MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK?

[Dx Revision Watch]

http://www.meassociation.org.uk/201...ut-possible-who-coding-changes-21-april-2018/


I am both disappointed and disturbed to note that the ME Association has linked to the initial version of O'Leary's "briefing document".


The initial version contains the following opinions held by Dr O'Leary:

"Criteria for BDD are not particularly problematic for ME patients. They are compatible with construing ME as a biological disease."

and

"What Can We Do About It?
It is very important to be clear and focused about the nature of the objection. ME advocates have no reason to object to the basic criteria for BSS in the ICD for primary care, ICD-11-PHC*. In fact, it is in the interests of ME patients to encourage the WHO to adopt just the basic criteria for BSS as they are currently in place. Both studies by the WHO support doing so, and an additional, independent study in Austria also supports doing so. This is the goal."


Caveat emptor.


These statements do not sit well with Forward-ME, AfME and the MEA's support in 2017 for the proposals submitted by me, and jointly with Mary Dimmock, for addition of exclusions for the G93.3 legacy terms under ICD-11's Bodily distress disorder.


However, the revised version is also problematic.

Suzy Chapman

 

[Dx Revision Watch]

From the MEA's website write up of the Forward-ME meeting:

• The Royal Colleges of Physicians and of General practitioners might not be aware of the effects that this reclassification would have on their members’ diagnosis of patients’ symptoms so the Chairman agreed to write to them.
• Other organisations representing people with MUS should be alerted so that, if they wish, they can make representations to the WHO. The Chairman would find as many of them as possible.

What isn't mentioned in any of the documents issued by O'Leary or by the Countess of Mar is the fact that the task of making recommendations for the revision of the

World Health Organization. (‎1996)‎. Diagnostic and management guidelines for mental disorders in primary care: ICD-10. Chapter 5, Primary care version

has been the purview of the Primary Care Consultation Group (PCCG).

Made up of half psychiatrists, half general practitioners, this 12 member external working group is chaired by Prof, Sir David Goldberg - who is now 84. (He still uses archaic terms like "effort syndrome" for which there is no ICD-10 code.)

Prof Goldberg had overseen the development of the 1996 publication.

Some of the WHO field trials for testing the proposed "Bodily stress syndrome" diagnostic category were part funded by the Institute of Psychiatry - Prof Goldberg's former employers.


One of the PCCG's Vice-chairs is Michael Klinkman; one of the other members is Marianne Rosendal (Fink's colleague).

Both Klinkman and Rosendal are key members of the revision committee for the WHO endorsed ICPC-2 (WONCA).

 

[lilpink]

Correction to this sentence in #683 -

That service will code the patient with ICD-10 F45.0 'somatization disorder' for complaints such as IBS, fibromyalgia and ME/CFS.

The 'somatization disorder' code appears to be utilised as the primary problem for all 'MUS' conditions on IAPT -

https://files.digital.nhs.uk/publication/7/7/iapt-int-rep-dec-2017-exec-sum.pdf

BUT

according to this IAPT document - https://webcache.googleusercontent.com/search?q=cache:YwnUE4lUKZUJ:https://www.digital.nhs.uk/media/31257/Report-on-integrated-IAPT-services-pilot-Executive-Summary-March-2017/pdf/iapt-int-rep-jan-17-mar-17-exec-sum+&cd=2&hl=en&ct=clnk&gl=uk

- in the IAPT LTC/MUS 'pilot' fibromyalgia comes under the LTC - Long-Term Condition of 'chronic pain' rather than 'MUS'.


This confusion arose from the fact that fibromyalgia is included under MUS in some of the medical literature, for example in the BMJ Book "ABC of Medically Unexplained Symptoms", and in articles such as this - https://www.tandfonline.com/doi/full/10.1080/09638237.2017.1322187 , and is implied to be included as a 'MUS' condition in presentations such as this - medically unexplained symptoms and psychological ... - NHS Networks .

Also the authors of this document - VLE – Frequently Asked Questions - UK Government Web Archive - an evaluation of the first phase of the IAPT LTC/MUS roll-out produced by the University of Surrey, on page 10 paragraph 2 seem to include fibromyalgia in the category of MUS rather than LTC.



