medicine 7 is specific to mental health – 4 points“Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend”
21Medicine Management Practice Guidance Written evidence Good to involve CPN (if available)Relatively small numbersWritten evidenceGrade C i.e. optionalAssessment VisitPractice should be able to demonstrate systemAssessors GuidanceIf the patient is under the care of the mental health team, and receives the medication from the team, then they should be excluded from the practice responsibility.
22Significant Event Monitoring Part of Organisational Indicators – Education9 indicatorsEducation Significant events in 3 years – 4 pointsEducation 7 – should include the following (if they have occurred)Any death on practice premises2 new cancer diagnoses2 deaths which occurred as part of terminal care1 patient complaint1 suicide1 Mental Health Act assessment
23Significant Event Monitoring In line with RCGP Occasional Paper. Reports should be laid out in one of two forms:Description of EventLearning outcomesAction planWhat happened?Why did it happen?Was insight demonstrated?Was change implemented?Non confrontational, multi disciplinary team activity
24In conclusion Quality and outcome framework Severe and enduring mental health41 pointsNES DepressionDepression£100 per pat.Patient Experience QuestionnaireMental health (?) patients100 pointsMedicine ManagementThose on depot neuroleptics4 pointsSignificant Event MonitoringSuicide and/or MHA Assessments