Issue 8, March 2012
Contents
Welcome to GP Matters ................................................................................................................... 2
Consultant spotlight: Dr Manny Bagary ............................................................................................ 3
News from the community mental health teams (CMHTs) ............................................................... 5
Pioneering NHS service to be introduced in all Birmingham and Solihull hospitals ......................... 6
Research and innovation showcase event and exhibition ................................................................ 7
Pharmacy update: Supporting medicines reconciliation within mental health .................................. 8
Birmingham Healthy Minds ............................................................................................................ 10
GP seminars .................................................................................................................................. 12
Sutton hub workshop on depression .............................................................................................. 13
GP Matters needs YOU! ................................................................................................................ 14
Who do I call out of hours? ............................................................................................................ 14
1
Welcome to GP Matters
Since the beginning of the year, the NHS in England
has been under a huge strain. This is because it is
being asked to undertake its biggest ever costcutting exercise, while implementing a wholesale
reorganisation of the NHS.
GPs are now very much at the heart of healthcare commissioning, controlling budgets and tailoring
services to the needs of the local communities which they serve.
March GP Matters includes updates from the Birmingham Healthy Minds team, a pharmacy update
on medicines reconciliation and news from the Zinnia community mental health team. This month
consultant spotlight falls on Dr Manny Bagary, consultant neuropsychiatrist at the Barberry centre.
Our trust wants to develop close, working relationships with commissioners which will be
continuously informed by the views and feedback from GPs in the localities that we serve.
Therefore it is vitally important that we hear your views on what we do, how we can work together
to improve our services and improve GP access to them.
We are committed to improve communication with our GP stakeholders. You will receive this
bulletin every month, with the latest news and updates relevant to you and your patients.
Please let us know what you think of these new developments, or even suggest future articles that
you may wish to include by emailing gp.matters@bsmhft.nhs.uk or julia.buckley@bsmhft.nhs.uk.
Peter Lewis
Dee Roach
Medical director
Executive director of quality improvement
and patient experience
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Consultant spotlight:
Dr Manny Bagary
Dr Bagary is a consultant neuropsychiatrist working
at the Barberry.
What motivated you to specialise in Neuropsychiatry?
Disorders of the brain have always managed to capture my
interest as the most complex and challenging cases across
the clinical spectrum. However, perhaps like most medics,
serendipity has had a major influence. Having worked in ophthalmology, neurology, general and
academic psychiatry, I stumbled into neuropsychiatry. I was fortunate to be exposed to
inspirational academics and clinicians whilst completing my PhD at the Institute of Neurology, and
clinical training at the Maudsley Hospital. I found myself drawn to those disorders at the interface
of neurology and psychiatry and in particular, epilepsy as the quintessential neuropsychiatric
disorder. I really do feel I have now the best job in the world, being able to spend most of my
clinical time managing patients with epilepsy, sleep disorders and other related conditions.
What has been the most rewarding achievement in your career to date?
I think being able to offer a comprehensive epilepsy service with a well equipped video-telemetry
unit and our patients giving the service very good feedback is my most satisfying achievement.
However, I continue to worry about our capacity, the length of our waiting times and some
administrative issues which we have struggled to resolve. My most rewarding experience is
receiving my PhD in neurological sciences at the same award ceremony as Professor Peter Higgs
who was awarded an honorary DSc.
The NHS is in a state of flux, facing wholesale reforms drawn up by the coalition. What is
your take on the White Paper?
My personal view is that the NHS has improved considerably (for example waiting times, infant
mortality and early intervention in psychiatry) over the past 10 years and provides good value for
money compared to other health care systems. This is often not recognised in the current political
climate. The aims of the White Paper are laudable but the timing and some of the proposed
mechanisms are lamentable.
Are you confident that an improved NHS will be the result of the Government’s reforms, if
approved by Parliament?
No. I worry that we may end up with a disintegrated system with increasing divisions between
primary and secondary care with fragmented, competing providers rather than the high quality,
seamless and fully integrated local services envisaged. Currently, my service is exposed to
funding approval for many of the investigations we require for diagnostic and/or prognostic
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purposes. I hope the reforms do not lead to more widespread use of this system of prior approval.