So to make it clear, the IAPT programme does not appear to now regard fibromyalgia as a 'MUS' condition but instead as a LTC Long Term (chronic pain) condition. Therefore, as far as I'm aware, it is not coded under IAPT as ICD-10 F45.0 'somatization disorder'.

Apologies for this mistake.

 

[Dx Revision Watch]

Correction to this sentence in #683 -

That service will code the patient with ICD-10 F45.0 'somatization disorder' for complaints such as IBS, fibromyalgia and ME/CFS....

Thanks for all the work being done on this, lilpink.

 

[Dx Revision Watch]

As submitted to MEA's website comments:

-------------------------------------------

The MEA’s summary report of the Forward-ME meeting of 28 March contains the following links:

1 Two links to the Dr O’Leary “briefing document” entitled “BODILY STRESS SYNDROME” INFO SHEET” (Document #1).

2 A link for a response by the Countess of Mar, dated 9 April.

An additional revised document was published several days ago on the website of ME Research UK entitled “*IMMEDIATE ACTION NEEDED*” (Document #2).


As a result, there is now considerable confusion as to whether Document #1 has been replaced by the revised Document #2 or whether both Documents are intended to be in the public domain.

On MEA’s Twitter feed, it is stated that “The potential changes to WHO coding for M.E. and CFS are complex. The ME Association hope to add some further clarity very soon.”

I am making available to the MEA background materials which will provide the MEA with accurate and up to date information on:

The status of decisions about PVFS, ME and CFS for ICD-11;
Changes to key ICD Revision personnel and to key committees;
The Timeline for release of the initial version of ICD-11 in June 2018;
SNOMED CT and CFS, ME;
SNOMED CT and BDD.​

I hope the MEA will find this material of use when preparing any responses or other texts in relation to the revision of ICD-11, the forthcoming release of an initial version of ICD-11 and changes to SNOMED CT.

Should the MEA have any queries around the information that is being provided to them, please contact me and I shall be happy to provide clarifications.

On a general note:

The WHO plans to release an initial version of ICD-11 in June, this year. WHO plans to take the ICD-11 to the WHA assembly, in May 2018. But WHO will not be seeking endorsement of the ICD-11 until May 2019.

It is important to understand that the version released in June won’t have been completed:

. the scope of the ICD-11 MMS has been scaled back and not all chapters in this initial release may include “Description” texts for the terms included;

. there are over a 1000 proposals for addition of new terms or for edits to existing content that remain to be processed; many of these are too late for addition to the June release and will have to be reviewed for potential incorporation at a later date.

. external support is being recruited on a contract basis to assist in clearing the workload of preparing user guides and other editing tasks between June through to December, as there is insufficient WHO manpower and resources to complete the work;

. it is unclear now many of the user guidelines and companion publications, for example, the “Clinical Descriptions and Diagnostic Guidelines for ICD-11 Mental and Behavioural Disorders” publication that expands on the Mental, behavioural or neurodevelopmental disorders chapter of the core ICD-11 (similar to the current ICD-10 “Blue Book”) or how many of the other specialty stand alone publications that had originally been planned will have been completed by June 2018, and if not, when they will be completed or whether they may need to be delayed until the content of the core ICD-11 edition has been endorsed by the WHA or until the ICD-11 codings are more stable.

The version of ICD-11 that will be published in 2018 is for testing, evaluation and implementation according to countries’ specific timelines and requirements.

There is no WHO mandated date by which member states will be required to migrate from ICD-10 to ICD-11.

Dr Christopher Chute has predicted it will likely take early implementers around 5 years to evaluate and prepare their countries’ health systems for transition to ICD-11. So no countries will be ready to move onto ICD-11 for several years. NHS Digital has yet to issue a tentative timeline for evaluation and potential migration to ICD-11.

ICD-10 and SNOMED CT are the mandatory classification and terminology systems for use in the NHS.

 

[anni66]

Correction to this sentence in #683 -

That service will code the patient with ICD-10 F45.0 'somatization disorder' for complaints such as IBS, fibromyalgia and ME/CFS.

