Powered by
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
Powered by
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
Powered by
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?
Powered by
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
Top Related