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

trishrhymes

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My shameful confession is that I am one. The ONLY good thing to result from ME, is that it prevented me from gaining a PhD in psychology and pursuing a career as a psychologist.

The utter shame of my previous false beliefs in psychology.

Hangs head in shame! I was young though........................
It's not the fault of undergraduate psychology students and new graduates, nor of nurses who are being trained in this garbage.

The fault lies squarely with the likes of Wessely, White, Sharpe and Crawley who are doctors who know perfectly well that it's all a pack of lies but choose their own careers above the truth.

You have nothing to feel ashamed of. And if you had stayed well, maybe you would have been one of the ones who recognised the lies you were being told and spoke truth to power.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Another very grateful thanks to Suzy for her amazing effort on this stuff, over many years. It is exactly the kind of detailed record that will help stop this insanity, and hold the perpetrators accountable.
Thank you, Sean, for your kind words. Though I don't hold out much hope for holding back the tide - at least not under this government.

Part of

The taskforce report "Five Year Forward View for Mental Health - NHS England"

https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf

Implementing the Five Year Forward View for Mental Health

https://www.england.nhs.uk/wp-content/uploads/2016/07/fyfv-mh.pdf

to which the government responded on January 9:


The Government’s response to the Five Year Forward View for Mental Health


https://www.gov.uk/government/publi...rd-view-for-mental-health-government-response

"This report sets out the government’s response to the work of the Mental Health Taskforce. The taskforce report to NHS England, the Five Year Forward View for Mental Health, is an independent and far-reaching overview of what modern mental health services should be.

"The government will accept the taskforce report’s recommendations in full. This report provides full responses to each of the 58 recommendations made to government."

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

http://psnc.org.uk/our-news/health-care-review-47/

NHS England announces new mental health services to help 30,000 people

9 January 2017

NHS England has announced a range of new mental health services launching next month (February 2017) designed to provide support for people living with long-term physical health issues. NHS England will be providing £31 million to fund these services and will also be working with 22 Improving Access to Psychological Therapies (IAPT) services starting from this month (January 2017).

The IAPT programme will be provided to an estimated 30,000 people over the next two years, covering 30 Clinical Commissioning Groups (CCGs). The programme will fund therapists, mainly based in GP practices. The therapists will be working directly with patients and support other clinicians.

A pilot conducted by NHS England demonstrated better outcomes and a 20% reduction in healthcare costs when physical health problems are treated alongside mental health problems in an integrated manner.

The first wave of sites will initially focus on diabetes, respiratory disease, cardiovascular disease and long-term conditions where the evidence of the impact of this approach is strongest. Services will also support people with cancer, and medically unexplained symptoms such as chronic pain and chronic fatigue syndrome.

Priorities for the NHS and social care in 2017

The King’s Fund has published a web-feature outlining five main priorities it has identified for 2017 across the health and care system.

The priorities were identified in the context of leaders being able to deliver their plans in accordance with the NHS Five Year Forward View and the NHS providing evidence to demonstrate that the new care models are delivering benefits.

The priorities identified are:

  1. supporting new care models centred on the needs of patients;
  2. strengthening and implementing Sustainability and Transformation Plans;
  3. improving productivity and delivering better value;
  4. developing and strengthening leadership at all levels; and
  5. securing adequate funding for health and social care.
 
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MEMum

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Suzy
You have done a brilliant job in putting this together.
Thank you so much for the time, effort and initiative.

I could only press 'like' for the first few posts as my main response is to want to scream!

Aaaaaaaaargh!:mad::mad::mad::mad::mad::mad::mad::mad::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head::bang-head:

Are there 2 parallel Universes here, with the psychs on one and the rest of us on the other?

In a way it's comforting that they are including other LTCs (long-term conditions) as maybe this will bring the farce into the public domain more quickly.

I was slightly amused by the Devon material: we "can help by supporting with ..stress, debt and isolation".
I thought this was what stigma initiated by PACE had already done...No surprise that it credits the Sharpe-Oxford model.
 
