A Complete Guide HOUSE CONCERN ANNUAL REPORT

A Complete Guide HOUSE CONCERN ANNUAL REPORT 2010-2011

House Concern A specialist psychotherapy service for doctors and dentists, and an education service for all health professionals working within the Northern Deanery Annual Report 2010 2011 Contents Executive Summary 4 1. Description of House Concern 1.1 Overview 1.2 Specialist Interventions Provided 1.3 Central Component of a Network of Quality Care 2. Economic Analysis 2.1 The Costs of Ill-health in Health Professionals 2.2 Reducing the Burden of Expenditure 3. Outcomes 3.1 Improving Work Attendance 3.2 Clinical Outcome Data 3.3 User Experience Outcome Questionnaire 5 5 6 7 8 8 8 10 4. Audit of Response Times 11 5. Description of Doctors and Dentists Treated 11 2

6. Educational Initiatives 6.1 A New Commissioned Training for GPs 6.2 Health for Health Professional Trainings 6.3 Society for Occupational Medicine North East 6.4 TEWV FT Education Conference 6.5 Reflective Practice Group for Senior Psychiatrists 6.6 Attendance at Regional and National Conferences 7. Emerging Themes 7.1 A Hard to Reach Group 7.2 High Risk 7.3 Excellent Outcomes 15 16 16 16 16 16 17 17 18 8. Shining a Light on Excellence Award 18 9. Relationship with the Northern Deanery 18 10. Risk Management 19 11. The Vision for the Future Development of Services 19 Appendix I Clinical outcome tools Appendix II House Concern staff profiles Appendix III Claremont House Appendix IV House Concern contact details 21 22 23 24 3

Executive summary The 2010-2011 House Concern Annual Report describes a highly productive year for the service. The key headlines from the report are: Increase in doctors and dentists treated. In the year 2010-2011, House Concern treated 104 doctors and dentists, representing a 49% increase in referrals over the last two years. Proactive service redesign in streamlining access, and enhancing clinical and administrative productivity, has ensured that House Concern has been able to achieve its ambitious access and response targets, and demonstrate outstanding employment, symptom and satisfaction outcomes, with no increase in resources and significantly increasing demand. High Cost-Savings for the Regional Health Economy. An economic analysis is presented, which estimates that the total cost in sick leave, suspensions and cover to the NHS of North-East doctors who fall ill is 6.18 million per annum, and presenteeism costs an additional 6.25 million per year. The report details the mechanisms by which House Concern and other services in the regional network reduce this burden of expenditure. Outstanding Outcomes. House Concern demonstrates first-class return to work outcomes, clinical and statistical significant symptom improvement, and achieves very high levels of satisfaction with the quality of the service. Spearheading Education. In 2011, House Concern was commissioned to lead a regional educational initiative to deliver a four-day training programme to senior General Practitioners to enhance competencies in providing services for health professionals in primary care. In addition, House Concern worked with the Royal Colleges of General Practitioners and Psychiatrists in delivering their national trainings in health for health professionals. The Vision for the Future. House Concern is a central component of a regional network building on established expertise and sustained success to deliver a comprehensive vision for the future health of health professionals in the North East. 4

1. Description of House Concern 1.1 Overview House Concern is a specialist psychotherapy service for all doctors and dentists working in the Northern Deanery region, and an educational service for all health professionals. House Concern was established in 1992 in a pioneering collaboration with the Northern Deanery. It is the longest running service of its kind in the United Kingdom, and has treated over 950 doctors and dentists, including approximately 700 trainee doctors and dentists. The service is provided by Northumberland, Tyne and Wear NHS Foundation Trust. A significant proportion of House Concern s work is funded by the Northern Deanery, and House Concern is the current provider of Specialist Psychotherapy Provision to the Northern Deanery. House Concern has extensive experience of working with other NHS organisations through its clinical and educational work. It values close and effective relationships with the Northern Deanery, NHS employers, occupational health departments, specialist mental health and addiction services, and primary care. House Concern has an in-depth knowledge of the educational and training structures, and the performance related procedures for doctors and dentists. The service regularly attends and contributes to Deanery and Trust-based conferences and training. It has established links with the regulators. It participates in national conferences on practitioner health, including the National Clinical Assessment Service conference, and is a member of the National Advisory Group for Doctors Health (which includes other Deanery-funded psychotherapy services such as MedNet in London, Take Time in Leeds, and Medic Support in Oxford) and the European Association for Physician Health. 1.2 Specialist Interventions Provided The highly experienced clinicians in House Concern and the wider regional network offer assessment and treatment for doctors and dentists presenting with a wide range of difficulties, including burnout, stress, bereavement, relationship problems, anxiety, depression, alcohol dependence, substance misuse, eating disorders and enduring mental illness. International evidence demonstrates that doctors and dentists are a hard to reach group in respect of healthcare delivery because of their fears around shame, stigma and confidentiality. In response to this evidence, House Concern offers a rapid access and responsive self-referral system that allows intervention at the time it is most needed. All referrals are responded to within 48 hours during weekdays, and all appointments are offered within two weeks of referral. The service is responsive to requests for out-of-hour appointments, and these are offered on two evenings per week. A successful initiative this year has been to offer appointments each week in Sunderland, in addition to Newcastle upon Tyne, so to increase accessibility for doctors and dentists in the south of the region. 5