There is a window of opportunity for commissioning by GP consortia to allow sensible, clinically
lead decision making. Let's hope this is not derailed by efficiency savings and austerity into a
Kafkaesque bureaucracy.
How can GPs gain a better understanding of mental health issues?
In my experience, GPs do have a very good, broad understanding of mental health issues but are
less aware of specialist services. This may be partly because specialist services are generally
accessed through secondary care referrals. The common mental health disorders NICE guideline
(CG 123) with a particular focus on primary care, published last year, is a useful resource. Locally,
the Birmingham Medical Institute psychiatry lecture series on the first Tuesday evening of the
month is a useful educational and networking meeting with an annual teaching day for primary
care built into the programme.
Do you think GPs have a role to play in helping to tackle the stigma attached to mental
illness, if so how can they work to address this issue?
My view is that it is widely acknowledged that all clinicians have a role to play in the education of
patients and their families to reduce stigma in mental illness and other medical conditions.
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News from the community
mental health teams (CMHTs)
Our trust staff and GPs met in February to
share ideas and to learn about community
services and referral routes from the Zinnia
centre community services team.
The meeting, at The Bond Company in Digbeth was
opened by Dr Patrick Ezeani, consultant psychiatrist who encouraged GPs to share their ideas
with the team about the trust’s services. Team manager, Heather Bartlett explained the different
referral routes and outlined the CMHT services and Dr Sara Willott advised GPs about therapeutic
services available to them. After a tasty buffet supper the Birmingham Healthy Minds (BHM) team
answered questions about their service and outlined new initiatives they are introducing such as
their access clinics.
Contact Heather Bartlett, team manager at the Zinnia centre on 0121 301 5300 for further details.
Over the next few months we will be arranging information evenings at various CMHT locations
across Birmingham and Solihull, so look out for more details of these events in GP Matters.
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Pioneering NHS service to be
introduced in all Birmingham and
Solihull hospitals
The award-winning psychiatric liaison service,
pioneered by Birmingham and Solihull Mental
Health NHS Foundation Trust at City Hospital is to be adopted by four hospitals in
the region.
The Rapid Assessment, Interface and Discharge (RAID) service – devised and developed by our
trust as part of a pioneering partnership with staff at City’s busy A&E unit, in Winson Green – will
be available at the new Queen Elizabeth Hospital Birmingham, Heartlands Hospital, Good Hope
Hospital and Solihull Hospital from Monday, April 2, 2012.
RAID will initially operate seven days a week between 8am and 8pm, at the Queen Elizabeth,
Heartlands and Good Hope Hospitals. The service at Solihull will be initially run between 8am and
8pm weekdays and 8am to 1pm at weekends. This will become a round-the-clock service at the
hospitals later in the year.
RAID is an innovative mental health model which has significantly improved quality of care in acute
hospitals for patients with mental illness and alcohol problems, especially for older people with
dementia.
GPs can be confident that their patients presenting with mental health issues in the A&E
department will be seen quickly and referred on to appropriate community teams cutting the length
of stay in hospital and reducing the likelihood of being re-admitted. However, it should be stressed
that for RAID to be effective GPs should not refer patients to A&E but continue to use the
pathways to appropriate community teams. Work has been carried out with the drug and alcohol
teams, the home treatment teams and the commissioners to streamline the service and make it
more effective.
RAID could potentially become a national model which has the ability to save the NHS a colossal
amount of money by improving quality, instead of cutting essential services.
For further information, visit the RAID page on our website which can be found at
http://www.bsmhft.nhs.uk/raid/
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Research and innovation
showcase event and exhibition
Our trust is one of the leading research-active
mental health trusts in the country and our work
enjoys both national and international
recognition.
The success of our five research programmes relies heavily upon the support of the trust board
and many clinical and non-clinical staff from across our services. Our showcase event on March
28 is another opportunity to present and discuss the results and impact of our research. This year
we have results to report on the implications of changes to mental health legislation and on
improving pathways to care for minority patients with emerging psychosis. There will also be
presentations on our exciting work in youth mental health, neuropsychiatry, addictions and
dementia.
The research and innovation showcase event will take place on
Wednesday, March 28, 2011
At the Midlands Art Centre (mac) in Cannon Hill Park, Birmingham B12 9QH.
