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Promoting the safe management of
people with Severe Mental Illness by
training practice nurses in primary
care

Dr Sheila ...
Contributors
Dr Geraldine Strathdee, National Clinical Director Mental
Health – NHS England
Dr Sheila Hardy, Nurse Consult...
Aim of Programme
To promote the safe management of people with
severe mental illness in primary care by increasing
the kno...
Background
Payment by Results (PbR) is the rules-based
payment system, introduced to health care in
England in 2012, under...
Cluster 11
Eligible for discharge from secondary to primary
care.
Clinical care they require will therefore need to be
del...
Current provision in
primary care
GPs in primary care in the UK receive government
funding through a payment contract (Qua...
Developing expertise
WHO definition: Primary care workers are skilled
and able to provide mental health services with
supp...
NHS London project
The medical directors of NHS London were aware
that:
• Clinical Commissioning Groups in London
recognis...
Objectives
1. Increase the ability of GP practices to deliver the
QOF annual physical health check for people
with SMI.
2....
Method
Project led by Dr Fiona Nolan, Camden and
Islington NHS Foundation Trust.
Collaboration of eight of the other nine ...
Developing the
training
The training materials were developed by Dr Sheila
Hardy and reviewed by the reference panel.
Desi...
Programme
• Depression and anxiety (including screening,
assessment, suicide risk and medication).
• Severe mental illness...
Preparing the training
• Liaison with Directors of Nursing in each London MH
trust
• 3 months negotiation period, with ide...
Organising and
advertising the training
•Dates and venues established in each trust by the link lead
in collaboration with...
Training practice
nurses
Hard copies of the training manuals (for practice
nurses and trainers) were posted to the trainer...
Evaluation
Practice nurses completed:
1. A pre and post training questionnaire asking
about their confidence and knowledge...
Results
Number of sessions= 22 + 30 + 19= 71 (63 delivered to
date)

Period: 3rd July 2012 -23rd September 2013
Trainers i...
Perceptions of attendees (1)
N= 385

Mean score
(1-5)
Pre

Understand schizophrenia and bipolar disorder

Aware of medicat...
Perceptions of attendees (1)
N= 385

Mean score
(1-5)
Pre

Understand schizophrenia and bipolar disorder

Aware of medicat...
Perceptions of attendees (2)
N= 385

Mean Score
(1-5)

Confident in assessing side effects
Aware of best practice in healt...
Conclusion
Brief training in mental health delivered by mental
health professionals to practice nurses has a
positive impa...
Next steps
Dr Sheila Hardy has been appointed as Education Fellow at
University College London Partners to further develop...
References
BMA and NHS Employers. (2013) QOF Guidance 2013-14 (sixth revision).
http://bma.org.uk/practical-support-at-wor...
Sheila.Hardy@northampton.ac.uk
Fiona.Nolan@candi.nhs.uk
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Promoting the safe management of people with Severe Mental Illness by training practice nurses in primary care

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This project, led by Dr Fiona Nolan, Camden and Islington NHS Foundation Trust, developed training for practice nurses and carried out research on the physical health needs of patients with Severe Mental Illness.

Previous research undertaken by Dr Sheila Hardy, Education Fellow, University College London Partners and Visiting Fellow for Primary Care, University of Northampton, found that contrary to popular belief, patients with serious mental illness will attend health checks, and proper training in this area for practice nurses increases the level of screening and lifestyle advice given.