The 'somatization disorder' code appears to be utilised as the primary problem for all 'MUS' conditions on IAPT -

https://files.digital.nhs.uk/publication/7/7/iapt-int-rep-dec-2017-exec-sum.pdf

BUT

according to this IAPT document - https://webcache.googleusercontent.com/search?q=cache:YwnUE4lUKZUJ:https://www.digital.nhs.uk/media/31257/Report-on-integrated-IAPT-services-pilot-Executive-Summary-March-2017/pdf/iapt-int-rep-jan-17-mar-17-exec-sum+&cd=2&hl=en&ct=clnk&gl=uk

- in the IAPT LTC/MUS 'pilot' fibromyalgia comes under the LTC - Long-Term Condition of 'chronic pain' rather than 'MUS'.


This confusion arose from the fact that fibromyalgia is included under MUS in some of the medical literature, for example in the BMJ Book "ABC of Medically Unexplained Symptoms", and in articles such as this - https://www.tandfonline.com/doi/full/10.1080/09638237.2017.1322187 , and is implied to be included as a 'MUS' condition in presentations such as this - medically unexplained symptoms and psychological ... - NHS Networks .

Also the authors of this document - VLE – Frequently Asked Questions - UK Government Web Archive - an evaluation of the first phase of the IAPT LTC/MUS roll-out produced by the University of Surrey, on page 10 paragraph 2 seem to include fibromyalgia in the category of MUS rather than LTC.



So to make it clear, the IAPT programme does not appear to now regard fibromyalgia as a 'MUS' condition but instead as a LTC Long Term (chronic pain) condition. Therefore, as far as I'm aware, it is not coded under IAPT as ICD-10 F45.0 'somatization disorder'.

Apologies for this mistake.

Carol Monaghan MP may be worth contacting - she has taken an interest and appears to be following up on PACE etc.
Unfortunately SNP MPs don' t generally intervene on areas which are devolved to Scottish Parliament, but this may just be a natter of time ...

 

[lilpink]

Carol Monaghan MP may be worth contacting - she has taken an interest and appears to be following up on PACE etc.
Unfortunately SNP MPs don' t generally intervene on areas which are devolved to Scottish Parliament, but this may just be a natter of time ...

I would love to contact Carol Monaghan, I have quite a lot of information that could be useful to her I think, but it seems well nigh impossible to get in contact with these MPs if they are not your own. If you have any way of contacting her and passing on my details that I could give you back channel then that would be great, or if you could perhaps give me a private contact for her?

 

[anni66]

I would love to contact Carol Monaghan, I have quite a lot of information that could be useful to her I think, but it seems well nigh impossible to get in contact with these MPs if they are not your own. If you have any way of contacting her and passing on my details that I could give you back channel then that would be great, or if you could perhaps give me a private contact for her?

All MPs have parliamentary email but i would imagine it' s difficult to get noticed amongst the many messages.
She is not my MP, however i will raise this with mine.
Carol is speaking at millions missing in Edinburgh and was briefed by MEA re Pace, so perhaps Janet Sylvester or @charles shepherd could provide a direct link.

I think we need to join forces with other illnesses and start a parliamentary petition to try and get a debate?

This is being slipped in with no evidence base with dire consequences for very many illnesses - yet few know

 

[lilpink]

A POCKET GUIDE TO IAPT

What is IAPT?

IAPT is the ‘Improving Access to Psychological Therapies’ programme that has been, and continues to be rolled out across England by the NHS.

It is the ‘brainchild’ of two men, Richard Layard, a Labour Lord and economist, and David Clark, who is currently Professor and Chair of Experimental Psychology at Oxford. Clark previously held the Chair of Psychology at the IoP, KCL, from 2000 to 2011. He was rewarded for his 'services to Mental Health' with a CBE in the 2013 New Year Honours list, the same list that gave Simon Wessely his knighthood.

The idea with IAPT is that a sizeable proportion of the population is afflicted with mental health problems – principally anxiety and depression, but of course other issues too. By allowing everyone access to psychological therapies all these people can be made happier, more positive, more productive in their work, and healthier, so to treat as many people as possible with psychological therapies will boost the economy and reduce health expenditure. People are not so much miserable because their circumstances are miserable, rather they’re miserable because of the way that they view themselves and the world. Change that and everything will be sorted, yay!