9.30am to 4.30pm.
Admission to this event is free and includes lunch plus refreshments.
However, there are only a few places left for this event.
For more information and to request a registration form please contact Audrey Smith or Laura Daly
on 0121 301 4345 or by email audrey.smith@bsmhft.nhs.uk or laura.daly@bsmhft.nhs.uk
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Pharmacy update: Supporting
medicines reconciliation within
mental health
Medicines reconciliation can be defined as the
process of obtaining an up to date and accurate list
of medication for a patient, that has been compared
to the most recently available information and has
documented any discrepancies, changes, deletion
and alterations.
Reconciling medicines following transfer of care between different settings can reduce prescribing
errors, reduce harm from medicines, reduce the number of missed doses and help to improve the
quality and timeliness of information on medicines available to clinicians. In turn, this can lead to
improved outcomes for patients.
Medicines reconciliation is important on admission into services and also following discharge from
a service. Within our trust, we are encouraging and promoting medicines reconciliation on
admission to our inpatient units, as well as within the home treatment setting. This will necessitate
the admitting clinical team to ascertain the correct list of medicines for a patient. This can be more
complex in a mental health setting as the physical health medicines will normally be provided to a
patient by their GP but often the mental health medicines will come from the patient’s mental
health team.
While we can be confident of the patient’s psychiatry medicines through trust records and
medicines charts, for a service user admitted as an inpatient, this will usually necessitate
confirming the information with their GP. Service users may bring medicines with them on
admission but they are often left at home.
There are a number of sources of information that we will use when reconciling medication lists for
our service users:
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A computer print-out from the GP surgery,
verbal information from the service user, relative or carer,
a recent FP10 prescription or repeat prescription (tear off section),
a recent referral letter,
a recent discharge prescription or previous recent trust prescription card, e.g. from home
treatment team, assertive outreach or community mental health team,
prison inmate records, and
prison medical records.
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The following are considered suitable complementary sources:
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Service user notes from previous admissions,
notes from pre-admission clinic (where applicable),
the service user’s repeat prescription sheet,
referral letter,
care home or social care medication administration records,
clinic letters,
community pharmacist patient medication records.
How can GP practices help us?
Many of our inpatient units will contact the service user’s GP to obtain an up to date list of
medicines. This will normally be through a fax request to comply with information governance.
If you receive such a request from us then it would be helpful to have a reasonably prompt
response. This will enable admitting doctors to complete the medicines card for an admitted
service user and provide greater assurance that we have captured the right information on all the
medicines that a patient is taking. Our admitting doctors can then ensure that medicines charts
are written up promptly and accurately thus reducing the risk of missed doses.
As well as asking for your help with admission of service users, it is important that we give you
prompt and accurate information on medicines when service users are discharged or following
outpatient attendances. Where this doesn’t occur, you should be asking us for the same
information so we reduce medication errors following discharge from inpatient or other episodes of
care within the mental health trust.
Medication errors can cause serious harm to patients. Accurate medicines reconciliation when
patients move between care settings is one way to reduce medication errors. By working together,
we can all play a part in improving medicines reconciliation and reducing medication errors.
Update by: Nigel Barnes
Director of pharmacy and medicines management
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Birmingham Healthy Minds
Birmingham Healthy Minds (BHM) is an NHS
Improving Access to Psychological Therapy
compliant primary care psychological therapies
service that works closely with Birmingham GPs.
BHM is an advice, guidance and brief
psychological talking therapy service that works
with people aged 16 or over who are often
feeling anxious, low in mood or depressed.
Number of referrals
BHM have received more than 14,000 referrals into the service between April and December 2011
and although some have not attended (DNA) we have assessed and signposted many people who
do not meet our criteria.
New referral criteria
Our new referral criteria are now available and staff will be visiting GP practices to share these
with you. In addition, to improve the patient journey, we will be updating the contact details of
organisations we signpost our patients towards. This will help GPs and primary care staff to direct
their patients to self-refer at step 1.
Number of patients treated
Since April 2011, BHM has seen 9,600 patients who have completed treatment in the first nine
months of the service.
Recovery rates - high achievements
Recovery rates of 72 per cent have been achieved which is above the national target by an
average of 22 per cent.
