Roles of general adult psychiatrists in follow-up clinics

Abstract

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.

Older people with enduring mental illness: a needs assessment tool

“…As recent work has shown that the level of intervention provided could differ between 'complex' and 'routine' patients (Mehta et al, 2007), a larger study might be needed to control for diagnosis. The findings on the prevalence of need identifies the range of problems that older people with enduring mental illness present to community mental health services, which differs significantly from their younger counterparts.…”

“…To make the survey more representative, this included both those under the community team and those seen at the out-patient department only. A recent study showed that these two groups of patients could need different levels of intervention provided between 'complex' and 'routine' patients (Mehta et al, 2007). Of the 77 people identified, 75 were interviewed (2 were untraceable) and their psychiatric keyworker was also interviewed separately.…”

How Non-Medical Prescribing may Impact on the Service Development of a Clozapine Clinic

“…Morer ecentlyt he European WorkingT imeD irectivesh avel imited junior doctors' working hoursm eaning that they arel essa vailablef or such,a rguably, inappropriate duties like the routine monitoringo fC lozapine patients (Harrison2 007).A lso,t he wayi nw hich Consultant Psychiatristsw orkh as been under reviewi nr ecent years, and it is suggested that current workingp racticesa re not in line with the 'New Ways of Workingi nM ental Health'i nitiative (Department of Health 2005;Mehta et al 2007).S ervice usersn ow expect moref romt heir health servicew ithm oret imew iths taff to 'participate in decision-makinga se qual partners' in regards to theirt reatment options (Harrison2 007: 471).W iths uchd emands on current practicesi ti sn ot surprisingt hat Clozapine clinicsa re identified as areas which could particularlybenefitfromnon medicalprescribing, utilisingthe speciale xpertise of the nursing staff (National PrescribingC entre2 005).I nf actL eppard( 2008) identifies Clozapine clinics as 'anexcellent exampleofarolefor asupplementaryprescriber in mental health' (p.164).…”