They wrote a book about this – ‘Thrive: The Power of Psychological Therapy’ , which was promoted in 2014 https://www.youtube.com/watch?v=a9eHyZmcLCk and their model was actively marketed to politicians of all parties in readiness for the 2015 General Election to try to ensure that they were all on board with the IAPT programme.

What’s the Problem?

Now, there’s perhaps nothing wrong with the idea of providing psychological therapies for free on the NHS to those who feel they may be helpful, but where IAPT starts to fall apart and become dangerous is that they have convinced Government that implementing IAPT will lead to savings across the board, help to cut the NHS budget, boost productivity, get people off benefits and back into work, and keep people in work. It has been heavily criticized by some psychologists (such as Oliver James https://www.youtube.com/watch?v=lTgnzee3vFA ) and therapists for a manualized approach to therapy, a one size fits all that tends to favour CBT above other therapies, and not tailored to the individual needs of the patients. It has also been criticized regarding the role of ‘Employment Advisors’ in the IAPT programme, with fears of sick people being forced into work under threat of benefit sanctions - https://www.disabledgo.com/blog/2017/12/improving-lives-fears-over-strategys-unacceptable-work-and-health-links/#.WtyZ0uSG-70 . The organization DPAC (Disabled People Against Cuts) has been strongly critical and regularly protests against IAPT https://dpac.uk.net/2018/02/protest-against-iapt-therapies/ .

The specific NHS model is that the IAPT programme will pay for itself within the NHS budget because if patients with Long Term Conditions (LTC) and Medically Unexplained Symptoms (MUS) can access the therapies then they will require less physical health services including investigations and outpatient appointments……well that’s the theory. The billions of pounds in savings from these two groups will then pay for the whole programme, including tens of thousands of low intensity therapists or ‘Psychological Wellbeing Practitioners’ (PWPs) - relatively low paid graduates who have received a total of 45 days training for the job and who are often under an immense amount of stress and pressure - https://www.theguardian.com/healthcare-network/2016/feb/17/were-not-surprised-half-our-psychologist-colleagues-are-depressed . If savings aren’t made from these two groups – LTC and MUS – then the project will have failed to deliver on its promise to Government. So the pressure is on for it to succeed. The first phase of the IAPT LTC/MUS roll-out has been evaluated, and unfortunately for them the healthcare costs after IAPT were more than they were before - VLE – Frequently Asked Questions - UK Government Web Archive

How are they evaluating the IAPT service and healthcare costs?

When patients attend IAPT each session they fill out outcome questionnaires. All this is fed into a large database that is managed by NHS Digital; this data collection is apparently key to the success of the IAPT programme. (It is rather like the ME/CFS National Outcomes Database or ‘NOD’ but clearly much larger). All IAPT patients answer questionnaires on anxiety (GAD-7) and depression (PHQ-9) but ME/CFS patients are also given the Chalder Fatigue Questionnaire. Some of the data, including the ‘problem descriptor’ or code (ICD-10 F45.0 ‘somatization disorder’ for all MUS including ME patients), is added to the patient electronic record, but the bulk of the IAPT data collected is added to the IAPT Data Set apparently to monitor and improve the services and for use for health informatics and health research purposes. It is pseudonymized and can then be combined with pseudonymized data from individual’s primary and secondary care record to arrive at costings of healthcare for each individual before and after IAPT treatment. Nice. (And talking of NICE, the information from the IAPT database could well be used to show NICE that CBT and GET work for ME/CFS patients - https://onlinelibrary.wiley.com/doi/full/10.1002/capr.12141 )

Why should ME patients be worried?

Well if you’re not worried by now then let’s spell it out. ME patients are categorized as having MUS in the IAPT programme which delivers them a ‘high intensity’ form of CBT together with GET. It is recommended that MUS patients follow a ‘matched care’ approach - medically unexplained symptoms and psychological ... - NHS Networks (page 15 of 17) rather than the normal ‘stepped care’ approach that is characteristic of IAPT and that sees other patients starting at low intensity interventions and moving up to higher intensity interventions if they’re not effective. Special treatment for more difficult customers!

