Modernising Mental Health Service User and Carer GP Feedback Event

Transcription

1 Modernising Mental Health Service User and Carer GP Feedback Event 1. Introduction Bristol Clinical Commissioning Group (CCG) is in the process of re-commissioning Mental Health services for the Bristol population. As part of the redesign of mental health services we are also looking to put in place a Locally Enhance Service (LES) to enable GPs to deliver more mental health care locally. In July 2013, the Bristol Modernising Mental Health Programme held a service user and carer GP feedback event to enable participants to outline their recent positive and negative experiences of mental health care from GPs and to discuss additional mental health care that could be delivered by GPs. 2. Document Purpose This document captures the comments from the Service Users and Carers that attended the GP feedback event and highlights the key themes to ensure that all the comments made are used in the development of the LES. 3. Key Themes 3.1. Positive mental health care experiences from GPs and GP practices Communication o Some GPs are encouraging patients to take the responsibility to vary their medication o Patients have been designated a GP, ensuring consistency o Some GPs attend a patient s care planning meetings with other health professionals o Some practices have information provided (leaflets). Administrative o Practice staff has personal mental health experiences and were willing to talk about their experiences with patients, putting the patient at ease o Some GPs have booked out double appointment to ensure time with the patient. If you need this document in a different format please telephone

2 3.2. Negative mental health care experiences from GPs and GP practices Communication o There is a lack of communication between Primary care and Secondary care o There is a lack of information provided (leaflets, interactive terminals, noticeboards) at some practices o Carers/family members are not supported by GPs. Knowledge o There is a lack (or inconsistency) of mental health knowledge from the GPs and practice staff o There is an discriminative (or hostile) attitude from GPs and practice staff o GPs are not reviewing/managing a patient s medication o GPs are mis-dialogising due to lack of knowledge. Administrative o The waiting times to speak to practice staff on the telephone is unreasonable o The practice staff are inflexible with appointments o The waiting times to see GP is unreasonable o Seeing the same GP is inconsistent o Waiting rooms are over stimulating to patients with mental health issues o GPs are unable to prescribe some medication o The 10 minute slot to see a GP is unreasonable Additional mental health care that could be delivered by GPs Communication o GPs should be part of the planning process between primary and secondary care o All patients should have a tailored care plan o CPAs should be held within the practice with the GP present o A specific mental health worker should be available in all practices to create a link between patients and GPs o All practices should readily have available information leaflets for mental health services. Knowledge o Patients and Carers should have a reoccurring physical assessment Page 2 of 8

3 o All GPs and practice staff should have the same mental health training which is reviewed and updated accordingly o GPs that have a special interest in mental health should be publicised o GPs should have a more holistic approach, encouraging alternative therapies Administrative o A quiet room within each practice should be made available for mental health patient o A consistent process for recording patient data should be created and adhered to o Clear protocols on confidentiality should be created and adhered to o Someone within the practice should become a champion /specialist of mental health issues 4. Summary Overall the group were happy to share their positive and negative experiences with GPs and GP practices. (Detailed comments from the services users and carers that attended are in the appendix) The group also came up with innovative ideas of what could be additionally provided by GPs and GP practices and were unanimous with the idea that service users and carers are a part of the development and implementation of the training package. 5. Next Steps The captured comments from the Service Users and Carers that attended the GP feedback event will be passed to Dr Barbara Compitus for the development of the LES. Page 3 of 8

4 Appendix 1 Positive Experiences Positive experiences depend on the type of GP you have Having a designated doctor has worked well, now the GP has left so I am back to the pick and mix. Experience of medication and training of GPs varies across GPs. Most accessible support is from a GP. Helped knowing which GP has a special interest in Mental Health. Using this information, I was able to get a GP who was on my side, although he was giving false expectations. Thought going back to GP would have been a more holistic care, seeing me a whole person. Had a double appointment to explain mental health issues. GPs could benefit from input from people recovering from mental health issues with training. If I wanted to come off medication, could I see a psychiatrist again? I was told yes. GP will phone me back if I can t get an appointment GP allows me to take the responsibility to vary my medication GP knows my story and books out appointments to come to care planning meetings with other health professionals Lots of mental health leaflets around which made me feel like I was welcome at the practice Nurse had self-harmed in the past and she happily showed her scars which made me feel at ease. Page 4 of 8