Proactive service redesign in streamlining access, and enhancing clinical and administrative productivity, has ensured that House Concern has been able to achieve its ambitious access and response targets, and demonstrate outstanding employment, symptom and satisfaction outcomes, with no increase in resources and significantly increasing demand. Each doctor or dentist presenting to House Concern is provided with a comprehensive assessment, over one to three meetings, exploring mental health and alcohol and substance use (including self-prescribing) issues. There is particular focus on assessing fitness to practice, risk to self and patients, and return to work planning. The assessment is informed by screening tools for psychiatric symptoms, risk, burnout, alcohol dependence, substance misuse and occupational functioning. The assessment provides the doctor or dentist with a detailed understanding of the predisposing, precipitating and maintaining factors related to their current difficulties, and a clear plan for recovery. The assessments are conducted in a sensitive and robust manner in order to achieve positive engagement, and are responsive to the feelings of shame and stigma present in many doctors and dentists at assessment. If a doctor or dentist does not attend an appointment they are actively followed-up. Following assessment, many of the doctors and dentists are suitable to proceed to psychoanalytic or supportive psychotherapy within the House Concern service. The service is able to offer a substantial intervention of up to 15 sessions in total. The psychotherapy demonstrates outcome benefits with regard to improving symptoms, maintaining safe work performance (or supporting an appropriate and sustained return to work), improving interpersonal relationships, and building resilience to effectively manage future stressful situations. The 15 session treatment achieves a highly successful balance between offering a substantive intervention effective in sustaining these significant outcomes, and maintaining rapid response and flow within the service. 1.3 Central Component of a Network of High Quality Care House Concern holds a central position within an effective and evolving regional network of care for doctors and dentists across specialist services in primary care, occupational health, secondary care and the third sector. This network allows doctors and dentists to smoothly access the highest quality primary and secondary care NHS services with specialist competencies and recognized expertise in treating doctors and dentists. Within Northumberland, Tyne and Wear NHS Foundation Trust, these NHS services include the following: The Newcastle and North Tyneside Addictions Service The Regional Affective Disorders Service The Regional Cognitive Behavioural Therapy Centre The Regional Department of Psychotherapy The Richardson Eating Disorder Service 6

Within primary care, House Concern has excellent relationships with services for doctors and dentists in difficulty, including Primary Care Support South of Tyne and Wear, and Durham and Darlington GP Choices. House Concern also has effective links with third sector organisations supporting doctors, dentists and their families, including the British Doctors and Dentists Group, the British Doctors and Dentists Family Group, the Doctors Support Network and the Royal Medical Benevolent Fund (for debt advice and financial assistance). 2. Economic Analysis 2.1 The Costs of Ill-health in Health Professionals These challenging financial times present NHS Trusts with a stark choice between reducing staff sickness absence, or making healthcare staff redundant. The direct cost of sickness absence in the NHS is 1.7 billion per annum, and the cost of presenteeism (attending work but underperforming due to ill-health) is at least 2.5 billion per annum 1. A one percentage point reduction in average sickness absence alone from 5% to 4% would save 600 million per year, enough to fund the services currently provided by Northumberland, Tyne and Wear NHS Foundation Trust twice over or 17,000 Band 7 staff. Considering the single professional group of doctors alone, there are 7,500 doctors in the North East (2,700 trainees, 3,000 hospital doctors and 1,800 GPs), and the costs of ill-health are estimated to be 2 : Suspensions owing to ill health cost 1.5 million a year over and above salary Dealing with cover for GPs on sick leave amounts to 280,000 a year Sick leave among hospital doctors is estimated to cost an annual 4.4 million. Presenteeism in hospital doctors is estimated to cost 6.25 million. Thus in summary the total costs in sick leave, suspensions and cover to the NHS of North-East doctors who fall ill is 6.18 million per annum, and presenteeism costs an additional 6.25 million per year. Revalidation will mean that more ill health in doctors will be detected and will need treatment, and Maree Barnett, Head of Revalidation at the Department of Health (DOH), recently said the economic argument for specialist services for doctors was a no brainer. 3 1 Boorman S. NHS Health and Wellbeing. Final Report. Crown, 2009. 2 NHS London Specialist Commissioning Group. NHS Practitioner Health Programme. Report on Two Year Prototype. 2010 (North East data adapted from figures presented.) 3 Barnett, Maree. Presentation at Ensuring Health for Health Professionals. 2011 7

