My Contribution Conceived the idea and led the study. Literature review, the protocol and ethics approval. Collected the data. Co-ordinated. Merged the data & analysed it. Prepared the manuscript and sent for publication. Revisions as first & corresponding author. Presented in RCPsych AGM, Liverpool and in my Trust.
Background NWW: enabling consultant psychiatrists, among others, to deliver effective and person-centred care. Acute care pathway – CRHT + In-patient. Functional model. Acute in-patient psychiatry – a subspecialty? Mind the gap Community consultant In-patient consultant Service user
Aim To investigate health professionals’, service users’ and carers’ opinions about the provision of separate consultants for in-patient settings and the community
Design Multicentre study : North Hertfordshire; the south lakes region of Cumbria; and Winchester. Tool semi-structured semi-qualitativequestionnaire (paper and online version) An information leaflet (without introducing any bias).
Data Collection Personally, by post and online. Through CMHTs, out-patient clinics, mental health wards and other places (e.g. the local centre of MIND). Admitted patients were not invited. Reminder - after a month.
Analysis Quantitative data – descriptive statistics. Qualitative data – framework analysis. Carers: too few to be included in the analysis.
Quantitative: Service providers 170/330 responded - response rate about 50%. 56 participants left after introductory questions. 72% participants having > 6 years experience in mental health.
Distribution of Respondents
Satisfaction of service providers
Quantitative: Service users 20/43 respondents had a history of admission. Duration of contact with mental health: 2-10 years. Awareness: 16/43 (36%) aware
Satisfaction of service users
Qualitative results Need of functional model: Unaware; divided opinions. to save money and/or time to reduce workload on consultants to improve patient care. Service need, no clinical need. Long-term future: driven by financial issues, so will stay (2/3) would be reversed (1/3)
Qualitative results Advantages 1/3 : no advantages of this change Disadvantages In-patient psychiatry – NOT a separate sub-specialty. Skills Training
STRESS, SKILLS & TRAINING
Less stress, more time.
De-skilling Vs specialisation,
Suggestion: Rotation CONTINUITY/COMMUNICATION
Both consultants attend CPA
Shared electronic records
Qualitative data DYNAMICS
Suggestion: Involve SU & C in service designing. Functional Model: Mind the Gap PATIENT CARE
Easily available consultant.
Problems with discharge.
In their own words... Assessment tools & referral notes - not a substitute for first hand knowledge of a patient and their circumstances. ......... a GP. Smooth running of wards. Likely to improve in-patient and community care individually but discontinuity will offset advantage. .......... Mental health professionals. The old system was on paper and we were seeing a different consultant every 3 months anyway. .......... A service user
Discussion Awareness. Driving force for NWW. It would continue despite a high level of dissatisfaction. The most consistent view - continuity of care, the therapeutic alliance, the doctor-patient relationship and trust Ensuring continuity of care was already a challenge
Evidence base Pioneering work at Guy’s hospital. East Suffolk (pilot in 2005). A survey of psychiatrists (Dale & Milner, 2009) : Generally negative attitudes, particularly effect on patient care, the erosion of the professional role of the consultant and quality of work life. Malik et al (2008) : the implications on training.
Strengths Explorative study Multicentre Both service providers (primary and secondary care, medical and non-medical) as well as service users included Highly relevant and Topical. Solution focussed.
Limitations Sample size and response rate. Response bias. Many participants did not experience this model. Admitted service users were not included.
Future directions To study that ‘actual’ long term impact of functional model on these issues. Thanks