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

anni66

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https://www.parliament.uk/business/...nts/written-question/Lords/2018-05-01/HL7468/

Chronic Fatigue Syndrome: Written question - HL7468

Asked by The Countess of Mar
Asked on: 01 May 2018

Department of Health and Social Care
Chronic Fatigue Syndrome

HL7468
To ask Her Majesty's Government what are the recovery rates of patients with myalgic encephalomyelitis who have received treatment under the Improving Access to Psychological Therapies programme.


Answered by: Lord O'Shaughnessy
Answered on: 15 May 2018

This information is not available.
So how is the programme assessed if there is no data?
Or is there noone to interpret it?

Raises questions re evidence base. Or is this another " beautiful ship" ?
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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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'.

Thought I'd mention, here, that for ICD-11, Fibromyalgia has been relocated from its ICD-10 legacy chapter location (Chapter: XIII Diseases of the musculoskeletal system or connective tissue) to ICD-11's Symptoms, signs chapter:

(and you need to drill a long way down)

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/236601102

ICD-11 Foundation

Chapter 21: Symptoms, signs or clinical findings, not elsewhere classified
> General symptoms, signs or clinical findings
>> General symptoms
>>> Pain
>>>> Chronic pain
>>>>> Chronic primary pain
>>>>>> Chronic widespread pain
>>>>>>> Fibromyalgia



The ICD-11 MMS (Mortality and Morbidity Statistics) Linearization is the ICD-11 equivalent to ICD-10's Tabular List.

Concept term Fibromyalgia is not discretely coded for in the MMS Linearization.

Instead, Fibromyalgia is rolled up as an Inclusion term under

MG40.01 Chronic widespread pain

so it takes the same code as concept "MG40.01 Chronic widespread pain".


Screenshot to show hover text indicating that Fibromyalgia is not included in the MMS Linearization as a discretely coded for entity, but as an Inclusion under concept, Chronic widespread pain:






https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/849253504

ICD-11 MMS (Mortality and Morbidity Statistics) Linearization

Chapter 21: Symptoms, signs or clinical findings, not elsewhere classified
> General symptoms, signs or clinical findings
>> General symptoms
>>> Pain
>>>> MG40 Chronic pain
>>>>> MG40.0 Chronic primary pain
>>>>>> MG40.01 Chronic widespread pain



Note the Description for the new parent block "Chronic primary pain":

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/1326332835

Description
Chronic primary pain is chronic pain in one or more anatomical regions that is characterized by significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). Chronic primary pain is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate independently of identified biological or psychological contributors unless another diagnosis would better account for the presenting symptoms. Other chronic pain diagnoses to be considered are chronic cancer-related pain, chronic postsurgical or posttraumatic pain, chronic neuropathic pain, chronic secondary headache or orofacial pain, chronic secondary visceral pain and chronic secondary musculoskeletal pain.


which is characteristically close to ICD-11's BDD descriptions.

In fact, Antonia Barke of the IASP Task Force on Classification of Chronic Pain (an NGO in official relationship with WHO, Chairmen: Rolf-Detlef Treede and Winfried Rief) had suggested, at one point, that consideration should be given to secondary parenting BDD to the new "Chronic primary pain" parent block, which might be considered a repository for so-called "functional disorders" for which chronic pain is the predominate feature.

There have been virtually no comments on this proposal (which will go through in June) from the Fibro "community". Though several Fibro groups have been made aware of this chapter relocation and new parent block.