2.2 Reducing the Burden of Expenditure House Concern and the regional network of services for senior health professionals save the NHS health economy/ tax payer money by: 1. Providing appropriate assessment and treatment enabling senior practitioners to stay in work safely or get back to work quickly. 2. Supporting senior practitioners appropriately, so when there is involvement of the regulator (for example, the General Medical Council), senior practitioners are allowed to continue working whenever possible. 3. Providing trusted services that deliver earlier and less costly interventions. 4. Reducing the need for expensive out-of-area referrals that in some regions are currently common in senior health professional patients. 3. Outcomes 3.1 Improving work attendance The House Concern service continues to deliver very high quality return to work outcomes for the doctors and dentists treated in the service. Over the last two years: Over 75% of the doctors and dentists who are not at work at the time of referral to the service, return to work during treatment. Over 85% of the doctors and dentists referred, remain in work, or return to work, during treatment. 3.2 Clinical Outcome Data In 2010, House Concern established the routine monitoring of outcomes for the doctors and dentists treated in the service. This routine monitoring was influenced by the work of the London Practitioner Health Programme, and House Concern is using many of the same outcome measures to facilitate collaborative work on outcomes. This report presents the clinical outcome data on the first fourteen doctors and dentists receiving treatment form House Concern since the introduction of these new measures in 2010. The analysis of two validated outcome measures, the CORE-OM and the Maslach Burnout Inventory, reveals clinical and statistical significant reductions in symptoms and burnout. The House Concern CORE-OM outcome data, which measures symptoms, is presented graphically below. The CORE-OM data demonstrates that doctors and dentists presented to House Concern reporting symptoms clearly above the clinical range (indicating significant mental health problems), and following treatment (an average of eight treatment sessions over 6 months) reported symptoms clearly below the clinical range. Before and after treatment scores show highly statistically significant decreases in total Global Distress (G), Wellbeing (W), Problems (P) and Functioning (F) sub-scales, demonstrating much reduced mental illness symptoms following treatment in House Concern. 8

Mean Score 2.50 2.00 1.50 1.00 Mean CORE-OM Sub-scale Scores Before and After Treatment from House Concern Wellbeing Problems Functioning Risk Global 0.50 0.00 Pre Post The Maslach Burnout Inventory (MBI) is the internationally recognized gold standard for measuring burnout, and the House Concern outcome data is presented graphically below. Comparison of MBI scores before and after treatment from House Concern 45 Mean Score 40 35 30 25 20 15 10 5 Emotional Exhaustion (Max. Score 54) Depersonalisation (Max. Score 30) Personal Accomplishment (Max. Score 48) 0 Pre Post 9

The MBI data shows the doctors and dentists presented to House Concern with mean scores for Emotional Exhaustion and Personal Accomplishment in the range indicating high burnout, and their scores after treatment fell to the low-average range. These are statistically significant improvements. 3.3 User Experience Outcome Questionnaire 3.3.1 Quantitative User Outcomes In 2009, House Concern introduced the routine evaluation of service user experience by asking every doctor and dentist to anonymously complete a questionnaire when they came to the end of their treatment. Over the last two years, the structured questionnaire consistently reveals a very high level of satisfaction with the service. The outcomes are: 100% of doctors and dentists would recommend House Concern to a colleague 99% of doctors and dentists would use the service again. 3.3.2 Qualitative User Outcomes The service user evaluation questionnaire also asks for free text comments. In 2010-2011 these comments describe very high satisfaction with the service. The most frequently reported themes are: High level of professionalism in psychotherapists Understanding and supportive psychotherapists Timeliness, flexibility and convenience of appointments Clear safeguards around confidentiality Positive, safe and relaxing environment A representative sample of the free text comments are presented below: In addition to providing support that was professional, responsive and dynamic, House Concern played a central role in engaging other services and facilitating my return to work. A fantastic service. Very reassuring to know House Concern is always there for when you re having difficulties Your empathy and professionalism were a huge source of comfort and support during a very difficult time. Useful, targeted approach, timely, confidential, sympathetic and enabling Very helpful, friendly, professional, easily approachable 10