5 Appendix 2 Negative Experiences GPs cant prescribe some medication Different GPs have different views on medication this is unsettling. Have to wait a long time to see the same GP The care is not person centred Mental health was blamed on being transsexual As a transsexual the GP practice staff treated me as a freak Most transsexuals don t like going to GPs for the fear of discrimination. Only go to specific GPs, most GPs have no experience Lack of knowledge leads to missed diagnosis. Civil partnerships are not considered as next of kin. GPs and staff who understand mental health issues, may not understand LGBTs. They take you at face value You need to be quite well to be able to attend appointments Too keen to dish out pills Waiting room is stressful due to overstimulation GP came across materialistic, not sure she knew what she was doing. Would prefer people are honest about what they know/more up front. Lack of information. I have been put on medications that I am still trying to come off. Important to try and see same GP all the time. If you work full time, this is not taking into account when trying to make an appointment. When someone has been with the recovery team and is being moved to GP. The GP needs to be involved and proactively arrange to see the patient. When really needed an expert for a work assessment, GP was on a 3 month sabbatical. When I saw the locum doctor they said People with Mental Health can still work. GPs need guidance on how often to see patients. South mead hospital had bad memories better to see the GP The GP was very focuses on my mental health but he missed the physical issues I had. Reception staff can be hostile, they don t have any mental health knowledge/training Not pushing optional therapy Page 5 of 8

6 I felt like I was being processed by LIFT psychology and they were rigidly bound within guidelines. GPs put physical difficulties down to my mental health issues GPs need to address presenting issue/s. Do GPs know that people will die earlier due to physical illness, eg coronary heart disease? Anti-depressants found to cause heart problems and it was trial and error to wean me off my medication. Hard to read lengthy information given to you about your medication. Once discharged from psychiatrist we are left to ourselves to manage our medication. Difficultly for family member to get a GP to see the person who needs help When the person is unwell, sometimes they won t admit to having a problem and will refuse treatment. This is an issue with GP not offering home visits. Family members are not supported by GPs People who can articulate their needs get the best treatment. GPs are sexist. One man and women have gone in with the same symptoms. The women goes down the mental health route, the man goes down the addictive route. Some people will not see their GP is their GP is their family doctor, for the worry that the GP will tell their family about their mental health issues. GPs over diagnose people with drug and alcohol dependence. They have a lack of knowledge of drug and alcohol issues. People in primary care do not have a care plan. Appointment slots are short 10 minutes Last GP took 1 month to get advice from AWP GPs are over worked and done have enough time. Not sure what extra funding will make, unless it encourages dedicated workers. Need to manage expectations of what GPs can achieve as Mental Health is a very complex issue. People don t know how to come off the medication. Page 6 of 8

7 Appendix 3 Ideas for change GPs should be part of the planning process between primary and secondary care. All GPs have the same mental health training. GPs that have a special interest in mental health should be publicised. GPs should join health groups. All practice staff should have mental health training. The practice should have an open discussion about who of the staff has had a mental health experience. GPs should consider family/context by doing a carer assessment. There should be clear protocols on confidentiality. GPs need to know their limits and assert their limits to others. Clear understanding of IT system. Monitor the GPs with referrals, medication etc. GPs and staff need to change their attitude through training A specific mental health worker should be employed by all practices to create a link between patients and GPs CPAs to be held at practices to enable GPs to be involved in CPAs. GPs should have a more holistic approach, encouraging alternative therapies GP practices should offer out of hours service GPs should have a proactive response in diagnosing Patients and carers should have a routine physical assessment. Service user and carers should be involved in the creation of the training programme Specific mental health line on GP practice phone directory to be created to enable patients to get an appointment. GP practices to offer mental health specific courses (i.e. mental health first aid) to patients and carers. Quiet room within the practice for mental health patient Proactively have information leaflets available within the practice Interactive screen for patients to access the wellaware directory. Well Aware directory should include all groups that are available. Training should include information on social prescribing Training should include LGBT awareness. Page 7 of 8

8 GPs and staff should accept civil partner as a next of kin. Training should include medication. The knowledge of GPs and staff should be monitored and training should be recurring Secret shoppers should test the knowledge of the staff and GP. Training should include how to ask the right questions GPs should off alternative therapies (mindfulness) There should be a mental health steering group. Tailor the care to the person. Single specialised mental health practice. Would this restrict the patient choice? Would a single GP just give you one treatment/regime? That GP could be supported to deliver a range of treatment/support options. User lead training for GPs Consistency of patient record to avoid repeat stories. Every patient has a care plan and the plan is created with the involvement of the patient. Every patient has a CPN Have to have clear service referrals and processed in the new mental health system. Someone within the practice becomes a champion/specialist of mental health issues GP practices offer crisis response. Page 8 of 8