If you really want to have your blood chilled, this slide presentation dating from 2012, sets out earlier (now superseded) proposals by IASP Chair, Winfried Rief:

https://www.sip-platform.eu/files/structure_until_2016/Symposia/SIP 2012 Programme/Workshop 1/Presentations/03_Winfried Rief_Copenhagen EFIC Pain Rief 2012.pdf

See Slides #13 to 15:

Potential partners in a new chapter: (Other) functional somatic conditions
 
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anni66

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Thought I'd mention, here, that for ICD-11, Fibromyalgia has been relocated from its ICD-10 legacy chapter location (Chapter: XIII Diseases of the musculoskeletal system or connective tissue) to ICD-11's Symptoms, signs chapter:

(and you need to drill a long way down)

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/236601102

ICD-11 Foundation

Chapter 21: Symptoms, signs or clinical findings, not elsewhere classified
> General symptoms, signs or clinical findings
>> General symptoms
>>> Pain
>>>> Chronic pain
>>>>> Chronic primary pain
>>>>>> Chronic widespread pain
>>>>>>> Fibromyalgia



The ICD-11 MMS (Mortality and Morbidity Statistics) Linearization is the ICD-11 equivalent to ICD-10's Tabular List.

Concept term Fibromyalgia is not discretely coded for in the MMS Linearization.

Instead, Fibromyalgia is rolled up as an Inclusion term under

MG40.01 Chronic widespread pain

so it takes the same code as concept "MG40.01 Chronic widespread pain".


Screenshot to show hover text indicating that Fibromyalgia is not included in the MMS Linearization as a discretely coded for entity, but as an Inclusion under concept, Chronic widespread pain:






https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/849253504

ICD-11 MMS (Mortality and Morbidity Statistics) Linearization

Chapter 21: Symptoms, signs or clinical findings, not elsewhere classified
> General symptoms, signs or clinical findings
>> General symptoms
>>> Pain
>>>> MG40 Chronic pain
>>>>> MG40.0 Chronic primary pain
>>>>>> MG40.01 Chronic widespread pain



Note the Description for the new parent block "Chronic primary pain":

https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/1326332835

Description
Chronic primary pain is chronic pain in one or more anatomical regions that is characterized by significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). Chronic primary pain is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate independently of identified biological or psychological contributors unless another diagnosis would better account for the presenting symptoms. Other chronic pain diagnoses to be considered are chronic cancer-related pain, chronic postsurgical or posttraumatic pain, chronic neuropathic pain, chronic secondary headache or orofacial pain, chronic secondary visceral pain and chronic secondary musculoskeletal pain.


which is characteristically close to ICD-11's BDD descriptions.

In fact, Antonia Barke of the IASP Task Force on Classification of Chronic Pain (an NGO in official relationship with WHO, Chairmen: Rolf-Detlef Treede and Winfried Rief) had suggested, at one point, that consideration should be given to secondary parenting BDD to the new "Chronic primary pain" parent block, which might be considered a repository for so-called "functional disorders" for which chronic pain is the predominate feature.

There have been virtually no comments on this proposal (which will go through in June) from the Fibro "community". Though several Fibro groups have been made aware of this chapter relocation and new parent block.


If you really want to have your blood chilled, this slide presentation dating from 2012, sets out earlier (now superseded) proposals by IASP Chair, Winfried Rief:

https://www.sip-platform.eu/files/structure_until_2016/Symposia/SIP 2012 Programme/Workshop 1/Presentations/03_Winfried Rief_Copenhagen EFIC Pain Rief 2012.pdf

See Slides #13 to 15:

Potential partners in a new chapter: (Other) functional somatic conditions
Truly scary.
 

lilpink

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This advert - https://www.jobs.ac.uk/job/BJZ817/clinical-learning-facilitator-community-torbay/ - may well disappear quite soon but it is for a ‘Clinical Learning Facilitator’ to teach year 5 undergraduate medical students at the University of Plymouth skills that they will need for primary care practice. The skills include telephone skills, video consultation analysis and, guess what? – Yes, you guessed it, ‘medically unexplained symptoms’.

No mention of how to deal with a consultation room full of marauding kids or with elderly patients who keep forgetting their appointments, or on how to take a full history, examine the patient and write up the consultation all within 10 minutes.