I found it to be immensely supportive and a very safe environment I was seen quickly and dealt with in a very understanding and professional manner A very valuable service and much appreciated. Thank you for your time and patience. It was very quick to see a psychotherapist. The reception staff were friendly and helpful. The therapist was excellent. The environment was discreet and caring. This is a brilliant resource to support healthcare professionals in the area. 4 Audit of response times House Concern recognises the key importance of responding to referrals quickly and effectively, and therefore sets the standards of responding to all referrals within 48 hours, and offering an initial appointment with 14 days. The service continues to achieve 100% compliance with these targets. This can be seen as a particular achievement given the 49% increase in referrals over the last 2 years, and the compliance reflects successful service redesign around access, and improvements in administrative and clinical efficiency. 5. Description of Doctors and Dentists Treated The aim of this section is to give a brief overview of the characteristics of the doctors and dentists treated in the period covered by this annual report, the 1st April 2010 to the 31st March 2011, and where appropriate compare figures to previous years. 2010-2011 represents the busiest year to date for House Concern. The service treated 104 doctors and dentists, which is a 13% increase on 2009-10 (92 doctors and dentists treated) and a 49% increase on 2008-2009 (70 doctors and dentists treated.) Of these 104 referrals treated by House Concern, 57 (55%) are doctors or dentists in training, and 47 (45%) are doctors and dentists in non-training grades. This represents a 22% increase in doctors and dentists in non-training grades treated since last year, and an 8% increase in trainees treated. 53% of the doctors and dentists treated are women, and 47% are men. This continues the trend over the last few years in the service moving toward attracting a more even distribution of the sexes. In examining the ethnicity of the doctors and dentists treated, 73% are white-british and 22% are Black and Minority Ethnic. 11

The service continues to attract doctors and dentists throughout the age range, from newly-qualified to approaching retirement, and as in previous reports the commonest age to present remains 30-39 years old (42% of all referrals). There has been an increase since last year in the number of doctors and dentists presenting aged 20-29 years old, with an increase in this age range from 22% to 28% of all referrals. Age 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 42% 28% 18% 12% 20-29 years 30-39 years 40-49 years 50+ years The grades of the doctors and dentists treated remains consistent with last year, with CT1-3/ ST1-3 grade comprising 26% of all referrals, and Consultant/GP Partner comprising 30%. Grade 35% 30% 25% 26% 30% 20% 15% 10% 7% 5% 0% F1/F2 ST 1-3 / SHO ST 4-8 / SpR 14% 7% 1% GP Trainee Dental Trainee Consultant / GP Partner Staff Grade / Others 15% A wide variety of specialities, including many smaller specialities, access the service. This year has seen an increase in the number of doctors in medical specialities accessing the service (from 15% to 25%), and a small increase in doctors from General Practice (26% to 31%), Anaesthetics (8% to 11%) and Obstetrics and Gynaecology (5% to 7%). The number of doctors from psychiatry accessing the service has fallen from 22% to 7%, and, if this pattern is maintained, merits further investigation. 12

35% 30% 25% Speciality 31% 25% 20% 15% 10% 5% 11% 6% 7% 4% 7% 8% 0% Anaesthetics Dentistry General Practice Medicine Obs & Gynaecology Paediatrics Psychiatry Surgery Doctors and dentists are accessing the service from Trusts throughout the Northern Deanery region. The three Trusts we have served most this year are Newcastle upon Tyne Hospitals NHS Foundation Trust (31% of referrals; up from 24% last year), County Durham and Darlington NHS Foundation Trust (11% of referrals; up from 2% last year), and Newcastle Primary Care Trust (10% of referrals; up from 7% last year). Tees Esk Wear Valley South Tyneside 6% 6% Trust South Tees 1% Northumbria Healthcare 3% Northumberland, Tyne & Wear Northumberland Care Trust North Tyneside 4% 4% 4% North Tees 2% Newcastle PCT 10% Newcastle Hospitals 31% Gateshead Health 8% Cumbria 2% Co. Durham PCT 4% Co. Durham & Darlington 11% City Hospitals Sunderland 2% 0% 5% 10% 15% 20% 25% 30% 35% All doctors and dentists presenting to House Concern are asked to identify the main precipitating factors for their difficulties. This year, 90% identified work stress, 68% 13

