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

[Dx Revision Watch]

(AHSN-NENC = The Academic Health Science Network for the North East and North Cumbria)

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

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.​

again, unreferenced. But note the above says: "Persistent physical symptoms (PPS) such as...account for..."


whereas, Deary et al have stated in their slide presentation:

"...Our work is focusing on three PPS:Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome (IBS) and Fibromyalgia.

These three PPS account for at least 15% of GP consultations and up to 30-50% of referrals to specialists"

​

So, he's jumped from all PPSs (of which CFS, IBS, FM are considered in the context of the above text to be a subset) to claiming CFS, IBS and FM account for up to 30-50% of referrals to specialists.

If I don't receive a timely response from him, I shall copy in another colleague and a superior and quote the above comparison of text.

 

[dyfalbarhau]

Seems very strange to be making 5 year plans forward when NICE guides for CFS/ME are up for review. Do they already know the answer about GET CBT???

I think the answer to any question along the lines of "Is CBT effective and cheaper than doing something else" is always going to be "yes", regardless of the contextual information that says otherwise, even if it gets downgraded to "adjunct therapy".

I am envisaging huge waiting lists for actual treatment at one or two far-flung centres (in the future), and whilst we wait we will be pushed into CBT/GET as a management therapy.

 

[slysaint]

A patient can also opt out of having an SCR

One of my first threads:
http://forums.phoenixrising.me/index.php?posts/664019/

they scrapped the idea last year...........but medical records are a mess.

 

[Dx Revision Watch]

One of my first threads:
http://forums.phoenixrising.me/index.php?posts/664019/

they scrapped the idea last year...........but medical records are a mess.

They scrapped the Care Data scheme but have they scrapped Summary Care Records (SCRs) being held by GPs and in some cases, pharmacists? This appears to be in use and over 95% of patients are opted in.

http://psnc.org.uk/contract-it/pharmacy-it/electronic-health-records/summary-care-record-scr-home/

What is the SCR?

http://psnc.org.uk/contract-it/phar...record-scr-home/scr-overview/what-is-the-scr/

SCR and the NHS

http://psnc.org.uk/contract-it/phar...record-scr-home/scr-overview/scr-and-the-nhs/

Implementation

http://psnc.org.uk/contract-it/phar...cr-home/preparing-for-scr/scr-implementation/



http://www.nhs.uk/NHSEngland/thenhs/records/healthrecords/Documents/2016/SCR-patient-leaflet.pdf

Your Summary Care Record
Care professionals in England use an electronic record called the Summary Care Record (SCR). This can provide those involved in your care with faster secure access to key information from your GP record.

 

[slysaint]

They scrapped the Care Data scheme but have they scrapped Summary Care Records (SCRs) being held by GPs and in some cases, pharmacists?

http://psnc.org.uk/contract-it/pharmacy-it/electronic-health-records/summary-care-record-scr-home/

What is the SCR?

http://psnc.org.uk/contract-it/phar...record-scr-home/scr-overview/what-is-the-scr/

SCR and the NHS

http://psnc.org.uk/contract-it/phar...record-scr-home/scr-overview/scr-and-the-nhs/

Implementation

http://psnc.org.uk/contract-it/phar...cr-home/preparing-for-scr/scr-implementation/



http://www.nhs.uk/NHSEngland/thenhs/records/healthrecords/Documents/2016/SCR-patient-leaflet.pdf

Your Summary Care Record
Care professionals in England use an electronic record called the Summary Care Record (SCR). This can provide those involved in your care with faster secure access to key information from your GP record.

When I first enquired about my SCR I was told it only contained information about allergic reactions to drugs (which in my case did not exist according to them so I drew up a list which they have since added, although I've opted out of all the NHS databases; at least I have requested to be opted out).

according to the NHS website SCRs:
"
If you are registered with a GP practice in England, you will have a Summary Care Record (SCR) unless you have chosen not to have one. Your SCR contains the following basic information:

• the medicines you are taking
• your allergies
• bad reactions you may have to certain medicines

It also includes your name, address, date of birth and unique NHS Number which helps to identify you correctly."

http://www.nhs.uk/NHSEngland/thenhs/records/healthrecords/Pages/overview.aspx#SCR

You can request to have other info added but I don't know if they are adding the Patient History Summary. From what I read I thought they had abandoned the idea because of the way it was set up ie you were automatically opted in unless you specifically requested to be opted out.
Once I saw my medical records (including a few pages of someone elses that had been inadvertently included) there was no way I wanted anyone else to base what could potentially be an important medical decision on what they contained.
Then when they were also talking of the DWP amongst others having access..............