Find out more at http://mentalhealthpartnerships.com/?p=13113

Published in: Health & Medicine
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Transcript of "Promoting the safe management of people with Severe Mental Illness by training practice nurses in primary care"

  1. 1. Promoting the safe management of people with Severe Mental Illness by training practice nurses in primary care Dr Sheila Hardy & Dr Fiona Nolan
  2. 2. Contributors Dr Geraldine Strathdee, National Clinical Director Mental Health – NHS England Dr Sheila Hardy, Nurse Consultant - Park Avenue Medical Centre and Visiting Fellow - University of Northampton Dr Fiona Nolan, Nursing Research Fellow - UCL and Deputy Director of Nursing - Camden and Islington NHS FT Claire Johnston, Director of Nursing - Camden and Islington NHS FT Nicola Vicks, Programme Lead - NHS London (Now CQC) Josie Turner, Programme manager - NHS London (now South London LETB)
  3. 3. Aim of Programme To promote the safe management of people with severe mental illness in primary care by increasing the knowledge of practice nurses and providing them with a support network.
  4. 4. Background Payment by Results (PbR) is the rules-based payment system, introduced to health care in England in 2012, under which commissioners pay healthcare providers for each patient seen or treated, taking into account the complexity of the patient’s healthcare needs (Department of Health 2012).
  5. 5. Cluster 11 Eligible for discharge from secondary to primary care. Clinical care they require will therefore need to be delivered by GPs or practice nurses. BUT GPs and practice nurses feel that care of such people is beyond their remit (Lester 2005).
  6. 6. Current provision in primary care GPs in primary care in the UK receive government funding through a payment contract (Quality and Outcomes Framework or QOF) to: • Provide annual cardiovascular screening and a plan of care for people with SMI plus monitor those taking lithium. • For patients with depression - carry out a biopsychosocial assessment. (BMA and NHS Employers 2013)
  7. 7. Developing expertise WHO definition: Primary care workers are skilled and able to provide mental health services with support (Funk and Ivbijaro 2008). The Joint Commissioning Panel for Mental Health (2012) advise that there should be continuous professional development and training curriculums for primary care staff that reflect current NICE guidance to ensure that relevant skills are gained and maintained.
  8. 8. NHS London project The medical directors of NHS London were aware that: • Clinical Commissioning Groups in London recognise that the safe management of some patients with SMI when discharged from secondary to primary care is a clinical and financial priority. • There is a need for training primary care staff. • Funding provided from NHS London
  9. 9. Objectives 1. Increase the ability of GP practices to deliver the QOF annual physical health check for people with SMI. 2. Enhance the capacity of primary care to manage the safe discharge of Cluster 11 patients. 3. Support the transfer of activity from secondary to primary care.
  10. 10. Method Project led by Dr Fiona Nolan, Camden and Islington NHS Foundation Trust. Collaboration of eight of the other nine mental health trusts in London to deliver the training. ‘Train the Trainers’ model. Reference panel of expert stakeholders - professor of primary care nursing, an expert mental health advisor, a mental health service user, a mental health carer and a community mental health nurse.
  11. 11. Developing the training The training materials were developed by Dr Sheila Hardy and reviewed by the reference panel. Designed to be three hours in duration. Package included a power point presentation, practice nurse manual, trainers’ manual, best practice guide for physical health checks, and navigating this website http://physicalsmi.webeden.co.uk/
  12. 12. Programme • Depression and anxiety (including screening, assessment, suicide risk and medication). • Severe mental illness (including medication and administering depot medication). • Assessment of physical health care in accordance with the Quality and Outcomes Framework (QOF) standards for people with severe mental illness. • Recovery focussed local supports and care plans. • Liaising with the local mental heath teams.