social stress, 43% childhood experiences and 14% other (includes physical health related and relationships.) A key feature of these figures is the vast majority of doctors and dentists identify more than one predisposing factor at presentation. Precipitating factors (percentages total to more than 100% as some people record more than one factor as precipitant) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 90% 68% 43% Work Stress Social Stress Childhood Experiences 14% Other All doctors and dentists presenting to the service are asked how they found out about the service. This year, 40% were recommended by a friend or colleague (up from 29% last year), 37% were recommended by their GP, Occupational Health Physician or other Health Professional (up from 26% last year), and 26% were recommended by their supervisor or trainer (up from 24% last year). In addition 26% accessed information from the website, 9% from a leaflet and 7% from a presentation. Service Recommended By (percentages total to greater than 100% as some people have multiple recommendations) Presentation 7% Friend / Colleague GP/ Occ health / Other Prof 37% 40% Supervisor/ Trainer 20% Website 26% Leaflet 9% 0% 10% 20% 30% 40% 50% House Concern offers psychotherapy treatment for up to 15 one hour sessions, and the service demonstrates this duration of treatment achieves a highly successful balance between offering a substantive intervention effective in sustaining significant 14

outcomes, and maintaining rapid response and flow within the service. In detailing the number of therapy sessions so far received by doctors and dentists presenting from 1 April 2010 to 31 March 2011, 13% have received 10-15 sessions, 32% have received 6-10 sessions, and 55% have received up to 5 sessions. It is important to remember that psychotherapy treatment in House Concern will still be ongoing for many of the doctors and dentists who accessed the service in 2010 and 2011, and therefore the total number of sessions offered to these doctors and dentists by the time they complete their psychotherapy will be more. 6. Educational Initiatives 6.1 Health Professionals as Patients? A New Commissioned Training for General Practitioners. In 2011, House Concern was commissioned to deliver a four day training programme for General Practitioners inspired by the Royal College of General Practitioners newly developed Health for Health Professional Competencies for General Practitioners Providing Services to Health Professionals. The aim of the training is to enhance the competencies of senior GPs who wish to further develop their established skills in providing services in primary care for health professionals. The training was launched in March 2011, and runs throughout 2011. The training has attracted nine senior GPs, and includes participants from highly respected services including Primary Care Support South of Tyne, and Durham and Darlington GP Choices. There has been close liaison with the Royal College of General Practitioners in developing the course, and there are very positive discussions regarding the training contributing towards the participants gaining Royal College of General Practitioners Specialist Interest status in providing services for health professionals. The four-day training combines presentations, small group work, case-discussion and simulated patients. Presenters on the training are Mr Blake Dobson (Head of Case Review, General Medical Council), Dr Richard Duggins (Clinical Lead, House Concern), Dr Eilish Gilvarry (Consultant Psychiatrist and Clinical Director, Newcastle and North Tyneside Addictions Service), Dr Tristan Graham (Secretary of North East British Doctors and Dentists Group), Dr Jamie Harrison (GP Deputy Director, Northern Deanery), Dr Andrea Hearn (Consultant Psychiatrist, Newcastle and North Tyneside Addictions Service), Dr Rhona Knight (Lead for RCGP Health for Health Professionals Programme), Dr Hamish McAllister-Williams (Senior Reader and Consultant Psychiatrist in Regional Affective Disorders Service), Dr Hamish Paterson (Consultant Occupational Health Physician, NCAS Assessor), Dr Chris Tiplady (Northern Deanery Regional Clinical Advisor for Education), Ms Judith Townsley (Principal Adult Psychotherapist, House Concern), and Ms Lucy Warner (Chief Executive of Practitioner Health Programme). 15

6.2 Royal College of General Practitioners and Royal College of Psychiatrists Health for Health Professionals Training House Concern was invited to present at the newly launched national competencies training hosted by the Royal College of General Practitioners and the Royal College of Psychiatrists. These training programmes are attended by senior GPs and Psychiatrists who wish to further enhance their competencies in treating health professionals. In the Royal College of Psychiatrists national training in May 2011, Dr Richard Duggins gave two presentations, on House Concern and on the London Practitioner Health Programme. At the Royal College of General Practitioners national training in September 2011, Dr Duggins will again present on two topics, House Concern, and the Daksha Emson Inquiry. 6.3 Society of Occupational Medicine North East Group House Concern was delighted with the opportunity to present to the Society of Occupational Medicine North East Group in November 2010, and enjoyed a very stimulating evening discussing House Concern and the role of psychotherapy in facilitating return to work. 6.4 Tees Esk and Wear Valley NHS Foundation Trust Education Conference House Concern had the opportunity to present a poster and run an information stall at the Tees Esk and Wear Valley NHS Foundation Trust Education Conference attended by over 100 psychiatrists, including supervisors and trainees. 6.5 Reflective Practice Group for Psychiatrists House Concern, in collaboration with The Regional Department of Psychotherapy hosts a reflective practice group for psychiatrists across the Northern Deanery to explore issues that cause stress and burnout 6.6 Attendance at Regional and National Conferences House Concern attends the National Advisory Group for Doctors Health three times per year, and is a member of the European Association for Physicians Health. Conferences, course and events attended in 2010-2011 were: Northern Deanery Conference: Supporting the Diverse Needs of Trainees and Trainers Northern Deanery Course: Supporting Underperforming Trainees NCAS Annual Conference: Disruptive Behaviour - Tackling Concerns about Practitioner Behaviour 16