"significant medical history" and requesting that any inaccuracies are amended.

tried this and they(Ie GP) said they couldn't as the medical records are owned by the NHS.

sorry I've got your thread off topic

 

[Dx Revision Watch]

tried this and they(Ie GP) said they couldn't as the medical records are owned by the NHS.

I would have challenged that.

 

[Dx Revision Watch]

Might be worth keeping on file:

http://www.medicalprotection.org/uk...and/england-factsheets/uk-eng-medical-records

Medical records
1 Feb 2015

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

http://www.nigb.nhs.uk/pubs/amendrecords.pdf

Requesting amendments to health and social care records

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

SH IG 07
Clinical Record Keeping Policy
Amending Inaccuracies in Clinical Records
August 2016

http://www.southernhealth.nhs.uk/Ea...ssetID=34443&type=Full&servicetype=Attachment

 

[Dx Revision Watch]

Meanwhile three clinical commissioning groups in the West Midlands have proposed reducing the number of people who qualify for hip replacements by 12% due to funding shortages.

"....Stephen Cannon, the vice-president of the Royal College of Surgeons, said the idea was futile and unfair...

"...In a statement earlier, he said: “While the CCGs have stated they hope this policy will save them £2m a year, it is unclear whether they have considered the costs of not treating a patient. This could include the cost of pain relief medication and a later operation when the patient does meet the required pain and weight thresholds.

“Delaying access to surgery also adversely affects a patient’s quality of life and surgical outcomes, meaning the operation may not be as beneficial as if it had been carried out earlier.”

He added: “Such criteria are in explicit contravention of Nice and surgical commissioning guidance, and have no clinical justification in being applied to a general population to determine who gets NHS treatment. This policy is the latest demonstration of how NHS financial pressures are directly affecting patients.”"

https://www.theguardian.com/society...urgeons-slam-plans-hip-knee-replacements-ccgs​

But never mind...you can have a CBT sticking plaster from IAPT for your long-term condition and your chronic pain and the misery this is causing you. NHS is chucking plenty of £££££ at that.

Very shortsighted. Even moderate pain from an arthritic hip will potentially limit ability to exercise which may have implications for cardiovascular health, Type 2 diabetes, weight gain, work place accommodations, ability to function as a caregiver etc.

 

[Countrygirl]

I have a couple of cataracts in the process of growing, and so sat up and took notice when I heard on the news that the necessary surgery is being cut. The NHS also claims you only need one eye so the other one will possibly remain blind.

http://www.dailymail.co.uk/news/art...life-changing-cataract-surgery-thousands.html

 

[Dx Revision Watch]

I have a couple of cataracts in the process of growing, and so sat up and took notice when I heard on the news that the necessary surgery is being cut. The NHS also claims you only need one eye so the other one will possibly remain blind.

http://www.dailymail.co.uk/news/art...life-changing-cataract-surgery-thousands.html

What if a patient drives? Are you permitted to drive with good sight in only one eye?

Answering my own Q: Yes with caveats:

https://help.rnib.org.uk/help/daily-living/transport-travel/monocular-drive

 

[Countrygirl]

What if a patient drives? Are you permitted to drive with good sight in only one eye?

It will drum up some more business for A&E if the roads are used by an army of elderly one-eyed drivers.

 

[Snow Leopard]

If I don't receive a timely response from him, I shall copy in another colleague and a superior and quote the above comparison of text.

It's clearly a falsehood. I just wonder why his audience didn't put up their hands and say "citation needed".

 

[Dx Revision Watch]

Open Access

PDF: http://bmjopen.bmj.com/content/7/1/e014844.full.pdf

http://bmjopen.bmj.com/content/7/1/e014844

Mental health
Research

E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services

M R Bennion1, G Hardy1, R K Moore2, A Millings1

1. Department of Psychology, University of Sheffield, Sheffield, UK
2. Department of Computer Science, University of Sheffield, Sheffield, UK

Abstract

Objective To document the range of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service (NHS) in England.

Design The study was conducted using Freedom of Information (FOI) requests and systematic website searches.

Data sources Data were collected via FOI requests to NHS services between 13 February 2015 and 31 March 2015, and searches conducted on NHS apps library websites between 26 March 2015 and 2 November 2015.