But ‘medically unexplained symptoms’ is apparently of key importance these days.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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https://www.england.nhs.uk/publication/the-improving-access-to-psychological-therapies-manual/

The Improving Access to Psychological Therapies Manual

Document first published:
4 June 2018

Page updated:
6 June 2018

Topic:
Mental health
Publication type:
Guidance


https://www.england.nhs.uk/wp-content/uploads/2018/06/the-iapt-manual.pdf

The Improving Access to Psychological Therapies Manual
  • PDF
  • 1 MB
  • 73 pages

Summary
This manual is for all commissioners, providers and clinicians of services that deliver psychological therapies. It serves as an essential manual for IAPT services, describing the IAPT model in detail and how to deliver it, with a focus on the importance of providing National Institute for Health and Care Excellence (NICE)-recommended care.


https://www.england.nhs.uk/wp-content/uploads/2018/06/iapt-manual-resources-v2.pdf

The Improving Access to Psychological Therapies Manual: Appendices and helpful resources
  • PDF
  • 3 MB
  • 54 pages
Summary
This resource pack accompanies the IAPT Manual and provides commissioners and providers with examples of positive practice and helpful resources to support IAPT service expansion, development and delivery.

 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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...While reviewing this Pilot from May 2013, I see that when compiling terms for my "Alphabet Soup" graphic, I had overlooked:

"Illness Distress Symptoms (IDS)"

"Idiopathic Physical Symptoms (IPS)"




*Source: PILOT OF ENHANCED GP MANAGEMENT OF PATIENTS WITH MEDICALLY UNEXPLAINED SYMPTOMS, NHS Barnet Clinical Commissioning Group, May 2013
https://dxrevisionwatch.files.wordp...lly-unexplained-sympthoms-kingsfund-may12.pdf


Here's another to add to the list:

Persistent Somatic Symptoms or (PSS)


https://www.eapmverona2018.com/docs/simposia-program.pdf

EAMP 2018 Symposia

THU 28 JUNE Somatic Symptom and Related Disorders in Primary Care.

THU 28 JUN ONET-SOMA PANEL DISCUSSION: Developments in diagnosis and understanding of Persistent Somatic Symptoms – DSM-5, ICD-11 and beyond.

FRI 29 JUNE Persistent somatic symptoms – novel concepts and innovative research from the EURONET-SOMA Group. FRI 29 JUNE Implementing interventions for persistent somatic symptoms - facilitators, barriers and perspectives.

SAT 30 JUNE epidemiology of the functional somatic syndromes: studies in the Netherlands and Denmark


https://www.eapmverona2018.com/docs/simposia-program.pdf

EAMP 2018 Symposia Detailed Program


2.
Hüsing, University Medical Center Hamburg-Eppendorf & Schön Clinic Hamburg-Eilbek, Germany
Somatoform Disorder, SSD, BDS, Functional Somatic Syndromes, Persistent Somatic Symptoms: You’ve got it, we name it.


EAMP 2018 Oral Presentations Detailed Program

https://www.eapmverona2018.com/docs/oral-presentation-program.pdf


EAMP 2018 Workshops Detailed Program
https://www.eapmverona2018.com/docs/workshop-program.pdf


MUS
MUPS
FD
FDD
FSS
PPS
PSS
PES
PSDD
BDS
BSS
BDD
SSD
IDS
IPS

Only a matter of time before:

Persistent idiopathic somatic symptoms (PISS)


I noticed, only yesterday, that the acronym for "Oppositional defiant disorder" (coded at 6C90 in ICD-11) is "ODD".

There is also "MADD" (Mixed anxiety and depressive disorder).

Though for ICD-11, they have reversed the order:

6A73 Mixed depressive and anxiety disorder

In ICD-10, it was:

F41.2 Mixed anxiety and depressive disorder

 
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Only a matter of time before:

Persistent idiopathic somatic symptoms (PISS)
This made me laugh out loud. If such a term came into parlance, it could at least be said that were a medical professional to take the PISS, a person with PISS might, therefore, have hope of a cure. Oh the double stigma of it.

