ngms and mental health nimhe, primary care programme
TRANSCRIPT
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nGMS and Mental Health
NIMHE, Primary Care Programme
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Where does Mental Health fit?
• Quality and Outcome Framework
• National Enhanced Service for Depression
• Patient satisfaction questionnaire
• Medicine Management
• Significant Event Monitoring
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Quality and Outcome Framework
• 41 points of 550 are related to severe mental illness
• Different to other clinical domains – patient has to agree to be included
• Three parts:– Develop a register– Monitor physical health– Manage lithium appropriately
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The Q & O Domain
Indicator Points Payment Stages
Register of people with a severe long term mental illness
7
Percentage of patients with a review recorded in the last 15 months
23 25 – 90%
Percentage of patients on lithium with a record of lithium in last 6 months
3 25 – 90%
Percentage of patients on lithium with a record of renal and thyroid function
3 25 – 90%
Percentage of patients on lithium with a recorded lithium within therapeutic range
3 25 – 70%
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Develop a register
• Who to include?– People with schizophrenia and bipolar affective disorder– On a case by case basis for others with significant mental
health and physical health needs
• What to call it?– Be aware that registers ( e.g.like supervision registers)
mean something different to users
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How?
• Search by diagnosis– Schizophrenia Eu 20.0– Bipolar disorder Eu 31.0
• Search by therapeutic category
• Ask the PHCT
• Ask the CMHT
• Label with 9H8
• Label those who do not wish to be included 9H7
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Why do it?
• SMR for schizophrenia and bi-polar disorder is about 200
• Cardiovascular and respiratory disease SMR is 400
• Diabetes is 5 times as common
• 90% of people who have schizophrenia smoke (30% of people with bipolar disorder)
• Drug and alcohol misuse
• HIV is 8 times as common
• HCV is (perhaps) 15 times as common
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What to do?
• Physical health review
• Medication review
• Communication review
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Physical Health• Cardiovascular disease
– BP
– History of arrhythmias
• Diabetes and obesity
– Urine analysis or blood glucose?
• Respiratory disease
– Peak flow
• Health Promotion
– Smoking
– Substance/alcohol misuse
– Cervical cytology
– Influenza?
• HIV/HCV?
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Medication Review – 8B3S
• Review what medication (all) is supposed to be prescribed
• What is the patient actually taking?
• Is the patient taking any OTC medication?
• Review side-effects, interactions etc
• Review concordance
• Consider referral to CMHT if medication has not been reviewed in the last 5 years by psychiatrist
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Communication Review
• Name of Key worker (if known to CMHT)
• Contact details for key worker in office hours and in emergencies/OOH
• Contact details for carer (if the patient has nominated a carer)
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Lithium Review
• Proportion that have had their lithium level checked in the last six months – Serum lithium 44W8%
• Proportion that have had their renal and thyroid function tested in the last six months– Thyroid function tests 442%– Serum Creatinine 44J3%
• Proportion that have their lithium level within the therapeutic range
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NES for Depression
• What is it?
• How much will it cost?
• Who can do it?
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NES Depression – What is it?
• Essential or additional services delivered to a higher specified standard
• Commissioned by PCTs
• Generally placed with GMS/PMS providers but need not be [2.15(iv)]
• Can be provided by the PCT itself [2.38 – 2.43]
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NES Depression – What is it?
• Aim: To meet main recommendations of Defeat Depression Campaign.
• Definition of Depression: Clinical judgement and evidence based diagnostic skills
• Service Outline:– Register of patients– Multi-disciplinary approach– Use CBT– Use screening procedures– Undertake training– Maintain personal health plans– Make referrals/enquiries– Review and feedback
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NES Depression – ££££ ?
For a PCT population:
• Use ONS data for prevalence
• Calculate % of patients between 16 – 65
• Weight the target population by the DH Mental health index
• Assume only 50% identified
• Assume that 90% will be treated in primary care
• Multiply that total by £100.00
• Light the blue touch paper and retire!
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NES Depression – Who can do it?
• GMS/PMS primary health care teams
• Mental health providers
• Voluntary Sector organisations
• PCO itself [2.44 – 2.46]
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Patient Satisfaction Questionnaire
Length of consultation
10 min booked, 8 min open surgery
30 points
Undertaken an approved survey annually 40 points
Undertaken the survey and reflected on changes if appropriate
15 points
Undertaken approved survey, discussed results as a team, an d with patient group of NED of PCT, and proposed changes with some evidence that some had been enacted
15 points
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Patient Satisfaction Questionnaire
• There is no approved questionnaire that is specific to mental health
• Yet– NIMHE Primary care programme is developing such a
questionnaire, which will need to be tested for face validity etc, and then approved by the National Panel.
– Available in 12 months?
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Medicine Management
• 10 indicators
• Medicine 7 is specific to mental health – 4 points
• “Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend”
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Medicine Management
• Practice Guidance– Good to involve CPN (if available)– Relatively small numbers
• Written evidence– Grade C i.e. optional
• Assessment Visit– Practice should be able to demonstrate system
• Assessors Guidance– If the patient is under the care of the mental health team,
and receives the medication from the team, then they should be excluded from the practice responsibility.
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Significant Event Monitoring
• Part of Organisational Indicators – Education
• 9 indicators
• Education 7 - 12 Significant events in 3 years – 4 points
• Education 7 – should include the following (if they have occurred)– Any death on practice premises– 2 new cancer diagnoses– 2 deaths which occurred as part of terminal care– 1 patient complaint– 1 suicide– 1 Mental Health Act assessment
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Significant Event Monitoring
• In line with RCGP Occasional Paper. Reports should be laid out in one of two forms:– Description of Event– Learning outcomes– Action plan
– What happened?– Why did it happen?– Was insight demonstrated?– Was change implemented?
• Non confrontational, multi disciplinary team activity
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In conclusion
Quality and outcome framework
Severe and enduring mental health
41 points
NES Depression Depression £100 per pat.
Patient Experience Questionnaire
Mental health (?) patients 100 points
Medicine Management Those on depot neuroleptics
4 points
Significant Event Monitoring
Suicide and/or MHA Assessments
4 points
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