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MeSci

ME/CFS since 1995; activity level 6?
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My shameful confession is that I am one. The ONLY good thing to result from ME, is that it prevented me from gaining a PhD in psychology and pursuing a career as a psychologist.

The utter shame of my previous false beliefs in psychology.

Hangs head in shame! I was young though........................
I did a psychology course too, but I was already suffering from M.E. and very sceptical of a lot of it. I don't know to what extent my niece has been taken in - she is studying it now...

Trouble is, my family don't seem to know anything about M.E. at all.
 

MEMum

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@Countrygirl . Not all psychs are bad.

I have a congenital spinal deformity. Basically a couple of wedge-shaped vertebrae and a few other dodgy bits (of spine).
It was fine till age 18, when I had major surgery. (I was deconditioned after 3 months in hsp, but common sense,rather than GET or CBT got me back to full activity). Then fine again till 22 years ago.
I have been helped by counsellors/psychotherapists etc to adjust to the life-altering physical limitations and pain.
It only took me about 18 years to accept that I was unlikely to be able to hold-down a part-time, paid job again....,and other unrealistic expectations. Still hoping for progress on replacement backs.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Two Scottish examples, just brought to my attention:

Scottish School of Primary Care GP Clusters
Briefing
Paper 4


Recognising and managing patients with “medically unexplained” physical symptoms

by Chris Burton


At the end:

"Clinician resources
NICE Irritable Bowel Syndrome: https://www.nice.org.uk/guidance/cg61
NICE Chronic Fatigue Syndrome (2007, due for up-date in 2017): https://www.nice.org.uk/guidance/cg53 "

PDF here: http://www.sspc.ac.uk/media/media_484730_en.pdf

and in attachment below.


Also Scotland:

http://www.nes.scot.nhs.uk/educatio...hology/mus-long-term-conditions-toolkit.aspx#

NHS Education for Scotland
Quality Education for a Healthier Scotland

MUS - Long Term Conditions Toolkit
 

Attachments

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Medically Unexplained Symptoms

This exciting and innovative conference is designed to bring together experts from primary and secondary care, who will present practical and thought-provoking models of work in the field of Medically Unexplained Symptoms (MUS).
" practical and thought-provoking"?

What, because they're just hypothetical and not based on evidence...
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Our old friend, Vincent Deary...

The AHSN Network

https://www.ahsn-nenc.org.uk/about-us/the-network/

"In May 2013, England became the first country in the world to create a nationwide system integrating the work of healthcare, academia and industry: the Academic Health Science Networks (AHSNs). The AHSNs have a unique opportunity to align: education, clinical research, informatics, innovation and healthcare delivery in support of economic growth.

"There are 15 AHSNs across England. Their activity is focused on two interrelated imperatives: improving population health and generating economic growth in our regions. AHSNs have also been established to deliver a step-change in the way healthcare providers identify, develop, adopt and spread new technologies..."


https://www.ahsn-nenc.org.uk/project/226/

North East and North Cumbria

Improving Patient Pathways for Persistent Physical Symptoms


"Persistent physical symptoms (PPS) such as Chronic Fatigue Syndrome, Irritable Bowel Syndrome and Fibromyalgia account for at least 15% of GP consultations and account for up to 30-50% of referrals to specialists..."



http://new.ahsn-nenc.org.uk/wp-cont...pPatientPath-Case-Study-30-AUG-2016-FINAL.pdf

Improving Pathways for Persistent Physical Symptoms: Case study

"For many Persistent Physical Symptoms there is now a good understanding of why symptoms occur and good evidence for the best treatments."