Royal College of General Practitioners, Faculty of Occupational Medicine, and Royal College of Psychiatrists Conference: Looking after Health Professionals to Ensure Good Quality Patient Care Royal College of General Practitioners Conference: Healthy Doctors - Healthy Patients Royal College of Psychiatrists Conference: Ensuring Health for Health Professionals Practitioner Health Programme End of Prototype Event 7. Emerging Themes 7.1 A Hard to Reach Group Despite a greater understanding of mental health and addiction difficulties in the general population, doctors and dentists remain a hard to reach group with regard to their own personal healthcare. A recent survey of 2,500 doctors published by the Royal College of Physicians shows that only 13% would seek help if they had a mental health or addiction difficulty. 4 House Concern s ongoing experience shows that feelings of shame and stigma, and fear of damage to professional status, remain very pronounced in doctors and dentists in psychological stress. In a significant proportion of doctors and dentists treated, the House Concern clinician is the first person in which the doctor or dentist has confided, and there has been no previous discussion with their GP, colleagues or even partner. House Concern s established trust within the professions, in combination with its rapid response, flexibility, and clear safeguards around confidentiality, ensure House Concern is serving what would otherwise be an unmet need. If this need was not met there would be severe consequences for doctors and dentists health, their patients health, and NHS costs related to sickness absence and presenteeism. 7.2 High Risk Doctors and dentists present to House Concern at high risk of severely deteriorating mental health or suicide. They often present after they have been unwell for many months, and this delay is because of feelings of shame and stigma, fear of damaging their professional status, and unsuccessful attempts at self-treatment. The delay in presenting often means doctors and dentists have already developed multiple complex (but hidden) problems at work and home, because the initial unaddressed problem has over time lead to a vicious circle of deteriorating mental health and functioning affecting multiple life spheres. Assessments need to be conducted by clinicians with high-level specific competencies because doctors and dentists, even if they do present, may otherwise still not reveal the true nature or extent of their difficulties, or engage in appropriate ongoing treatment. Clinicians working in House Concern also need to be clear and robust in managing risk in order that, when appropriate, other agencies are involved, and the employer and the regulator are informed. 4 Hassan, TM, Ahmed, SO, White, AC and Galbriath, N. (2009) A postal survey of doctors attitudes to becoming mentally ill. Clinical Medicine, 9, 327-32 17

7.3 Excellent Outcomes Evidence is emerging that the outcomes for doctors and dentists are outstanding when they are engaged in appropriate treatment. The data presented in this report from House Concern demonstrates very high return to work rates, and high levels of symptom reduction. The outcomes of the London Practitioner Health Programme 5 also show high return to work rates, and symptom reduction, and a recent publication by MedNet in London (a service with great similarity to House Concern offering bespoke assessment and treatment informed by psychodynamic principles) demonstrates significant symptom reduction. 6 A fascinating recent audit performed within the Trust s Regional Affective Disorders Service based in Newcastle upon Tyne demonstrates that with specialist treatment almost all doctors, even those presenting with severe episodes of psychiatric illness, can expect to recover and return to work as a doctor. 7 8. Shining a Light on Excellence Award House Concern was delighted to be nominated, shortlisted and high-commended in the Northumberland, Tyne and Wear NHS Foundation Trust 2011 Shining a Light on Excellence Award. The Award was in recognition of House Concern s productivity, demonstrated outcomes and effective service redesign. 9. Relationship with the Northern Deanery House Concern is very grateful for the sustained support and investment it receives from the Northern Deanery. It is this ongoing support and investment that allows the service to deliver, develop and advance the treatment of doctors and dentists across the region. In 2010 2011, House Concern has valued opportunities to meet with Professor Gray, Postgraduate Dean, Mr Paul McLaughlan, Operations Manager, and Dr Chris Tiplady, Regional Clinical Advisor for Education. House Concern is delighted by the establishment of regular meetings with Dr Tiplady to share good practice and learning, and the service is also very grateful to Dr Tiplady for his very well received presentation to the House Concern organised competency-training for senior General Practitioners providing services to health professionals. 5 NHS London Specialist Commissioning Group. NHS Practitioner Health Programme. Report on Two Year Prototype. 2010 6 Meerton, M, Bland, J, Gross, SR and Garelick, AI. (2011) Doctors experience of a bespoke physician consultation service: cross-sectional investigation. The Psychiatrist, 35, 206-12 7 Duggins, R. and McAllister Williams, H. (2011) House Concern and the wider regional network. Royal College of Psychiatrists Ensuring Health for Health Professionals: A one day course for Consultant Psychiatrists. 18