I noticed the IAPT "Technical Output Specification" for national data collection purposes would also have an appropriate acronym.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Don't think we have posted this one, already:

NHS Chorley and South Ribble CCG

https://www.chorleysouthribbleccg.nhs.uk/january-2017-practice-matters

January 2017 practice matters

In profile

MSK re-procurement

In our local area, the CCGs currently commission Musculosketal (MSK) and related services through a variety of providers including Lancashire Teaching Hospitals, Ramsay Healthcare, Lancashire Care Foundation Trust, Virgin Care, Chorley Medics and The Integrated Care Clinics (TICCs). A review of the services and patient feedback has highlighted that the current delivery model is fragmented, often due to the need for multiple handovers between different providers. This has created a service that can be complicated leading to an unsatisfactory patient journey.

In line with national guidance and publications such as the Five Year Forward View (2014), Right Care Commissioning For Value (2016) and the Department of Health’s Musculoskeletal Services Framework (2006), Chorley and South Ribble CCG and Greater Preston CCG will be going out to procure an integrated community service for MSK, Physio, Pain Management and Rheumatology in February 2017 with a go live date of November 2017. The service will deliver effective diagnosis, treatment and management of both short and longer term musculoskeletal related conditions. This integrated model approach is supported by evidence in other areas, such as Newcastle West CCG, Oldham CCG and Bedford CCG which are now benefitting from a better value service and improved patient outcomes.

The model is currently in the process of being developed, however our vision is to have a service with:
1) Single point of access for all disciplines with a triage and treat model – this will streamline pathways and waiting times into the service and ensure patients see the most appropriate clinician for their needs
2) Self-referral or GP directed self-referral for patients needing straightforward physiotherapy – this will free up GP time and encourage patient ownership of their condition

3) Fully integrated working between disciplines underpinned by a single IT system – this will ensure the patient only has to tell their story once as all relevant notes and information will follow them throughout their journey
4) Care-coordinator approach if patients are transferred between different disciplines - a named clinician will take responsibility for these patients who will ensure that patients do not have a longer patient journey than is absolutely necessary
5) Multi-disciplinary approach encouraged for complex patients – this will encourage a holistic treatment approach across disciplines for better outcomes

6) Specific commissioned provision for patients with CFS and fibromyalgia – these are patients with complex needs and the current commissioned provision is not set up to treat them satisfactorily
7) Focus on self-management and patient empowerment – enhancing patient wellbeing, quality of life and health outcomes
8) Value for money – through economies of scale and reduced duplication

We welcome all clinical involvement and engagement from GPs to make sure that we get the model right.

If you would like to give any feedback or comments please contact Alison May in the CCG Elective Care Team via Alison.may@chorleysouthribbleccg.nhs.uk, or 01772 214412. Alternatively if you would like to work more closely with the commissioners in designing the model please contact Alison who will arrange a meeting to discuss the specifics in further detail.

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

On January 11, 2017, an online survey (via SurveyMonkey, and now closed) was posted on the site of the Chorley VCFS Network and on their blog. Note that Chorley VCFS stands for "Voluntary, Community and Faith groups in Chorley and South Ribble area."

https://www.chorleyvcfsnetwork.org/...algic-Encephalopathy-Chronic-fatigue-Syndrome
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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As some of you will already be aware, I am retiring from advocacy at the end of August/early September.

Since it was created in January 2017, this thread has accumulated a good deal of useful reference material on MUS, PPS, IAPT etc.

It would be a pity if the thread were to dwine and lose search engine rank.

Over the next two or three weeks, I shall be busy updating my Dx Revision Watch site and this is probably the last post I shall post in this thread.

I'd be grateful if someone would take it upon themselves to keep this thread active with new MUS, PPS and IAPT related content.
 

Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
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Bump

As some of you will already be aware, I am retiring from advocacy at the end of August/early September.

Since it was created in January 2017, this thread has accumulated a good deal of useful reference material on MUS, PPS, IAPT etc.

It would be a pity if the thread were to dwine and lose search engine rank.

Over the next two or three weeks, I shall be busy updating my Dx Revision Watch site and this is probably the last post I shall post in this thread.

I'd be grateful if someone would take it upon themselves to keep this thread active with new MUS, PPS and IAPT related content.