" We developed a range of resources for health professionals and people with PPS, which to our knowledge, is the first of its kind in the UK.” Dr Vincent Deary, Project Lead, Health Psychologist and Reader in Health Psychology, Northumbria University

Resources:

We need to talk about symptoms: an introduction
Information for health professionals on Persistent Physical Symptoms
http://new.ahsn-nenc.org.uk/wp-cont...ed-to-talk-about-symptons-an-introduction.pdf

We need to talk about symptoms: narratives and explanations
Information for health professionals on Persistent Physical Symptoms
http://www.ahsn-nenc.org.uk/wp-content/uploads/2014/12/387698SA-We-need-to-talk-Narratives-HR.pdf

We need to talk about symptoms: a GP Perspective
Information for health professionals on Persistent Physical Symptoms
http://new.ahsn-nenc.org.uk/wp-content/uploads/sites/3/2014/12/WNTT-GP-Perspective.pdf

Top Tips for successful Persistent Physical Symptoms consultations
http://www.ahsn-nenc.org.uk/wp-content/uploads/sites/3/2014/12/Top-Tips-for-PPS-Final.pdf

What’s causing my symptoms?
http://new.ahsn-nenc.org.uk/wp-content/uploads/sites/3/2014/12/Whats-causing-my-symptoms.pdf


Persistent Physical Symptoms Resource Pack
This resource pack brings together a range of resources from NHS organisations, charities and research institutions to support health professionals and people with Persistent Physical Symptoms manage a range of symptoms.
http://www.ahsn-nenc.org.uk/wp-content/uploads/sites/3/2014/12/Resource-Pack-Final.pdf


A presentation here (if you can stomach it):

Improving care pathways for people with Persistent Physical Symptoms

Dr Vincent Deary, Joanne Smithson, Dr Michaela Faye.

https://www.rcplondon.ac.uk/file/2177/download?token=pIT1Eu2Y

"Who is the PPS patient?

"Before falling ill, the vast majority of participants in our
research had enjoyable, full, often stressful, jobs and
careers, juggling multiple interests and commitments.
Many vividly describe their ‘crash’ out of the work:
“I used to work 50 hours a week, then 25, then 10 then
I gave up”.
“I’d been a hard worker and I was having problems and
- for a GP to turn around and say to somebody who
could work so hard, that there’s nothing wrong with
you? It just blew a fuse in my head”



The AHSN Network

http://www.ahsn-nenc.org.uk/about-us/partners/national-ahsns/

Eastern Academic Health Science Network
East Midlands Academic Health Science Network
Greater Manchester Academic Health Science Network
Health Innovation Network (South London Academic Health Science Network)
Imperial College Health Partners (North West London Academic Health Science Network)
Kent, Surrey and Sussex Academic Health Science Network
North West Coast Academic Health Science Network (The Innovation Agency)
Oxford Academic Health Science Network
South West Academic Health Science Network
UCL Partners Academic Health Science Network
Wessex Academic Health Science Network
West Midlands Academic Health Science Network
West of England Academic Health Science Network
Yorkshire and Humber AHSN

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

http://fabnhsstuff.net/2016/06/06/new-persistent-physical-symptom-service/

Report:

The new Persistent Physical Symptom Service

"The Persistent Physical Symptoms Service offers an integrated pathway for all patients with persistent symptoms (rather than due to any underlying pathology) in North, East and West of Cumbria.

There was some wonderful feedback – with most attendees commenting that the PPSS launch is an exciting and much needed development

• “I think it is very exciting and long awaited development in Cumbria. It should fill a large hole for patients who in the past have had nowhere to go.”

• “Thrilled about such a positive resource for patients.”

• “Excited for patients and a well needed service.”

• “It sounds like a really useful and rounded resource for managing so very difficult to help patients”

• “Hallelujah! At last we have some support in managing these challenging patients. I look forward to working with the PPSS team to improve the lives of these patients.”

“Seems too good to be true. Already have a list of patients who would benefit.”
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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https://www.gsttcharity.org.uk/what-we-do/our-impact/stories/persistent-physical-symptoms

Guy's and St Thomas' Charity

Development of a single approach to caring for people with PPS

Start date: April 2014
End date: September 2017
Grant value: £2,259,603

Improving care for people with persistent physical symptoms
Creating a single approach to treating people with PPS


"This project plans to address this issue by creating a single approach to treating people with PPS that brings together the expertise of GPs, hospital clinicians and psychologists."

