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Dr Theresa Eynon MRCPsych MRCGP CLAHRC Clinical Translation Fellow WLCCG

Commissioning an integrated mental and physical health service for people with Long Term Conditions and Medically Unexplained Symptoms. Dr Theresa Eynon MRCPsych MRCGP CLAHRC Clinical Translation Fellow WLCCG. Session Plan. The Mind the Body and the NHS

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Dr Theresa Eynon MRCPsych MRCGP CLAHRC Clinical Translation Fellow WLCCG

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  1. Commissioning an integrated mental and physical health service for people with Long Term Conditions andMedically Unexplained Symptoms Dr Theresa Eynon MRCPsych MRCGP CLAHRC Clinical Translation Fellow WLCCG

  2. Session Plan • The Mind the Body and the NHS • Change the behaviour and the thoughts will follow • Outcomes or process? • Monitor the outcomes and the service will improve

  3. Overlapping problems

  4. Why not?

  5. Pro-Active care: Exclusions • Patients who because of lifestyle and social conditions tend to be high users of services in an unplanned way. They are often labelled as using services “inappropriately” but this can be because of a lack of understanding, or chaotic life events. It prevents them from getting the best from the support available to them. They include patients with mental health problems, learning disabilities, and drug or alcohol addictions.

  6. FootPain 85yr old lady I have no reason to go out anymore Little dog dies Seeking medical help and avoiding movement Low mood Painful feet

  7. Medieval Mind

  8. GP clinic helps with MUS?

  9. Service characteristics Effective psychosocial interventions identified in reviews tend to show three characteristics: • They have a clear structure/model/plan. • They have a focus on problems of relevance to the patient/client. • They build on the relationship with the practitioner.

  10. LTCs: In a Good Service... • They will be supported to self care, have more confidence and control over their condition and understand the impact it will have on their lives. • There will be a genuine shift towards addressing a person’s full range of needs, including psychological and emotional support, rather than simply focusing on a medical model. • (Department of Health, 2010)

  11. How would we know? • Who could help this person? • What skills will they need? • How could you measure whether or not the team had helped this patient? • Wellbeing measures, PHQ9, GAD7 • Physical measures HbA1C, BMI, walking distance • Social measures WASA, return to work, PROM • Service measures LTC6

  12. Patient Centred Outcomes

  13. Mrs Drucker has diabetes • diabetic review increased metformin 3m ago • increased HbA1C 8.0 • increased weight 7k • BMI 40.1 • Painful knees 

  14. Five Areas Model (after Williams 2001)

  15. Upskilling professionals • Motivational interviewing skills • Simplified behavioural CBT models suitable for primary care • Patient centred outcome models • Compassionate mind or intelligent kindness?

  16. Barriers to person-centred care • What are the organisational and professional barriers to providing person-centred outcome measured services? • How could these be overcome? • What training do professionals need to have to help them integrate physical and mental health care?

  17. Commissioning for outcomes • Hugh Griffiths – DoH at PRIMHE 2011 • We need to measure outcomes that matter in people’s lives • The person at the centre care is in the best position from which to measure the effectiveness of “person-centred” care services

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