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GPs forced to undertake training in 'motivational interviewing'

Exclusive GPs must undergo compulsory training in motivating patients to take their prescribed medicines, as part of a CCG scheme aimed at reducing hospital admissions from improper medication use.

NHS Lambeth CCG has told practices that all prescribers, including non-medical prescribers, must undergo a two week course on motivational interview techniques for medicines adherence before December.

But GPs have said they are being treated like ‘children’ and that compulsory training was ‘a further nail in the coffin’ of GP professionalism, and takes up appointment time that should be spent with patients discussing alternatives to prescribing.

The email, circulated to practices by the medicines optimisation team at Lambeth CCG, states: ‘As part of the 2014-15 Medicines Optimisation Plan, all prescribers are required to undertake motivational interview technique training on Medicines Adherence as offered by Future Learn/Kings College London.’

It adds: ‘Please circulate this message to all prescribers (including non-medical prescribers) in your practice to ensure they have access to the training.’

The CCG says that GPs must register before the end of August or inform the medicines optimisation team who will arrange alternative training ‘as all prescribers need to undertake training’.

The online course, run by Kings College London’s Institute of Pharmaceutical Science, requires two hours of GP time per week in order to ‘enhance’ GP understanding of medicine adherence.

It states GPs will ‘gain increasing awareness of where in your own day-to-day consultations you can apply these techniques and approaches to better support patient self-management of medicines and effect behaviour change’.

Former RCGP chair Professor Clare Gerada, whose Hurley Group practice received the communication from Lambeth CCG, told Pulse: ‘It’s a further nail in the coffin of professionalisation, being a professional means being able to determine your learning needs.’

Dr Gerada added: ‘To insist that every GP does it - albeit only a two-hour  [a week] online programme - goes with the information governance, the hand-washing governance, all of the stuff now which is two to three hours of online trainin. It’s a further nail in the coffin.’

‘It’s more work, for what benefit? Actually, what we should be doing is spending more time with our patients to make sure that we don’t prescribe medicines, not that we make them take medicines, but that we don’t prescribe.’

‘And a motivational interview is a good technique, but only if you choose to want to do it, also insisting on the format of how you learn: it’s something you do to children.’

Pulse reported in May that, as part of the same medicines optimisation scheme, Lambeth CCG would be investigating practices who went over their prescribing budget, particularly those who overspent on care home prescribing.

A spokesperson for NHS Lambeth CCG told Pulse: ‘As with other healthcare professionals, prescribers are required to participate in  continued professional development  to maintain high quality care for patients.’

‘As medicines adherence is a priority in NHS Lambeth CCG, the Lambeth Borough Prescribing Committee took the decision to include training as part of the medicines optimisation plan for all prescribers,  to support  them in identifying and addressing  medicines adherence issues and to put patients at the heart of the decision-making process around medication. GPs sit on the Committee alongside medicines colleagues.’

 

Readers' comments (26)

  • JDFDI

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  • Unbelieveable.
    Is it 1 April already?
    I thought CCGs were supposed to be GP led? What blithering idiot came up with this scheme to infantilise GPs, and why won't the Lambeth GPs and the GPC tell them where to stick their scheme and that this time it is too much, and en masse refuse to take part.
    I guess that once again GPs will be too cowardly to stand up against this sort of destruction of their profession.

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  • 3.54pm is so right. There are so many ways that GPs could take industrial action by refusing to cooperate in hairbrained schemes and so long as they stick together in sufficient numbers there is nothing that CCGs, NHS England or even Jeremy Hunt could do about it. As for the patients, such action would greatly improve the service to them.

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  • I am Stephen Rollnick, one of the co-founders of motivational interviewing, and a trainer of primary care practitioners for 25+ years. I am truly astonished by this story.

    Motivational interviewing is not a set of techniques for getting someone to do something that they would not otherwise want to do, or something that a practitioner or commissioning group want them to do? Its done for and on patients behalf.

    To oblige practitioners to attend a course like the one described (I dont know its content though), is about as far from principles of good practice in education as I can imagine.