  13. 13. Preparing the training • Liaison with Directors of Nursing in each London MH trust • 3 months negotiation period, with identification of lead nurse in each organisation • Mental health nurses were identified by each lead to attend the train the trainer sessions • The trainers were provided with electronic copies of all materials. • 45 attended 3 sessions delivered by Dr Sheila Hardy.
  14. 14. Organising and advertising the training •Dates and venues established in each trust by the link lead in collaboration with FN •Advertising strategy a) Email distribution list to 1350 GP practice nurses and practice managers in London (modified from Pro-list) b) Royal College of Nursing and their publications- Nursing standard c) A practice nursing website •All bookings taken centrally by FN
  15. 15. Training practice nurses Hard copies of the training manuals (for practice nurses and trainers) were posted to the trainers in advance of the sessions. Training delivered in three phases- final one to be completed end September 2013
  16. 16. Evaluation Practice nurses completed: 1. A pre and post training questionnaire asking about their confidence and knowledge in relation to dealing with specific mental health problems 2. A questionnaire rating the training content and delivery and include their suggestions for improvement. Questionnaires developed by S Hardy for the purposes of the programme
  17. 17. Results Number of sessions= 22 + 30 + 19= 71 (63 delivered to date) Period: 3rd July 2012 -23rd September 2013 Trainers involved in delivering the sessions= 42 Attendees to date= 531 Total number booked= 661 (ongoing) Total number of evaluations completed = 385 (72% RR)
  18. 18. Perceptions of attendees (1) N= 385 Mean score (1-5) Pre Understand schizophrenia and bipolar disorder Aware of medication prescribed 3.0 Post 4.2 Pre Can assess the severity of anxiety and depression Can respond to depression or anxiety 0.0001 2.8 Post 4.0 Pre Can recognize depression and anxiety P= 0.0001 3.5 Post 4.2 Pre 2.7 Post 3.8 Pre 3.0 Post 4.1 0.0001 0.0001 0.0001
  19. 19. Perceptions of attendees (1) N= 385 Mean score (1-5) Pre Understand schizophrenia and bipolar disorder Aware of medication prescribed Can recognize depression and anxiety Can assess the severity of anxiety and depression Can respond to depression or anxiety P= 3.0 Post 4.2 Pre 0.0001 2.8 Post 4.0 Pre 3.5 Post 4.2 Pre 2.7 Post 3.8 Pre 3.0 Post 4.1 0.0001 0.0001 0.0001 0.0001
  20. 20. Perceptions of attendees (2) N= 385 Mean Score (1-5) Confident in assessing side effects Aware of best practice in health checks for people with SMI Confident in care planning Understand role of community MH teams 2.4 Post 3.8 Pre Confident in assessing risk of suicide Pre P= 2.2 Post 3.7 Pre 4.1 Pre 0.0001 2.3 Post 0.0001 2.2 Post 3.6 Pre 4.1 0.0001 2.6 Post 0.0001 0.0001
  21. 21. Conclusion Brief training in mental health delivered by mental health professionals to practice nurses has a positive impact on their self-reported confidence and knowledge. This form of training is cost effective and builds on the existing expertise of the trainers who are exposed to one session on use of the training materials.
  22. 22. Next steps Dr Sheila Hardy has been appointed as Education Fellow at University College London Partners to further develop this model nationally Funding is being sought from Health Education England and CCGs by FN to continue the existing programme in London Further development will involve provision of sessions dealing with specific presentations Important to pursue an evaluation of the impact of the training on attendees’ practice and patient outcomes
  23. 23. References BMA and NHS Employers. (2013) QOF Guidance 2013-14 (sixth revision). http://bma.org.uk/practical-support-at-work/contracts/independentcontractors/qof-guidance Department of Health. (2012) A simple guide to Payment by Results. Leeds: Department of Health. Funk M and Ivbijaro G. (2008) Integrating mental health into primary care: a global perspective. Geneva: World Health Organization/WONCA (World Organization of Family Doctors). Lester, H., Tritter, J. & Sorohan, H. (2005) Patients' and health professionals' views on primary care for people with serious mental illness: focus group study. British Medical Journal, 330:1122 doi: 10.1136/bmj.38440.418426.8F Joint Commissioning Panel for Mental Health. (2012) Guidance for commissioners of primary mental health care services. Online: http://www.rcpsych.ac.uk/pdf/JCPMH%20primary%20care%20(March%202012).pdf
  24. 24. Sheila.Hardy@northampton.ac.uk Fiona.Nolan@candi.nhs.uk
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