We are also issuing patient evaluation questionnaires.
Non-attendance (DNA) rates
The DNA rate across the service is 14 per cent. We would like your support in reducing this figure.
We are looking at the use of text messaging by encouraging patients to respond to their
appointment and confirm using one of the following options - keep it, change it, cancel it.
Many thanks for your support.
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New developments
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We are developing a wider range of interventions across the city to tackle waiting times.
We continue to support the training of our staff in other NICE recommended therapies.
We are arranging more workshops across the city and new leaflets will be available soon.
We are piloting an information gathering form, which is sent out for patients to complete
before their first appointment. Help is available for those people who might find this difficult.
We are setting up employment support groups to help people stay in work and a support group for
people who are unemployed and wish to move off benefits into employment.
For more information please contact Kully Ingram, partnership manager, by email
kulwinder.ingram@bsmhft.nhs.uk or Terry Downes, service development manager, at
terry.downes@bsmhft.nhs.uk.
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GP seminars
Since GP Matters was launched, our
consultants have been keen to share their
knowledge in a series of educational seminars.
The programme will be offered at venues across
Birmingham and Solihull and attendance certificates and
CPD points will be awarded.
GP Matters will be compiling a programme of seminars tailored towards our GPs and their needs.
Some of the following seminar topics will be offered:
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The criminal justice system and the health needs of offenders coming out of prisons and
living in the community,
primary care mental health research network updates,
obtaining feedback from patients about their consultations,
increasing compliance-concordance (using motivational interviewing),
working together – GPs and social care and
using CBT first aid in general practice.
If there are other topics you would like to be included in the programme please email
julia.buckley@bsmhft.nhs.uk or gp.matters@bsmhft.nhs.uk
GPs workshop on engaging and supporting families
Family relationships can influence adherence with treatment and contribute to a person’s recovery
in relation to both mental health and physical health issues. If a person has a heart attack this can
have a great effect on family members, impacting on their physical and psychological wellbeing.
GPs are in the unique position of being able to develop longstanding relationships with families.
The Meriden Family Programme is developing a skills-based half-day workshop for GPs, aimed at
helping them to identify the impact an individual health issue can have on the whole family and
strategies for engaging and supporting them.
We are working with GPs to develop the content and would welcome any ideas or thoughts about
issues you feel should be included.
Please contact Chris Mansell via email chris.mansell@bsmhft.nhs.uk to share your views.
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Sutton hub workshop on
depression
The Sutton hub is a new initiative to bring
together carers, clinicians and service users in
mental health. The group meets quarterly to
discuss an aspect of mental health.
A workshop on the latest research and treatment into understanding and managing depression is
planned.
When
April 20, 2012
Time
1pm to 3 pm
Where
Sutton Coldfield United Reform Church
Gracechurch Centre
1 Brassington Avenue
B73 6AA
Who is invited
Carers, clinicians and service users
Cost
Free
Refreshments available.
For further details from Dr Pravir Sharma, BSMHFT co-ordinator, email
sheila.blandford@bsmhft.nhs.uk, call Adam Roe on 07985 883 474 or Jotee Motee, staff nurse on
0121 301 0941 or 07985 883 592.
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GP Matters needs YOU!
The key to what makes this bulletin work is clear – our GP
stakeholders. In order to communicate better with you and
highlight the issues that matter to GPs, we need your input.
If you have any ideas for articles, want to nominate a
consultant of the month or just raise something that matters
to you and your practice, email gp.matters@bsmhft.nhs.uk
or julia.buckley@bsmhft.nhs.uk
The next issue of GP Matters will be sent on April 16, the deadline for which is April 5.
Deadlines for 2012
Bulletin date
April 16
May 14
June 11
July 16
Deadline
April 5
May 3
June 1
July 6
Who do I call out of hours?
Emergencies are not confined to the 9 to 5 working day, so it
is important to know where to go to make a referral or raise a
query out of hours.
GPs with any queries or referrals out of hours should call the
trust switchboard on 0121 301 0000.
Calls to this number can be answered by reception staff at our major sites, who will put calls
through to a middle-tier doctor on call, who can deal with any issues outside working hours.
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