General psychiatrists discovering new roles for a new era … and removing work stress

Many good ideas seemingly come out of the blue – in my case, dreaming of early retirement. If work felt like a painful sprint, at least it would be short-lived. I considered the impact of a stressed, adult psychiatrist on recruitment, for medical students and junior trainees spend the majority of their training with such consultants. Early retirement can increase the workload of the remaining psychiatrists, given the existing unfilled posts, which can create a domino effect. Previously, the idea of jogging along had felt self-indulgent. Now, it seemed as essential for the profession as for myself.

Section: The Impact Of the Revised Job Plan: Impressionsmentioning

confidence: 71%

It just took a blank sheet of paper: changing the job plan of an adult psychiatrist

Hampson¹

2003

“…This style of working is probably more in keeping with that of sustainable future practice for those working in general adult psychiatry, both psychiatrists (Kennedy & Griffiths, 2001) and CPNs.…”

Section: Discussionmentioning

confidence: 87%

“…The increasing workload of psychiatrists and community psychiatric nurses (CPNs) appears unsustainable in its present form. New ways of working for both psychiatrists and CPNs need to be considered (Kennedy & Griffiths, 2001). We describe a local solution.…”

Section: Discussionmentioning

confidence: 99%

Service innovations: redesigning a community mental health team

Shajahn¹,

Forde²,

McIntosh³

et al. 2006

Aims and MethodWe describe the redesign of a community mental health team in Lanarkshire (the focused intervention team for Bellshill). Their remit is to provide focused, time-limited therapeutic intervention for patients with mild-to-moderate mental health problems.ResultsThe redesign involved a closer working relationship with the psychiatrist, establishing a concurrent community psychiatric nurse/ psychiatric clinic, recategorisation of ‘soon’ and routine referrals to the team, opt-in letters and the introduction of new assessment formats.Clinical ImplicationsThese measures combined to provide a shorter waiting list, increased joint working and management plans for patients. Team functioning and morale improved.

“…However, there have been some success stories, for example Hampson's (2003) restructured job plan in keeping with the new consultant role described by Kennedy & Griffiths (2001) who interviewed general adult psychiatrists to reveal emerging new roles for consultants in the climate of risk avoidance as well as reasons why others were unable to make similar changes to their work. The authors identified three types of consultant role: traditional, adapted traditional and the new role.…”

Section: Discussionmentioning

confidence: 99%

Roles of general adult psychiatrists in follow-up clinics

Mehta¹,

Salvaji²,

Abed³

2007

Aims and MethodCore features of New Ways of Working include concentrating on service users with complex needs, acting in a consultative role and carrying out interventions that are timely rather than routine. In this service-mapping exercise a retrospective analysis of 150 case notes was performed to evaluate clinical activity in general adult out-patient clinics and to attempt to measure the complexity of the workload.ResultsAnalysis of care programme approach (CPA) level revealed that 40% of patients were not on CPA and 16% of patients were on enhanced CPA. Only a third of the sample had a non-medical care coordinator. Absolutely no changes were made to the management plan in around half of the sample. A minority of patients needed to be seen acutely, within a month, or had their appointment brought forward.Clinical ImplicationsCurrent out-patient activity of consultant teams does not appear to be consistent with New Ways of Working. Psychiatrists will be required to reflect on their roles in out-patient clinics to avoid ‘routine’ appointments and to use their time more efficiently.