Aims and methodTo validate care cluster allocation for payment by results (PbR) in mental health and to evaluate clustering and auditing methodologies. We applied exclusion criteria to the patient population of a mental health trust. An automated validation compared cluster with expected ICD-10 codes or scores on the Health of the Nation Outcome Scales (HoNOS) and Mental Health Clustering Tool (MHCT). Six hundred ‘mismatched’ cases were reviewed in depth to better understand the reasons why these cases appeared misclustered.ResultsThere was a significant mismatch between ICD-10 codes, HoNOS and MHCT scores and allocated care cluster, with differences between services and localities. Some clusters appeared to be more accurately allocated. The ‘deep dive’ analysis indicated that most mismatches occurred because psychosis was allocated to a non-psychotic cluster and vice versa, but also as a result of inherent weaknesses of the MHCT.Clinical implicationsHigh levels of inappropriate care cluster allocation highlight the need to improve practice. Weaknesses in the MHCT and ICD-10 coding mean that the final arbiter should be clinical judgement. Auditing will, by necessity, have a significant margin of error.

SummaryA genuinely critical and reflective approach to psychiatry can potentiate learning, improve practice and promote personal development. To support this assertion, I attempt to link theory and practice. Following a brief overview of the seminal ideas that permeate the literature on critical thinking, I present three perspectives of reflective practice – those of the psychiatric trainee, the teacher and the practitioner – through examples of reflective exploration of personal experience, under the light of relevant evidence. I conclude with a critique on the limitations of reflective psychiatry.

The author identifies some of the main theoretical constructs related to leadership; the pedagogical underpinning of medical leadership programs; their learning objectives; and the mixture of methods, individual and collective, to achieve them. INSIGHTS: How to best develop leadership through medical education remains an open debate. Experiential learning, reflective practice, action learning, and mentoring could provide the foundations of leadership development. Application of the aforementioned should be cautious due to limitations of the concept of leadership as currently promoted and lack of robust evaluation methodologies.

Purpose – Medical leadership has attracted significant attention over the recent years as one of the factors that could potentially improve quality in healthcare. In response, various stakeholders in UK medical education have been looking into the most efficient ways of developing leadership among trainee doctors and invested in various courses and programmes. This paper aims to briefly set the theoretical basis for evaluating leadership development in postgraduate medical education. Design/methodology/approach – Critical review of available theoretical and empirical literature and review of the content of a number of leadership and management development programmes available to postgraduate trainee doctors in the UK. Findings – This review suggests that programme evaluation can be approached through four different “frames”: their pedagogical content, the conceptualisation and achievement of leadership, the contribution in quality improvement and the consideration of practical aspects that increase engagement and participation. On this basis empirical methodologies of evaluation can be developed. Originality/value – The evaluation of leadership initiatives for medical trainees is an important task that has not been adequately addressed in the literature. This paper provides a theoretical approach to developing more robust methodologies of evaluation.

Aims and methodTo inform the development of a new, recovery-oriented rehabilitation service, identify local needs and create a pathway for appropriate referrals, accelerating the build up of case-load. We surveyed 1353 secondary service users using a purpose-made needs assessment and case identification questionnaire, completed by nominated care coordinators.ResultsSignificant unmet need for rehabilitation and recovery-oriented interventions was found. The results were used to invite referrals, create a case-load of 150 and allocate the appropriate resources for the new team.Clinical implicationsThe results highlight the untapped recovery potential among users of mainstream secondary mental health services and support investment in rehabilitation at a time of resource restriction. This work also supports a similar, evidence-based approach to targeting appropriate referrals during the development and the early stages of rehabilitation services.