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Primary Care Practitioners Survey

Dr Paul Campbell, Consultant Clinical Psychologist

Methodology

• Two sets of questionnaires • For GPs • For IAPT workers

• Interviews with IAPT Clinical and Operational Leads

• Quantitative methods used but qualitative data more important • due to lack of representative sample

Rationale

• PLAN Standards • No significant consultation with primary care MH • Only those working in hospitals were consulted

• Only minor recommendations for liaising with primary care

68Total Responses

_________________________________

GP Questionnaire

Q1: Is there a psychiatric liaison/psychological medicine service commissioned in the hospital that serves your provider area?

89%

Q2: Are you aware of what services your current psychiatric liaison/psychological medicine service are able to provide?

Other than Acute Assessment and signposting

on I am not sure

I have only a very sketchy awareness

40%

50%

Q3: Would you like to be able to refer directly to your local psychiatric liaison/psychological medicine service?

88%

we already can

GPs have a Single Point of Access to

via A&E is OK and saves us

appointments and time

that would be very helpful, direct referral to psychiatric services for a

patient deemed to be at risk is a hit and miss affair.

Q4: If you could refer directly to your local psychiatric liaison/psychological medicine service, what form would you like this referral to take? (Check all that apply)

I would like them imbedded into our community teams so I could ring for advise and opinion if needed

Not so keen on forms as often take long time to complete and don't self populate with EMIS data.

Useful to be able to speak to someone about the referral.

Q5: How often does your team (or a member of your team) meet with your local psychiatric liaison/psychological medicine service?

We have no engagement. They are surprised when I call about a patient and know what I'm talking about.

These have now been stopped by the liaison team due to workload. these were really useful

To include them in our multidisciplinary meetings would be a godsend

Q6: Are there any specific medical conditions which you feel would benefit from a psychiatric liaison/psychological medicine service?

3%3%6%

6%

6%

6%

34%

34%Depression or anxiety

PD or Psychosis

Dual diagnosis

Autistic spectrum conditions

Cancer

DiabetesIBS & CFS

Chronic pain

Q7: Would regular meetings in your GP surgery with psychiatric liaison/psychological medicine teams regarding complex patients be useful?

61%

Should be imbedded in the

team just like community matron,

district nurse etc

In ideal world yes, but never enough hours in the day for all the possible

meetings

no but the occasional phone call

to or from a team member is helpful at

the time of crisis

Q8: Are you satisfied with the level of service currently available from your local psychiatric liaison/psychological medicine service?

52%

22%26%

Q8: Are you satisfied with the level of service currently available from your local psychiatric liaison/psychological medicine service?

52%

22%26%

Not entirely sure what is on offer

it can be a bit patchy and has reduced over time

Needs to be directly accessible to Primary Care

and for more robust follow up to occur. I find it frustrating not to be

able to speak directly or refer directly to a psychiatrist

Feel psychiatry generally is

under resourced and difficult to access

I think they are a good team but can only

provide a service for which they are commissioned

The service provided is excellent from the clinicians

manning the service

Q9: Are you happy with the level and timeliness of the communication received after patients have been seen by your psychiatric liaison/psychological medicine service?

45%

38%

Usually receive a faxed summary within 24 hrs

which is very useful.

Fairly happy but can be a delay.

very little if any communication

acute psych liaison is

faxed through often same day but

outpatient can take some time

Q10: Are you happy with the level of follow-up received by patients seen by your current psychiatric liaison/psychological medicine service

20%

56%

Patients not usually followed up directly

by the service

Patients appear to be discharged very quickly

most pts are discharged back to us after 1 appointment - often

with a list of suggested things for the GP to do - most of which I think they

could / should have done

Q11: Do you feel patients find benefit from your current psychiatric liaison/psychological medicine service?