"The ambition is that this approach will lead to a service that is twice as effective as current practice, and which could save the NHS £3.6m a year across Lambeth and Southwark if made available to all individuals suffering with PPS"

"The project will develop and test a new way of treating patients with PPS in both general practice and hospital care over the next three years, helping up to 1,300 individuals experience better care as they do so."


"The project team plan to keep in close contact with local clinical commissioning groups to maximise the chances of a successful pilot being adopted by the NHS and becoming part of regular services."

"The project brings together healthcare organisations from across King’s Health Partners, working in collaboration with local GPs."

"The support of the Institute of Psychiatry is vital in ensuring that the new approach is effectively evaluated."
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Edited to add Update

There is a PRINCE Secondary Care Trial
https://clinicaltrials.gov/ct2/show/NCT02426788

The PRINCE Secondary Study: Persistent Physical Symptoms Reduction Intervention: a System Change and Evaluation in Secondary Care


which was written about in this PR thread in November:

http://forums.phoenixrising.me/inde...ptoms-reduction-intervention-cbt-trial.48121/

in which a participant in the PRINCE Secondary Care Trial contributes her experiences.

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

https://clinicaltrials.gov/ct2/show/NCT02444520

Feasibility study:

Persistent Physical Symptoms Reduction INtervention: a System Change & Evaluation in Primary Care (PRINCE Primary)

ClinicalTrials.gov Identifier:
NCT02444520

This study is not yet open for participant recruitment.
(see Contacts and Locations)
Verified May 2015 by King's College London
Sponsor: King's College London
Collaborator: South London and Maudsley NHS Foundation Trust
Information provided by (Responsible Party): King's College London

Medically unexplained symptoms (MUS) can be defined as physical symptoms that at present have no clear physical pathological cause. In primary care between 20 and 40% of patients have medically unexplained physical symptoms and in secondary care this figure rises to 50% in many specialties.

This study design is a cross over randomized controlled trial with a waiting list to evaluate the acceptability and feasibility of studying a whole systems approach to care in general practice for adults with PPS. 'Integrated GP care' will be compared with treatment as usual (TAU) within a waiting list design.

The aim of this study is to assess the feasibility of conducting a future randomized trial and to identify suitable primary outcome measures (outcomes that may be affected by 'integrated GP care'), for a future trial evaluation and to inform the sample size/power calculation for such a trial.

(...)

Estimated Enrollment: 240
Study Start Date: May 2015
Estimated Study Completion Date: October 2017
Estimated Primary Completion Date: March 2017 (Final data collection date for primary outcome measure)

(...)

Sponsors and Collaborators
King's College London
South London and Maudsley NHS Foundation Trust

Investigators
Principal Investigator: Trudie Chader, PhD King's College London
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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https://www.hsj.co.uk/sectors/commi...nts-with-unexplained-symptoms/5068228.article

Commissioning

Detective work: help patients with unexplained symptoms

10 March, 2014 By Helen Payne

"A new Hertfordshire University spin-off company is delivering proven treatment for high costing patients suffering from chronic physical symptoms without any medical explanation such as fibromyalgia, myalgic encephalomyelitis, irritable bowel syndrome and chronic fatigue."

Pathways2Wellbeing has transferred knowledge from proof of concept, market research and health economy studies into Hertfordshire NHS, and is actively pursuing other clinical commissioning groups in the UK.

(...)

"Repeated consultations and tests only reinforce that there is a diagnosis but it just has not been found yet"

(...)

Exploring symptoms
Patients are encouraged to practice various techniques, including relaxation such as guided imagery, body awareness exercises such as breathing and mindful movement to help positive reassociation with the body.

There are also exercises designed to encourage appreciation of the nature of their symptom, such as taking up a physical stance to represent one quality of their symptom. This leads to an exploration of their relationship to the symptom such as a role-play dialogue and examining the symptom’s purpose through creative media such as collage and clay modelling.

(...)

