What do we need from other services? Dr Susi Harris Clinical Lead for Calderdale SMS GPwSI Bradford CDAT

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1 What do we need from other services? Dr Susi Harris Clinical Lead for Calderdale SMS GPwSI Bradford CDAT

2 What do we need from each other? - Nothing! All patients should be treated in primary care vs Decommissioning of traditional secondary care services is dangerous and wrong

3 What can we offer each other? Nothing! Only primary care practitioners treat holistically vs Only secondary care practitioners have real expertise

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5 When I was a GP Keyworkers to be competent and confident Have my hand held to get involved in direct patient care and start to gain rewards Feel reasonably up to date myself without too much effort 2ary service to be on end of phone 2dary service to take on the complex or non-responding patients 2ary service to take on the violent or abusive patients

6 When I am a clinical lead..gps GPs: work with us not against us Treat drug users same as other patients Don t prescribe benzos! Provide GMS, health promotion, sick notes (bonus - ECG, phlebotomy, BBV test/referral) Shared care GPs: Take an interest get involved with direct patient care get involved with service development/cg (bonus recruit others, deliver training)

7 When I am clinical lead.mh Outward looking Treat substance users same as other MH Access, eg crisis team, dual diagnosis Use of their secure facilities Specific skills Mental health Assessment, risk assessment Prescribing and interactions Extreme prescribing: injectables, funny opiates, amphetamines Academic: research, keeping abreast of literature

8 When I am GPwSI: Use of my GP skills: Physical healthcare: angina, OA, pitted keratolysis, thyroiditis, VIN From other GPs/services Contraception Pregnancy Acute physical illness

9 Who has the expertise then? Primary care: Physical Perinatal Secondary care: Severe and enduring mental health problems Academic underpinning for treatment What about. Co-dependencies? Recovery?

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11 Who has the holistic approach? Primary care: Family medicine Community based multidisciplinary Secondary care: Time to dig deep Specialist setting multidisciplinary

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13 Clinical leads 1. What do we want from our clinical leads? 2. Does GP or psych background work better in clinical lead role? 3. How can we make best use of both sets of skills?

14 1. High level clinical skills A) Complex needs: Pregnancy Co-dependencies (eg heroin, benzos and alcohol) Liver problems Chronic pain B) Specialist treatment: Long term benzodiazepines Amphetamines Prescription medicine/unusual drug dependencies Initiation of naltrexone Initiation of prescribing outside guidelines/licencing Care of sick h care professionals for GMC etc End of the line C) Intensive treatment modalities Titration and stabilisation Transfer between therapies (esp Meth > Bup) Detoxification

15 2. Develop and support other services Recruit and develop 1ary care-based rx Support 1ary care: advice, fast-track ref Services for pts not covered by 1ary care (as interim solution) Support hospital inpatients (perioperative, acute medical, GI) Support hospital outpatients (pain, perinatal)

16 3. Non-clinical services Specialist level: Court attendance/reports, expert witness Child protection reports DVLA reports Professional body regulatory authority reports (eg GMC, NMC, BPS) Benefits and housing reports

17 4. Systemic Quality Assurance Teaching and training generic h care staff GP trainees, A&E, 1HCT, pharmacists etc Clinical supervision/appraisal shared care GPs, NMPs Clinical leadership and policy development Active CG participation Systematic CG review as group Audit SEA Address underperformance issues Innovative practice and research

18 5. Supporting local partners Clinical advice to DAAT/Partnership Advice and liaison with PCT: Pharmaceutical advisors, PEC, PCT Clin Governance Advice and liaison with LMC Ditto CJS: police, probation, courts, prisons Ditto acute trusts: A&E, mental health

19 GP or Psychiatrist as clinical lead? Multidisciplinary working: HVs MWs, p/nurses, pharmacists, all acute specialties Real-life management: running own business, needs to learn leadership on the job Access: will take on any number, low threshold Culture: Involved, intuitive, uncertainty-managed, skill-mix Team lead training: teaching, supervision, clinical governance Consultant training: management, leadership, comes ready made Access: will take on any diagnosis, high threshold Culture: detached, analytical, risk-managed, hi-qualified staff Costs? Funding streams??

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22 How do we make it work? Rehab Outsourced Detox Other routes to recovery Dual diagnosis Primary care led Shared care Rest of primary care l l Safe haven SMALL TOWN SCENARIO

23 How do we make it work? Other routes to recovery Rehab Detox Mental Health led Primary care led CITY SCENARIO Shared care Rest of primary care l l Safe haven Primary care led

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25 DISTRICT SCENARIO Rehab Detox Primary care led Mental Health led city Shared care Primary care led Dual diagnosis town Shared care Shared care Primary care led Dual diagnosis town

26 District Consensus Group Would include: All the clinical leads in the district Lead pharmacist Lead DRM from NTA Would look at: Referral criteria within district, across PCT boundaries Prescribing policies Clinical governance Oversight on patient flows, patient access Tier 4: detox and rehab Recruitment management shared care