10. Risk Management House Concern conducts a formal and comprehensive risk assessment with every doctor and dentist presenting to the service. This risk assessment is an essential component of the initial clinical interview, and the assessment is informed additionally by standardised questionnaires and screening tools. All aspects of risk are considered, including risk of suicide and self-harm, risk to patients, risk to others, and risk to children and vulnerable adults. Risk is further managed by the service in that all new assessments are discussed in supervision within the team, including in externally facilitated fortnightly team supervision. Appropriate and robust action is taken with regard to all risks. With the specific issue of safeguarding patient care, the GMC publication Your Health Matters stresses that the regulator does not typically need to be informed if a doctor recognises they have a problem and are receiving and complying with treatment. The GMC generously offers to the House Concern clinicians the opportunity to telephone to anonymously discuss complex cases and gain guidance on the need for regulatory involvement. House Concern does occasionally face situations when a doctor and dentist is unwilling to engage with appropriate and safe management of their illness and difficulties, or a doctor or dentist reveals a clear breach of good medical or dental practice, and in those situations it is necessary and appropriate that we break confidentiality and contact the patient s employer, the Northern Deanery if the patient is a trainee, and if required, the General Medical Council or General Dental Council. The development of the regional network of care for doctors and dentists with mental health and addiction problems allows House Concern timely access to specialist advice, assessment and treatment. This means that the doctors and dentists with the most complex needs can be held within a system of coordinated care that clearly addresses all of their needs. In addition, House Concern can directly access psychiatric crisis assessment and treatment teams, and if appropriate, inpatient care, for those doctors and dentists at highest risk. 11. The Vision for the Future Development of Services There is now clear evidence and national recognition that the assessment and treatment of doctors and dentists, pioneered by House Concern, is effective, essential and cost effective. The two year report by the London Practitioner Health Programme demonstrates high levels of cost savings to the NHS, and outstanding outcomes in terms of return to work and symptom reduction. This evidence has resulted in the London Practitioner Health Programme evolving from a prototype to an essential service with secure recurrent funding. Services such as House Concern, the London Practitioner Health Programme, MedNet (London), Take Time (Leeds) and Medic Support (Oxford) demonstrate that the demand for services is significant and increasing. Revalidation is highly likely to identify increased numbers of doctors with health concerns impacting on their performance, and these doctors will need specialist treatment. 19

The recognition of the extensive cost savings and the improvements in patient safety resultant on the appropriate treatment of doctors and dentists has led the Royal College of General Practitioners, Royal College of Psychiatrists and the Faculty of Occupational Medicine to launch competency trainees to develop specialists in treating health professionals across the country. These drivers have led to an evolving vision in the North East of England of Practitioner Health North. This would be a coordinated system of care that brings together the specialist expertise in treating health professionals in secondary care, primary care, occupational health and the voluntary sector. This system of care would build on the network of care developed over the previous years to deliver a coordinated, standardised and comprehensive package of specialist assessment and treatment to senior health practitioners with mental ill-health, alcohol and drug addiction, and physical difficulties that have an impact on work performance. The development would initially be focussed on doctors and dentists in the North East, with a clear plan to extend the service to all senior health practitioners over time. Working with our partners, House Concern are committed to continuing to explore the potential development of Practitioner Health North, and over the coming year we will continue to participate in discussions at a national level with the aim of ensuring that the North East is given the opportunity to participate in this important initiative. 20

Appendix I: Clinical Assessment and Outcome Tools Clinical Outcomes for Routine Evaluation Outcome Measure (CORE-OM) (Evans et al., 2002). A validated measure of distress consisting of 34 items scored on a five-point scale, asking participants to rate how often the statements apply to them. Four sub-scales can be measured relating to well-being, psychological problems, functioning and risk. Maslach Burnout Inventory (Maslach et al., 1996). This is the standard tool for measuring burnout, and uses a three dimensional description of exhaustion, cynicism and inefficiency. Social Adjustment Scale (Mundt et al., 2002). A brief measure of impairment in day-to-day functioning that indicates each participant s impairment in work, home and leisure activities. Alcohol Use Disorders Identification Test (AUDIT) (WHO, 2001). Validated screening tool to detect a problem with alcohol, including hazardous or harmful drinking, and alcohol dependence. Substance Misuse Questionnaire. A brief measure to detect substance misuse and self-prescribing in doctors and dentists. 21

