Bridging the Gap The Severn School of Psychiatry

Bridging the Gap: The Severn School of Psychiatry Improving Knowledge, Skills and Quality of Care for patients with Medically Unexplained Symptoms An Innovative Joint Education initiative for Psychiatrists & GPs Dr Leanne Hayward, ST 6 Psychiatrist, AWP; Dr Guy Undrill, Consultant Psychiatrist, 2 Gether; Dr David Beales, Practising Physician in Behavioural Medicine, MRCGP; Dr Liz Alden, GP Educator, Severn Faculty. BACKGROUND In England over 15 million people have a long-term medical condition which can be controlled rather than cured (1). Care of such conditions accounts for 70% of the health and social care budget. With a £ 14 billion productivity gap facing the NHS, improving quality of care for long-term conditions is essential (2). Evidence suggests that: patients with medical illness are three to four times more likely to develop a psychiatric disorder than a member of the average population (3) ; co-morbid psychiatric disorders reduce treatment adherence, outcomes and increase healthcare costs (2) ; and having a psychiatric and medical illness delays recovery from both (4). There appears to be scope for mental health services to support improved productivity both in psychiatric services and across the NHS more widely (2). A key improvement target identified in the literature is to strengthen the interface between mental and physical health care for those with long-term conditions. A recent King’s Fund review (2) recommended that mental health professionals ‘see the productivity challenge as being their responsibility’ and GPs ‘develop improved forms of care for those with long term conditions or medically unexplained symptoms (MUS)’. MUS account for 20% of new GP presentations, 20 -40% of medical outpatient referrals (5) and present a challenge to acute hospital clinicians, psychiatrists and GPs alike. The condition is managed both in primary and secondary care, and bridges the gap between physical and mental health. Patients are often referred between multiple specialists, and undergo potentially unnecessary, costly and sometimes damaging investigations and treatment (6) , before a psychological component to their presentation and referral to a psychiatrist is considered. Effective treatment interventions include Motivational Interviewing (MI) (7). METHODS RESULTS The primary author identified that few courses cover the physical/mental health interface for doctors from more than one discipline, or promote development of skills to facilitate improved quality of care in complex patients. § The primary aim was to develop a joint learning event to meet the needs of GPs and Psychiatrists § The course had 5 major objectives and was designed by the primary author, including didactic and interactive sessions, to cover the topics of MUS and MI. Table 1: The 5 major objectives of the course and the type of sessions used to meet them. § 26 participants attended: the course: 63% GPs, 27% Psychiatrists. § The number of participants ranking as “good” (score 4 or 5) their: knowledge, skills, collaborative working and interdisciplinary communication increased post-course. § Participants were positive about interdisciplinary learning, requesting future events of this nature. Table 2: Evaluation measures and modal values (highlighted) demonstrating improvement in skill ratings after course attendance Table 3: Qualitative analysis of themes promoting interest and attendance on this course § Pre and post-course surveys comprising likert-scales evaluated change in: § § Participant knowledge Skills Collaborative working Interdisciplinary communication § Free-text responses were thematically categorised CONCLUSION In an era where Clinical Commissioning Groups hold the budgets for provision of care, it is vital that primary and secondary care doctors work more closely and effectively together. A joint education initiative offers significant benefits, not only for improving knowledge across disciplines and enhancing working relationships but in advocating a more integrated approach to providing and improving the quality of care for complex patients. Key messages: § This innovative course improved knowledge and skills for managing complex patients in primary-care and mental-health settings, offering potential to significantly improve quality of care in both. § This model can be applied to other areas of healthcare where complex conditions are managed by more than one discipline. § Bridging the Gap between GPs and specialists is key to improving patient care and service integration. § Further courses are under development to create a “Bridging the Gap - Joint Education” series. REFERENCES: 1 Department of Health (2013) Policy: Improving Quality of Life for people with long-term conditions [online] ……………………… Available at: https: //www. gov. uk/government/policies/improving-quality-of-life-for-people-with-long-term-conditions 2 Naylor, C. & Bell, A. (2010) Mental Health and the Productivity Challenge: Improving Quality and Value for Money. The King’s Fund. [online] Available at: http: //www. kingsfund. org. uk/sites/files/kf/Mental-health-productivity-Chris-Naylor-Andy-Bell-2 -December-2010. pdf 3 NHS Confederation (2009) Healthy Mind, Healthy Body: How Liaison Psychiatry Services can Transform Quality and Productivity in Acute Settings. NHS Confederation. 4 HM Government (2011) No Health without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages. Department of Health, UK. 5 Royal College of Psychiatrists & Academy of Medical Royal Colleges (2009) No Health without Mental Health: The ALERT Summary Report. Ao. MRC. [online] Available at: http: //www. aomrc. org. uk/publications/statements/doc_view/58 -no-health-without-mental-health-alert-report. html 6 NHS Commissioning Support for London (2011) Medically Unexplained Symptoms (MUS): Project Implementation Report. NHS Commissioning Support for London. 7 Heijmans M, olde Hartman TC, van Weel-Baumgarten E et al (2011) Experts' opinions on the management of medically unexplained symptoms in primary care. A qualitative analysis of narrative reviews and scientific editorials. Family Practice 28 (4): 444 -455. Accepted for publication in BMJ Careers November 2013