Data collection/extraction methods Data were compiled from responses to: (1) FOI requests sent to all Improving Access to Psychological Therapies (IAPT) services and NHS Mental Health Trusts in England and (2) NHS apps library search results.

Results A total of 61 (54.95%) out of the then 111 IAPT service providers responded, accounting for 191 IAPT services, and all 51 of the then NHS Mental Health Trusts responded. The results were that 13 different web apps and 35 different smartphone apps for depression, anxiety or stress were available through either referral services or the online NHS Apps Libraries. The apps used and recommended vary by area and by point of access (online library/IAPT/trust).

Conclusions Future research is required to establish the evidence base for the apps that are being used in the NHS in England. There is a need for service provision to be based on evidence and established guidelines.

http://dx.doi.org/10.1136/bmjopen-2016-014844

 

[Countrygirl]

http://www.jcpmh.info/wp-content/uploads/jcpmh-mus-guide.pdf

More of the same!

(Not sure if it has been posted elsewhere, but thought it should be stored here)

 

[Esther12]

http://www.jcpmh.info/wp-content/uploads/jcpmh-mus-guide.pdf

More of the same!

(Not sure if it has been posted elsewhere, but thought it should be stored here)

That looks rubbish. It's worrying how much stuff like that can affewct people's lives.

 

[Countrygirl]

https://dxrevisionwatch.files.wordpress.com/2013/06/mus-whole-systems-approach.pdf

The GP would under-take to review the most severely affected patients 6 monthly (or yearly) with a senior mental health professional. The GP would be the named doctor for the patient. The GP would keep track of any attendances at A&E departments, walk-in centres etc. The GP would watch for any new referrals from these points of contact in to secondary care and if they were for known conditions that the patient had been investigated for, they would halt the onward referrals. The GP would liaise with the local hospitals, ensuring consultants did not refer to secondary care colleagues unless appropriate.

I am just wondering if this new way of throwing patients under the bus which has already been adopted here, explains why my GP is ignoring letters (a few of them now) to investigate the causes of the malignant hypertension which is laying me low after my bout of last weekend. I am puzzled why the surgery is completely ignoring the instructions of the A&E doctors to arrange investigations. I was told it is a secondary condition and the primary cause must be sought because if it is left the long-term survival rate is only 1%, but considerably higher if treated appropriately. The only offer I have had from my GP is to see a new CBT outfit they have set up here, while I am left with hypertensive encephalopathy and angina from the last attack. I have little doubt that if I did not also have ME that I would have been investigated and the cause treated by now.

This may sound a little strong, but from where I am sitting right now I think they are risking a charge of manslaughter..........if not more..................as they are deliberating withholding investigations into an ultimately fatal condition, or worse, paralysis. Not that it would be viewed that way, of course.

 

[Chrisb]

I begin to suspect that we should all keep an updated history of our medical neglect on the mantelpiece with strict instructions that it be passed to the coroner as and when necessary.

 

[MeSci]

I begin to suspect that we should all keep an updated history of our medical neglect on the mantelpiece with strict instructions that it be passed to the coroner as and when necessary.

I was thinking similarly.

 

[Countrygirl]

I was thinking similarly.

That was my thought this morning too.

I also considered asking the GP to put in writing that they are refusing to follow the hospital doctor's instructions (repeatedly!) to investigate and that, instead, they are recommending CBT.

I could imagine that this would not be greeted with overwhelming enthusiasm and it would be refused. Still..................I might still ask. Maybe follow it up with a similar request to the practice manager.

 

[trishrhymes]

That was my thought this morning too.

I also considered asking the GP to put in writing that they are refusing to follow the hospital doctor's instructions (repeatedly!) to investigate and that, instead, they are recommending CBT.

I could imagine that this would not be greeted with overwhelming enthusiasm and it would be refused. Still..................I might still ask. Maybe follow it up with a similar request to the practice manager.

Excellent idea, @Countrygirl .

I suggest you put your request for this referral and their response in writing, and lodge a copy with your lawyer, and tell the doctor you are doing so. And take a witness with you to the appointment...

It must surely be unethical for a GP to refuse to refer you for tests recommended by a hospital doctor. You could also say you are going to send a copy of this correspondence to the hospital concerned to place in your file for the record.

Look after yourself, you are worth far more this shoddy treatment and dangerous neglect.