MUS patients are coded as having ‘somatization disorder’ ICD-10 F45.0 which should be quite a rare diagnosis (if indeed it exists at all). This coding is transferred to their electronic patient record so other healthcare professionals may have access to it and so, from the outset, regard them as somatizers. Doctors and other health professionals have been taught about MUS in workshops and conferences across the country. An emphasis has been placed on the cost of these patients to the NHS, as well as on the problems of ‘somatization’, false illness beliefs and health anxiety. The strong impression is given that these patients are a waste of NHS resources due to their neuroses, and this is bound to create stigma so that doctors do not give them the care and attention that their symptoms warrant or that they deserve. It would be foolish to think that this is in any way accidental. The more pressure that they are under to show that the IAPT model works, the more we should be worried that they will further stigmatize and limit biomedical care to MUS patients to ensure that physical care costs are reduced as a result of the IAPT initiative. Patients with Long Term Conditions should also be worried for similar reasons, as should the elderly who are being targeted with respect to MUS - Hidden in plain sight - Age UK.

They are also seeking to make the IAPT model go global eg this presentation by Professor Clark in Sweden - https://www.youtube.com/watch?v=qRqVJq6LVNo .

Does this have anything to do with Simon Wessely?

Although Wessely appears to have kept somewhat under the radar with this one, it is highly probable that he was involved in the development of the JCPMH ‘Guidance for Commissioners of Services for People with Medically Unexplained Symptoms’ that was jointly produced by the Royal College of Psychiatry and the RCGP and that steers NHS commissioners down the IAPT path for MUS services. Wessely used to be rather enthusiastic about IAPT - https://www.youtube.com/watch?v=EJJOB8-xXuM (from 4 mins) - and called it “the greatest revolution in British mental health in fifty years” - http://www.yhscn.nhs.uk/media/PDFs/mhdn/Mental%20Health/IAPT-LTC/1.%20YH%20IAPT-LTC%20Slides%20-%20October%202017.pdf , but more recently he has been critical of the concentration on ‘mental health awareness’ because apparently the system can’t cope - https://www.bmj.com/content/358/bmj.j4305 . Of course, ‘mental health awareness’ is key to the IAPT model. It’s unlikely though that Wessely’s criticism will extend to challenging the treatment of patients with ME/CFS or ‘MUS’ any time soon.

 

[lilpink]

This is being slipped in with no evidence base with dire consequences for very many illnesses - yet few know

Absolutely. Please feel free to use any info I've posted here if you are able to contact CM.

 

[lilpink]

CBT and GET are not neutral treatments and BDD and BSS are not neutral terms/clinical codes.

Now that in England CBT and GET are being delivered via IAPT, a programme that automatically codes ME/CFS patients with ‘somatization disorder’, no UK ME/CFS charity should regard these treatments as worth considering, even for patients with questionable diagnoses or very mild problems.

Similarly, no UK ME/CFS charity should consider BDD (Bodily Distress Disorder) or BSS (Bodily Stress Syndrome) to be acceptable or workable diagnostic terms/clinical codes. Dx Revision Watch has made this quite clear.

In my opinion, if UK patients want meaningful change then they must demand that their charities vehemently oppose these treatments and codes, and should be prepared to stop supporting the charities if they refuse to do this.

 

[anniekim]

One of the PCCG's Vice-chairs is Michael Klinkman; one of the other members is Marianne Rosendal (Fink's colleague).

Both Klinkman and Rosendal are key members of the revision committee for the WHO endorsed ICPC-2 (WONCA).

@Dx Revision Watch, briefly, am I correct the PCCG committee is a separate committee to the ICPC-2 revision committee? Thank you.

 

[anniekim]

Have I understood it correctly Per Fink’s, Bodily Distress Syndrome construct which is proposed to be renamed Bodily Stress Syndrome in the Primary Care arm will not be listed in the core ICD 11 Tabular list?

