1. Bio-Psychosocial Assessment
Miles Mack

2. Social Media
@milesmack
Today’s event #QoFQP
#5AreasBPA
This presentation and other resources: -

3. A GPs role in Depression?
If you were a patient with depression, what would you expect from your GP on your 1st visit?
As a GP what quality criteria are you expected to show?

5. QoF Criteria
DEP001.
The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have had a biopsychosocial assessment by the point of diagnosis.
The completion of the assessment is to be recorded on the same day as the diagnosis is recorded.
21 Points, Achievement threshold 50–90%
DEP002.
The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 and not later than 35 days after the date of diagnosis.
10 Points, Achievement threshold 45–80%

6. Content of BPA current symptoms including duration and severity;
personal history of depression;
family history of mental illness;
the quality of interpersonal relationships with, for example, partner, children and/or parents;
living conditions;
social support;
employment and/or financial worries;
current or previous alcohol and substance use;
suicidal ideation;
discussion of treatment options;
any past experience of, and response to, treatments.

7. Depression Local Enhanced Service SLA
Use screening tool 2Q+help for at risk groups
Use PHQ9 to asses the severity
Record diagnosis
Implement a management plan
Review- 3 management plans in 6/12
Follow care pathway 7

8. My model 1) Spot it! Have a high index of suspicion
Remember 2+1 questions

9. Screening Test -The Two Question + Help Test
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by little interest or pleasure in doing things.
Do you want help? 9

10. My model
2) Make a positive diagnosis

11. Diagnostic criteria for depression ICD-10
Key symptoms:
persistent sadness or low mood and/or
loss of interests or pleasure
fatigue or low energy
for at least 2 weeks
if any of above present, ask about associated symptoms:
disturbed sleep
poor concentration or indecisiveness
low self-confidence
poor or increased appetite
suicidal thoughts or acts
agitation or slowing of movements
guilt or self-blame

12. PHQ-9

13. My Model 3) Use PHQ 9 Aid to diagnosis Assess severity
A baseline to assess response to treatment

14. My Model
4) Find out more:
5 Areas Assessment

15. 5 Areas Sheet Life situation/relationships or practical problems
Altered thinking
Altered Emotional Feelings
Altered Physical feelings
Altered behaviour

16. My Model 5) Agree a treatment plan and follow-up Practical advice
Talking therapies
Medication
Referral

18. Life situation/relationships or practical problems
the quality of interpersonal relationships with, for example, partner, children and/or parents;
living conditions;
social support;
employment and/or financial worries;
personal history of depression;
any past experience of, and response to, treatments.
family history of mental illness;

19. Altered Emotions current symptoms including duration and severity;
Low mood
Anxiety
Irritability/Aggression

20. Altered physical symptoms
current symptoms including duration and severity;
Sleep
Tiredness
Appetite
Restlessness/lethargy
Poor concentration

21. Altered Behaviour
Alcohol/drugs
Exercise
Staying in
Comfort eating

22. Altered Thinking suicidal ideation; Automatic negative thinking
“What if…” thoughts
Guilt/regret, loss of hope

25. Life situation/relationships or practical problems
Problem solving
CAB
Relationship counselling
Occupational Health

26. Altered thinking Reduce time frame Encourage self empathy
Build resilience/self esteem
Question automatic –ve thoughts
Beware “What if…” thinking

27. Altered behaviour Avoid inappropriate coping strategies
Alcohol
Tobacco
Cannabis or other street drugs
Caffeine
Building blocks of a healthy life
Exercise, Diet
Activities, friends and families
Sleep hygene
Sexual relationships

28. Altered Emotions Amenable to medication; reserve for Severe cases
Co-existing anxiety
Recurrent or resistant 28

29. Referral Options Living Life to the Full – by phone or IT
Guided self help
Formal CBT
Mindfulness
Community Mental Health Team
Psychiatric review .

30. Referral to specialist services
Failure to respond to treatment
Suicidal risk assessment
Dual diagnosis (alcohol/drugs/borderline personal disorder)
To access additional resources nota available in primary care
Risk of abuse or neglect
Diagnosis uncertain

31. 5 Areas -practicalities
Complete it as a collaborative exercise
Print a copy for the patient
Save a copy to Docman
As a record of the consultation
To refer back to at the review appointment
To attach to referrals
To fulfil QoF Dep 001 criteria

32. Quiddity Vs This-ness
“The thisness of my dog lies in the way she wags her tail, prefers ball games even to food, twitches her nose; all the things which make her just herself and not another dog.”
Between ‘thisness’ and quiddity: the place of the GP. Gervase,V
British Journal of General Practice, July
DOI: /bjgp13X669284

33. References/Further information  
“Improving consultation skills using cognitive-behavioural therapy: a new ‘cognitive-behavioural model’ for general practice” David, Lee; Freeman, George. Education for Primary Care, Volume 17, Number 5, September 2006 , pp (10)
My accompanying blog:
My blog on PHQ9:

34. Social Media
@milesmack
Today’s event #QoFQP
#5AreasBPA
This presentation and other resources: -