Asked to see patient' (ATSP) is a near-peer teaching programme that aims to address the anxiety experienced during the transition from medical student to newly qualifi ed foundation year 1 (FY1) doctor. It is delivered annually in the North West of England Foundation School just prior to the August changeover date when new doctors may feel the most stressed. Each spring, a 'Teach the teachers' training day is advertised to existing FY1 doctors; the training equips them with the knowledge to become certifi ed ATSP teachers. Teachers subsequently deliver ATSP to incoming FY1 doctors at their trusts. Feedback on ATSP is collected from new FY1 doctors via an electronic survey. Results show that ATSP is well received, with 77% of newly qualifi ed doctors engaging with the programme in 2016. 'Asked to see patient' is a Health Education England-endorsed teaching programme that develops clinicians who are structured and confi dent in their approach, and cultivates the clinical teacher in existing doctors.

ObjectivesBest Practice Tariff (BPT) guidelines recommend that paediatric patients with diabetes should have a minimum of four MDT clinic appointments, and an additional eight contacts with the diabetes service per year. Trusts must achieve 90% compliance with these targets to receive incentive payments (upto £2988 per child). This audit compares performance in a DGH against these recommendations. It seeks to determine whether there is a correlation between amount of contact with the service and average HbA1c level.MethodsAnalysis of a database recording contacts with a total of 159 children between April 2014 and March 2015 (BPT financial year)ResultsOf the 159 patients, 21 (13%) were newly diagnosed, 19 (12%) were transitioning to adult services, and one had care shared with another hospital. These were analysed separately. For the remaining children the median total number of contacts per year was 23. The median number of MDT contacts was four per year, and of additional contacts was 18.5 per year. Additional contacts included telephone calls, texts, school visits and home visits. 93% of these children were offered at least four MDT appointments per year, 100% were offered at least eight additional contacts with the service, and 100% had a total of at least 12 contacts. The median HbA1c was 61mmol/mol and 35% of patients had HbA1c <58mmol/mol (i.e. “good” control as per NPDA definitions). There was no correlation between total number of contacts per year and median HbA1c (P = 0.18). However, there was a weak positive correlation (Pearson’s rank 0.34) between number of MDT clinic appointments and median HbA1c (P < 0.001).Abstract G454(P) Figure 1 Pie chart showing distribution of HbA1c control (N = 118)Abstract G454(P) Figure 2Graph showing a weak positive correlation between no. of MDT contacts and median HbA1cConclusions/recommendationsCompliance with BPT guidelines was achieved in the majority of cases, although 7% were offered less than four MDT clinic appointments for the year. Patients received on average 11 more contacts per year than the minimum requirement (these were mostly ‘additional contacts’). Correlation between MDT contacts and HbA1c suggests that the paediatric diabetes team are recognising patients with poor control and organising additional follow up. More comprehensive routine data collection will allow further analysis of the contacts taking place to ensure quality as well as quantity.

AimsTo identify the number of adult inpatients prescribed HDAT across GMMH.To establish whether guidelines for the prescribing and monitoring of HDAT are adhered to.To consider the initiation of HDAT, evaluating whether prescriptions of HDAT are intentionally made by consultant psychiatrists and the MDT, or by rotational junior doctors.BackgroundHigh Dose Antipsychotic Therapy (HDAT) is defined by the Royal College of Psychiatrists as either: a total daily dose of a single antipsychotic which exceeds the upper limit stated in the BNF or A total daily dose of two or more antipsychotics which exceeds the BNF maximum as calculated by percentage.The decision to prescribe HDAT should be made by a consultant psychiatrist and discussed with the patient and wider MDT. Clear documentation of this discussion, including the clinical indication, should be recorded within the case notes.The use of HDAT comes with greater risk of physical health complications and requires regular monitoring of ECG, BMI and blood biochemistry. For patients detained under the Mental Health Act, consent and appropriate consultation with a SOAD should be sought for HDAT where the patient lacks capacity.This audit investigates prescription of HDAT in the acute adult inpatient population within Greater Manchester Mental Health NHS Foundation Trust (GMMH).MethodSix junior doctors were recruited to collect data across the 5 sites covering general adult inpatients within GMMH. Data were collected week beginning 21st January 2020. Data were collected from all 20 general adult inpatient wards within the trust. Medication cards for each patient on the electronic bed-state at 9am on the day of the audit were checked for HDAT prescription. Subsequently, data were collected from electronic notes of patients identified as being on HDAT. Data were collated and submitted to the audit lead for analysis.Result31 patients were identified as being on HDAT, of those, 21 instances of HDAT were commenced during the patients MDT, although in only 2 of these cases was it noted that the medication prescribed would result in initiating HDAT. Of the remaining cases, 8 were prescribed by junior doctors and 2 were unclear. 15 out of 31 patients had an ECG within a month prior to commencing HDAT, of 24 patients on HDAT for longer than 3 months, only 5 had a repeat ECG within this time.ConclusionGuidelines are not closely adhered to, there is clear and necessary scope for improvement.

Paediatric Best Practice Tariff Criteria for Diabetes• Offer a minimum of four clinic appointments per year with a multidisciplinary team (MDT), i.e. a paediatric diabetes specialist nurse, dietician and doctor.• Offer additional contact with the diabetes specialist team e.g. check ups, telephone contacts, school visits, troubleshooting, advice, support etc.  Minimum of eight additional contacts per year.