 

[Dx Revision Watch]

Have I understood it correctly Per Fink’s, Bodily Distress Syndrome construct which is proposed to be renamed Bodily Stress Syndrome in the Primary Care arm will not be listed in the core ICD 11 Tabular list?

Short answer: Yes.

Longer answer:


BDD:

For the core ICD-11 MMS (which is the equivalent to the Tabular List and the classification mandated by WHO for member state use):

Since 2012, the proposed disorder construct has been "Bodily distress disorder"

ICD-11's BDD has been adapted from the DSM-5's SSD construct, and "Somatic symptom disorder" is listed under Synonyms to BDD.

ICD-11's BDD has also been added to SNOMED CT (in July 2017).



BSS:

For the revision of the ICD-10 PHC (a 25 mental disorder diagnostic and management publication that is not mandatory for member state use):

The construct that has been proposed since 2011 by the external PCCG working group is "Bodily stress syndrome". This has been adapted from Fink's BDS.

More recent field trials have used some further modifications of the original Bodily stress syndrome characteristics and criteria.

Decisions about this construct and its criteria set have not yet been announced. There is no published projected date for the finalization and publication of the revised edition.


Fink had lobbied WHO/ICD Revision to include a special section in the ICD-11 core edition that would incorporate his BDS construct - but it wasn't the shoo in he had hoped for.

At the 2014 Danish parliamentary hearing, Fink also stated he and his colleagues had tried to get WHO to incorporate a section for a special group of disorders where BDS could be placed that was located neither in psychiatry nor in general medicine, but had not been successful.

 

[Dx Revision Watch]

Update #1 and Update #2

Larger version here:

https://dxrevisionwatch.files.wordpress.com/2018/04/update-1-1-timeline.png

Larger version here:

https://dxrevisionwatch.files.wordpress.com/2018/04/update-2-2-timeline.png

Update #3: Current status of PVFS, ME and CFS in ICD-11 Beta draft to follow in few days.

 

[Dx Revision Watch]

@Dx Revision Watch, briefly, am I correct the PCCG committee is a separate committee to the ICPC-2 revision committee? Thank you.

Short answer: Yes, the PCCG is a separate committee but two of its members are also members of the ICPC-2 update and revision committee.


Longer answer: The Primary Care Consultation Group (PCCG) was convened by the WHO Department of Mental Health and Substance Abuse.

The PCCG is a 12 member external working group comprising a mix of mental health and primary care professionals from across the globe, including substantial representation of low- and middle-income countries.

It is chaired by Prof, Sir David Goldberg who had oversight of the 1996 edition.

PCCG's Vice-chairs are Dr Geoffrey Reed [USA] (Senior Project Lead for the Revision of Mental and behavioural disorders chapter of ICD-10). Dr Reed is on secondment to the WHO for the during of the revision process. He is sponsored by the International Union of Psychological Science.

The other Vice-chair is Dr Michael Klinkman [USA].

One of the other PCCG members is Dr Marianne Rosendal [Denmark].

It is Dr Klinkman and Dr Rosendal who are members of the ICPC-2 update and revision committee.

I have meeting summary reports from 2010 that indicate that a BDS construct or a BDS-like construct has been one of the constructs under consideration for potential inclusion in the ICPC-3.


The ICPC-2 is a WHO approved terminology system for recording data in primary care; recording reasons for encounter, practitioner’s assessment of diagnosis, care plan etc. It is managed by WONCA. Available in 34 countries, it is used in primary care in 27 countries and is the mandatory terminology system for recording data in primary care in 6 or 7 EU countries, including Belgium.

The revision of ICPC-2 for ICPC-3 is in development but there is no projected completion date available yet.

The full product is made available under License but a two page PDF of just the codes and disorder categories can be downloaded from the WHO's site. I've attached the PDF.


http://www.globalfamilydoctor.com/s...onal Classification of Primary Care Dec16.pdf

Introduction to International Classification of Primary Care:

Policy-makers, funders and providers of healthcare need to have information about the epidemiology of their communities, and they need to understand what is happening within primary care to improve health services. For providers to effectively record information about this as part of routine clinical practice, easy to use classification tools are necessary.