    Shocking

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  • There seem to be two things here - one being the Medicines Management team involved!
    Before everyone gets excited about "motivational interviewing" have a look at the Futurelearn two week module on Medicines Adherence
    https://www.futurelearn.com/courses/medicines-adherence-2
    "This two week course is designed for pharmacists, doctors, nurses and other healthcare professionals with a role or interest in supporting patients with long-term conditions."
    and watch the trailer.No mention of "motivational interviewing" - and it sounds as though it will mainly be about why patients don't adhere and methods which have been tried to improve compliance...
    If it looks useful, don't let the CCG put you off!
    I admit to being a Futurelearn enthusiast

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  • Must Pulse bombard me with breaking news emails everytime a local scheme might generate a good headline?

    Perhaps breaking news emails might be reserved for issues that affect more than one CCG, even if it might otherwise lead to a few extra hits on a page and clicks on an advert...

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  • I think all GPs should do this course: https://www.futurelearn.com/courses/hadrians-wall
    I think we would all find it soothing.

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  • Does this give practices the green light to close at 4pm on Fridays and divert all patients to A+E as all the prescribers will be doing their learning module between 4pmand 6pm on the Friday,

    Add in a few hours for appropriate reflection and we could all go home (to study obviously) at lunch time.

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  • Here we go.

    Yes the CCG is clinically led, and there are several GPs on the Prescribing Committee. The LMC was fully involved and informed when developing this incentive scheme. The LMC feedback was crucial, and amendments were made. All practices attended launch events for the scheme over a month ago, where the online learning was described. Dr Gerada did not attend, and instead of asking her Partners, she contacted Pulse magazine, which is a shame.

    No-one is going on strike, this is an enhanced service. If you don't want to participate, then your practice will not get the ££.

    50% of the meds we prescribe are not taken properly, so what's wrong with learning how to work with the patient to achieve a jointly agreed treatment plan? Better patient outcomes can only be good. Plus you get two free hours of CPD without going anywhere.

    There is NO motivational interviewing training, this is an error. I have looked at the email that was sent out, and I agree that the language could have been softened a bit.

    Our local Community Pharmacists will also be involved in our scheme by encouraging adherence and more medicines use reviews.

    Hopefully all this will keep Lambeth prescribers in the top ten nationally for many of the prescribing indicators.

    Di Aitken
    Chair, Lambeth Borough Prescribing Committee.

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  • as it is clear from most of the above, don't sign up to any silly les for this, don't do it. it will die the death it deserves and stop this nonsense from appearing again hopefully anywhere in the country. THERE IS NO TIME FOR THIS BS.

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  • Arrogant, authoritarian, unprecedented, unproven.
    And negligent and illogical to force practices to use their limited human resources which overall will have negative impacts. It is immoral to investigate overprescribing without also investigating under prescribing. This heavy handedness is about cutting costs and increased rationing for NHS patients, with 'medicines adherence' being used to further restrict our clinical freedoms that are essential for optimising patient care.

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  • I think there is loads of international evidence to support the fact that patients don't take their meds properly.
    7.12pm: isnt helping patients with "adherence" only supporting them to take what you have prescribed using your clinical freedom, rather than stockpiling the meds in their cupboards?

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  • 1 all cpd should be free regardless, if it's not , it's not worth doing,
    2 if Lambeth is in the top 10 prescribing then why ch age it. Motivational interviewing is not going to work.
    3 most crappy prescribing actually is due to secondary care not giving crap on what happens in the wider community, and most wastage is usually due to constant change on medications done when pts attend opa usually just after they have collected a repeat script .or when they get admitted as an emergency. There is nothing at all you can do about it. Life is unfair etc etc

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  • Even if it is an enhanced service money is being taken away from another pot. It's incredible that the CCG is actually supporting this! GPs must not support dictats & just say No!

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  • The usual knee jerk responses to a sensationalist headline. Di has clarified the situation very well; there is no obligation to do this - it is an enhanced service, yet still there is "outrage" from anon from Clapham.

    Personally,I would much rather spend my time learning to earn some ES pennies than some of the pointless QP activities of the past or the current admission avoidance DES which has absolutely no evidence base whatsoever.