48%

18%

I get mixed reports as to how helpful it has been

limited benefit

Although not as many as could do

Q12: Do you feel confident in managing patients with Medically Unexplained Symptoms?Answered: 65 Skipped: 3

42%

58%

Difficult to know at what point to stop seeking a

medical diagnosis and accept that symptoms may be

psychologically mediated.

partially

reasonably confident but would like more training

Q13: Have you had any previous training in relation to Psychological Medicine?Answered: 66 Skipped: 2

68%

32%6 months

psychiatry SHO

Had a 1 hour educational session with liaison

psych

Q14: Would you be interested in training courses to help improve your knowledge of Psychological Medicine?

77%

waste of time and resources

I would like to develop CBT skills

Q15: Do you think greater knowledge of Psychological Medicine would improve your primary care skills?

76%

In a real world 10 minute appointments treadmill and heavy

workload ever increasing where is the time to indulge in above

Probably not as I don't have the time to

put it to good use

Any knowledge update or training would be helpful provided it is at high

enough a level

Q16: Would you be less likely to refer to other specialties if you had greater skill and/or knowledge of Psychological Medicine?

40%

22%

38%

regardless of training as mentioned above problem is lack

of time

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Main themes from GPs

Realising there is a problemonly 22% of GPs are satisfied with LMH

Better working relationships

needed

Barriers to access GPs feel ill equipped to deal with certain complex patients

GP practice guide has been produced for clients with MUS

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Mental health liaisonThe views of IAPT providers

82%

Q1: Is there a psychiatric liaison service commissioned in the hospital that serves your provider area?

Q2: Can your local psychiatric liaison service make DIRECT referrals to your IAPT service?

They can but the referrals are often poor and

for adjustment disorders and self-harm

83%

they really don’t know what

we do

11%

Q3: If your local psychiatric liaison service cannot make DIRECT referrals to your IAPT service is there an agreed referral pathway for them to make referrals?

No, but there is a pathway in place

patients can be directed to self refer

45%

22%

33%

Q4: Is your local psychiatric liaison service able to provide follow up appointments to patients after they are discharged from hospital?

No, and this often leads to risky people coming our

way

There is 7 day follow up arrangement by the Home Treatment

Team (HTT)

There was a limited pilot project which was very successful, but unfortunately

not ongoing

42%

26%

32%

Q5: Can a service user’s case be open to both your team and your local psychiatric liaison service?

58%42%

If this is a brief review and med

adjustment IAPT would retain the case.

This is dependent upon risk

Q6: Do you REGULARLY receive referrals from your local psychiatric liaison service for the management and/or treatment of Medically Unexplained Symptoms (MUS)?

21%

63%

MUS alone would not meet our criteria

16%

Q7: Do you REGULARLY receive referrals from your local psychiatric liaison service for the management and/or treatment of anxiety or depression specifically associated with Long Term Physical Health Conditions (LTCs)?

56%

39%We are not commissioned to

treat CMD associated with

LTC’s

Q8: Has your service been approached by your local psychiatric liaison service about the possibility of their staff shadowing or observing some of the work your service does?

89%

We have suggested this but it has not been taken

up

Q9: How often does your team (or a member of your team) meet with your local psychiatric liaison service?

A&E liaison don’t

know what we

Although staff are great, they

are understaffed

We tend to get all referrals that do

not meet the very high threshold for

secondary care

we need a face to face relationship

we need a closer working relationship

surely IAPT don’t see LTC or

MUS clients

We don’t have the facility to follow people

up

Please tell us of any other issues you have about the interface between Mental health liaison and primary care

Main themes

Better systems/relationships needed

Talking therapies not convenient and accessible for those with LTCs

There are barriers to access

IAPT staff need more support & training

Induced fear

Induced fear

• Providers

• What about our recovery rates? • unclear what recovery can be expected for people with LTC & FS

• no data as yet published by HSCIC • HSCIC refusing to publish under FoI

• Where is the workforce coming from • LTC & FS not on current training curricula

Induced fear

• Commissioners • what about prevalence and access targets?

• what does the evidence say re efficacy?

• will GPs complain?

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Next steps

Leaders neededBoth commissioners & providers

Data needed from the number crunchers at HSCIC

Training for IAPT staff and GPs

Co-located therapists

It is achievable