The International Classification of Primary Care (ICPC) is the most widely used international classification for systematically capturing and ordering clinical information in primary care. It is developed and updated by the World Organization of Family Doctors’ (WONCA) International Classification Committee (WICC). The most recent version is ICPC-2 which was revised in 2015.

ICPC is formally recognised by the World Health Organization’s (WHO) Family of International Classifications (WHO-FIC) as a classification system for primary care. It is mapped to the International Classification of Diseases (ICD). This allows communication between the two classification systems and complementary usage. Ongoing cooperation between WONCA and the WHO-FIC network exists for the revision of ICD-10 to ICD-11 and harmonization with ICPC.

(...)

Why (also) use ICPC and not (only) ICD?

ICPC-2 was last revised in 2015, and was carefully mapped to ICD-10. Whilst ICPC is a full classification system in its own right, it is enhanced by being mapped to ICD. ICPC and ICD therefore are complementary rather than in competition.

(...)

How does it relate to clinical terminologies and other resources?

ICPC codes are most commonly used by family doctors as they provide a sufficiently detailed level for reporting, analysis, and payment of healthcare services. Linking ICPC to clinical terminologies, as for instance the Read codes or SNOMED, makes it easier without becoming too detailed or increasing the risk of coding inconsistencies, to collect data to classify morbidity data, for indexing of medical records, and health statistics. ICPC codes can also be linked to guidelines, prescription systems, laboratory tests, patient leaflets etc. on computerised records, this can enhance their use.

etc.

-----------------------------

I have a paper on the use of the ICPC-2 which states that after ICPC-2, ICD-10 is the second most used classification system in primary care.

 

[Dx Revision Watch]

Because of the moves towards greater harmonization of ICD, SNOMED CT and ICPC-2, and increased integrability between these systems, I would oppose any call for modifications to the BSS criteria set that would bring the criteria closer towards the ICD-11 BDD construct's criteria.

This might potentially facilitate the adding of BSS under Synonyms to ICD-11's BDD and under SNOMED CT's BDD concept (which has been added as an exact match for ICD-11's BDD).


In my view, there is no "better" or more acceptable version of the BSS criteria options. And no flavour of BSS can be considered in the best interests of ME patients.

Failing their omission altogether, I consider it would be better to have BDD across both publications, but with specified exclusions for CFS and ME.

The more BSS moves away from the "pure" Fink construct and criteria set and closer towards BDD, the easier it would be for ICD Revision to justify adding BSS under Synonyms to BDD in the ICD-11 core edition, and to SNOMED CT, for which ICD-11's BDD concept was added in July 2017.

I consider as great a differential as possible should be maintained between the two constructs.

I do not want to see BSS or any flavour of BSS, diluted or not, creeping into the core ICD-11 edition; nor into SNOMED CT - which is now the mandatory terminology system for use in NHS Primary Care.

Additionally, having two differently conceptualized disorder constructs, with very different criteria sets, which capture different patient populations makes it easier to argue against the use of unaligned disorder constructs across these two publications.

 

[Snow Leopard]

Short answer: Yes.

Thank you. All of this goes over my head too.

This stuff is bureaucratic to the extreme and hard to navigate by the uninitiated.

 

[Griffin]

Thank you. All of this goes over my head too.

This stuff is bureaucratic to the extreme and hard to navigate by the uninitiated.

I wonder if this is deliberate?

 

[lilpink]

IAPT's joint principal architect, LORD LAYARD, in the House of Lords debate on the PACE Trial - 6th February 2013:


https://hansard.parliament.uk/Lords/2013-02-06/debates/130206114000195/PACETrialChronicFatigueSyndromeMyalgicEncephalomyelitis at 5.54 pm


Similar to Lord Winston's claims of vilification of researchers (contribution starting at at 5.36 pm), Lord Layard winds up his contribution with claims of insults, death threats and harassment. (I'd love to know what he was about to say when he was interrupted with a reminder about the time.)

A bit of a theme going on there. ( And Baroness Northover in the closing speech reminds the listener of Lord Winston's and Lord Layard's claims ....... hmm).