Quick wins for the new contract
Establishing a register for mental health
nSearching for patients Use a practice information support officer and/or primary care pharmacists to run searches by drug groups, Read codes or care programme approach (CPA) data. Request 'enhanced CPA' data from the CMHT or CPA co-ordinators, and make sure to cross-check notes. Ask for advice from your mental health lead or mental health HIMP/ NSF working group for a local protocol for SEMI.
Who to include:
nMost patients with schizophrenia and allied psychoses
nPatients with bipolar affective disorder, unless stable for many years and perhaps not taking treatment
nPatients with chronic, severe depression this will include patients who attend psychiatric outpatients and who are on regular antidepressants and whose functioning is affected
nAll forms of dementia this will help cross-check with information needed for Standard 7 of the older people's NSF, and there will be small numbers per practice.
nAsk for a database By asking for a database from the local mental health team/CMHT/psychiatry of patients on enhanced CPA, this will give you a kick-start for the register.
Who not to include:
nDrug/alcohol-induced psychoses and one-off psychotic episodes
nPersonality and anxiety disorders
nMild, moderate, reactive depression (especially if not under secondary care). For example, do not Read code new patients with depression until you are certain they have a long-term limiting illness: ask PISO for a list of alternative Read codes to use. There are often problems with old Read codes for patients who have had depression, such as endogenous depression. If all these are included you will have a huge number of patients on the register and this is unworkable.
nThere is no easy way Forming the register may require a list trawl of all searches as above, or an anecdotal list made by all the partners. Each partner can then manually tick or delete patients to go on the register. The question you need to ask is, who really needs structured monitoring on a yearly basis?
Laura Pogue is a metal health specialist GP in St Helens