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  • We are sinking under a welter of non-evidence based interventions. I want to be freed up to offer patient care, not bogged down in more of these worthy but ill judged schemes. Where was the consultation on this one?

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  • There is a whole pile of this waiting in the wings I hope - smoking and alcohol, addiction, counselling,CHD,CKD etc just to name a few. Great stuff. Keep it coming to this namby pamby lot of GPs that we are now. Thanks GPC.

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  • This is fluffy nannying of the "we must do something, here is something, we must do it" sort.

    It's a waste of time and money.

    Patients will carry on wasting medicines for one simple reason - they aren't paying for them.
    If people had to pay a huge whack for every med, and no excuses for being unemployed or pensioner, they would either take the meds or they wouldn't keep getting them and srtockpiling them, they would stop asking for them.

    The problem is purely and simply the result of one policy - the free/subsidised prescription policy. Therefore no other intervention can affect its outcome, only a change to the policy that causes the problem will alter the outcome.

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  • What if you havent got the motivation to be motivated to motivate others?

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  • Enhanced services are not voluntary. The money they earn is not a bonus on top of an already satisfactory income. Practices are so hard up that enhanced services are core, often critical, income. To say that practices can choose to ignore it pretends that all practices have a choice, and many do not, they simply can't afford not to take part.

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  • As a self-confessed MI enthusiast I was pleasantly surprised to see Stephen Rollnick contribute this thread.
    He rightly points to the irony of coercing GPs into using a non-coercive method.

    In any case - as above - the article and headline need to be taken with a pinch of salt.

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  • There isnt any motivational interviewing training!! the course webiste states:
    "This two week course is designed for pharmacists, doctors, nurses and other healthcare professionals with a role or interest in supporting patients with long-term conditions. We’ve invited a range of inspirational healthcare professionals. researchers and clinical academics from across King’s college London’s Institute of Pharmaceutical Science and the Pharmaceutical Clinical Academic Group at King’s Health Partners to contribute to this course. You will be able to immerse yourself in our engaging video material, scenarios and discussions to explore the challenges of medicines non-adherence, factors that may influence patient medicines use and approaches that can be used to effectively engage patients in patient-centred consultations about self-managing medicines.

    Delivered in bite-sized sections, you will be able to enhance your own understanding of medicines adherence and, importantly, gain increasing awareness of where in your own day-to-day consultations you can apply these techniques and approaches to better support patient self-management of medicines and effect behaviour change. We look forward to walking you through this important and challenging area of healthcare provision.

    By the end of this two week course, learners will have developed their understanding, and reflected upon their own clinical practice and consultation skills, in order to:

    1) Identify patients at risk of medicines non-adherence

    2) Employ strategies to support these patients with the use of their medicines."

    Come on Pulse Magazine, you can do better than that!

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  • "must undergo a two week course" - no.

    Have been given the option to undergo a 4 hour course staged over 2 weeks to be completed in a 4 month window, for which it appears they will paid and which will add to individuals' mandated CPD.

    Story out of nothing.

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  • Stupid idea that rather ignores the fact that a high (and rising) proportion of A&E admissions are down to *proper* medication use. Agree with comments above. This is all getting rather sinister. Am also reminded of the plans (not yet that strongly rejected) to force people to have mental health treatment (unspecified as to what, exactly) on pain of having their benefits removed.https://www.opendemocracy.net/ournhs/louise-mccudden/take-our-treatment-or-well-stop-your-benefits-tories-threaten-mentally-ill.

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  • Its those badass pigs on two legs again.

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  • Azeem Majeed

    There has been some previous research on the effectiveness of interventions to improve medication use among patients, including some systematic reviews. It would be helpful to know if the Lambeth CCG team looked at this evidence before planning their own medicines optimisation programme. Although the CPD element of this programme is described as ‘free’, it is not actually free in that it requires around fours of GP time to complete (which is time I could spend on another professional activity). I am a Lambeth GP and I did receive a letter from the CCG about this programme yesterday. However, the letter did not address the concerns that I and some other Lambeth GPs have about the programme and in particular, the CPD element.

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