Appendix II: House Concern staff profiles Dr Richard Duggins is Service Lead for House Concern, and is a Consultant Psychiatrist in Psychotherapy. He holds dual accreditation as a General Adult Psychiatrist, and a Psychiatrist in Psychotherapy. He is a Psychoanalytic Psychotherapist registered with the British Psychoanalytic Council. He is a member of the National Advisory Group on Doctors Health. He works full-time in House Concern. Dr Merja Makinen-Martindale is a psychoanalyst with background training as a Clinical Psychologist. She is a fellow in the British Psychoanalytical Society. She works part-time in House Concern. Ms Judith Townsley is a British Psychoanalytic Council registered psychoanalytic psychotherapist and Registered Mental Health Nurse. She has extensive experience of working with patients with complex difficulties in the National Health Service. She works part-time in House Concern. Ms Christine Everatt is a British Psychoanalytic Council registered psychoanalytic psychotherapist. In addition, she is a Senior Accredited Counsellor and Senior Accredited Supervisor with the British Association of Counselling and Psychotherapy. She has held previous posts as Head of the University Counselling Service in two universities, and Head of Staff Counselling for Newcastle Primary Care Trust, and Northumberland, Tyne and Wear NHS Foundation Trust. She works part-time in House Concern. Ms Deborah Warburton is a group analyst and adult psychotherapist. She is a Member of the Institute of Group Analysis, and Convener of the Foundation Course for Group Analysis for the North East of England. Dr Lucy Buckley is a Specialist Registrar Psychiatrist in Psychotherapy training within House Concern. This training allows her to gain specialist expertise in assessing and treating doctors and dentists. Mrs Angela Reay is the Medical Secretary for House Concern. Angela deals with confidential telephone calls, emails, written correspondence, and prepares promotional material. She books people directly into clinicians diaries, which maximises flexibility and responsiveness. Mrs Julie Tuck is Office Manager for the Regional Department of Psychotherapy and Cognitive Therapy Centre. She generously offers her expertise as a senior administrator to House Concern, and acts as an important contact for people making enquiries about the service. Julie is able to book people directly into clinicians diaries. 22

Appendix III: Claremont House House Concern is privileged to be based at Claremont House. Claremont House prides itself in offering a discrete and sensitive environment for doctors and dentists. The service is located just outside Newcastle city centre and is easily accessible by train, metro and bus. House Concern s position near to the Royal Victoria Infirmary (RVI) means the service is also easily accessed by the Newcastle Hospitals Hopper Bus system. Disabled parking is provided on site, and metered parking, including a large public car park on Claremont Road, is available for people travelling by car. House Concern s friendly reception staff are sensitive to the complex feelings of many of our doctors and dentists, and as a result the service does not require visitors to give their full name on entering the building. Tea, coffee and chilled water are provided in the waiting room, and appointments always start on time to avoid doctors and dentists having to wait unnecessarily. The consulting rooms at Claremont House are sensitively furnished, and provide a quiet and comfortable space that is protected from interruptions. The group rooms at Claremont House provide excellent facilities for education events and meetings. The option of appointments in Sunderland is available for doctors and dentists who live or work in the south of the region. Appointments can also be arranged at other locations if this is important to the doctor or dentist contacting the service. House Concern is a part of Northumberland, Tyne and Wear NHS Foundation Trust and this allows the service to access free and valuable advice quickly from colleagues, and if necessary consultation, from a rich array of the Trust s highly regarded specialist and regional services including the Newcastle and North Tyneside Addictions Service, the Regional Affective Disorders Service, the Regional Cognitive Behavioural Therapy Centre, the Regional Department of Psychotherapy, and the Richardson Eating Disorders Service. For doctors and dentists with complex difficulties the option of joint management with these fellow services is available. House Concern s position within the Trust allows the service to draw upon intensive psychiatric support for doctors or dentists in crisis. The service has established and valued links with primary care, and third sector organisations. 23

Appendix IV: House Concern contact details We welcome your comments on this Annual Report and your feedback on the service. We are eager to receive feedback, and find this immensely valuable in guiding our future development, focus and improvement. We would be delighted to arrange to come to meet with you to discuss House Concern further or give a presentation on our work, and we also welcome visits to the service by any interested individuals or groups. The service can be contacted through Mrs Angela Reay, House Concern Medical Secretary on (0191) 2824547, or via our email address houseconcern@ntw.nhs.uk We also welcome enquiries via our confidential 24-hour answer-phone on (0191) 230 0043 Our webpage on the Northumberland Tyne and Wear NHS Foundation Trust website can be found at: http://www.ntw.nhs.uk/section.php?l=3&p=384 A map showing the location of our service and our postal address is provided below. House Concern Claremont House Off Framlington Place Newcastle upon Tyne NE2 4AA 24