"Potential savings
The potential savings per GP per year from using Pathways2Wellbeing groups for all medically unexplained symptoms patients is 383 hours in consultation time and includes savings of:
  • £70,757 for consultations;
  • £22,537 for prescriptions;
  • therefore the total savings for medically unexplained symptoms patients per GP per year is £93,294; and
  • GPs have an increased capacity – approximately 383 hours per year per GP – and hospital referral letters, tests, scans and appointment costs are saved amounting to approximately £133,000 for every 30 patients.
(...)

The aim is to facilitate alternative connections between physical symptoms and patient perception of their symptoms based on creative practices, which develop mindfulness, body awareness, activity, self-regulation and stress reduction, reflection and meaning making.

In this way the group promotes a new relationship with symptoms, expanding the patient’s inner resources.

(...)

They enjoy meeting other patients and exploring their symptoms together. No one has to disclose their symptoms but they do have to open their minds to the possibility that the symptom may have a purpose and be willing to creatively examine this...

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

Clay modelling to examine the symptom's purpose, anyone?

I'll be posting more on Prof Helen Payne's Hertfordshire University spin-off, tomorrow.
 
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Sean

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The concept of medically unexplained symptoms can also include people who have a physical condition but experience symptoms at a level that is disproportionate to the severity of that condition.*
Disproportionate as judged by what means?

No room for error there, huh? Completely safe.

"For many Persistent Physical Symptoms there is now a good understanding of why symptoms occur and good evidence for the best treatments."
Lies.

"Before falling ill, the vast majority of participants in our
research had enjoyable, full, often stressful, jobs and
careers, juggling multiple interests and commitments.
Many vividly describe their ‘crash’ out of the work:
“I used to work 50 hours a week, then 25, then 10 then
I gave up”.
“I’d been a hard worker and I was having problems and
- for a GP to turn around and say to somebody who
could work so hard, that there’s nothing wrong with
you? It just blew a fuse in my head”
Ah, the ol' stress and burnout model cult is back.

Yep, a cult.

"A new Hertfordshire University spin-off company is delivering proven treatment
More lies.

clay modelling
Yeah, that will fix it. o_O

:bang-head::bang-head::bang-head:
 

Ysabelle-S

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I am raging. Have been raging on twitter for a good part of today over this. Utter mendacious quacks. They're not even clever about hiding their real motives. That's the level of arrogance and/or incompetence. They must think we'll never see this stuff, or that there will be no come back for them. There is a moral sickness in UK psych/medicine & academia. ME will probably be rescued before some other illnesses (tho they will try to cling on as long as they can), but we cannot abandon those other patients. The psychosomatic cult & its quack beliefs needs to be thoroughly exposed.
 

Sean

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Hallelujah!
Maybe that was in gratitude for the convenient arse-covering excuse to not do your job properly with the harder cases that come through your clinic, to not have to simply admit that you and your profession don't know what the problem is, and have little to offer.

So much easier to lie and put the blame back on the patient.
 

Esther12

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Thank you, Sean, for your kind words. Though I don't hold out much hope for holding back the tide - at least not under this government.
What about if PACE falls? I think that could do a good job of undermining the whole field. Lots of people wouldn't want to acknowledge that, and we'd still have a lot of fighting to do, but it is the jewel in their crown - to show it's a con job wouldn't help their prestiege.
 

antherder

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Clay modelling to examine the symptoms purpose, anyone?
This suggestion alone warrants a response--in the form of a mockumentary. I'm thinking a youtube skit with a clay modelling class setting. (Title, Fun with Clay, maybe? Or Clay Play...or Okay With Clay...)

An interviewer goes around the room asking each participant to explain their clay creation, and how it has helped "cure" them of their illness belief. They all look sick, and disinterested, because, you know...they are...

Not sure of all the details yet, but at the end, the camera pans to reveal a giant clay pig, being molded by the only enthusiastic participant--the class teacher/facilitator. The pig's purpose, of course, is to hold all of the money amassed from his/her psychobabble.

Would have to be loaded with sarcasm/wit, naturally.