In my spare time I am a trustee of a small mental health ‘not-for-profit’ organisation (i.e. charity) called ASSIST Trauma Care.
It provides assessment and therapy for victims of Post Traumatic Stress Disorder (PTSD). Therapy is evidence-based (following NICE guidelines) and all the staff are highly trained in delivering trauma-focussed CBT. The therapists regularly attend national and international conferences to ensure that they are completely up to date with training and current practice. Feed-back from both professionals and clients (including senior military) is excellent.
However in these recessionary times charitable money is drying up (mental health is not ’sexy’), consequently the trustees decided that there is no option other than to seek funding from referring organisations (e.g. PCT, military, fire service, police) or self-funding clients.
Last week a highly regarded local GP contacted the office, wishing to refer a patient who had suffered a dreadful trauma two years ago and who continued to suffer with disabling symptoms of PTSD. The patient had been rejected by the local IAPT team on the grounds that the condition fell outside their remit. Local psychology services were able to see the patient in about six weeks for assessment, but could not guarantee to provide any therapy for up to 18 months. Past experience has also shown that they have no particular expertise in treating PTSD. While psychiatric referral was an option, the local psychiatrists also admit to having no particular expertise in this area and in the past have referred their patients to ASSIST for therapy.
The problem was that, although in the past the local PCT had provided some funding, this had now been withdrawn due to “financial constraints”. The frustrated GP was left with a severely disabled patient, an excellent therapeutic service on the doorstep, but no access to any source of funding and no mechanism for referral, effectively blocked by the PCT. It should be noted that the charge for a 12-week course of CBT at ASSIST would be far less than the cost of therapy within the NHS and hugely cheaper than referral to a private clinic.
Consequently, wearing my trustee hat, I strongly welcome the publication of the White Paper, Liberating the NHS which aims to put commissioning in the NHS firmly in the hands of the GP who know the patient and who can assess their individual health needs. I refer especially to the bullet point (page 17) where it states: ‘Begin to introduce choice of treatment and provider in some mental health services from April 2011, and extend this wherever practicable’. In the case I have described I know that both the GP and the patient would chose ASSIST without hesitation.
Yes, I know that the white paper raises more questions than answers and that there are clearly some very thorny issues ahead. I also accept that we are all bog-weary of NHS reform and would welcome a bit of stability for a bit. However I think we should give it a go. Who knows, it just may deliver the goods for a change.
Tags: Commissioning
Maybe the white paper will deliver the goods » Hospital Dr…
I found your entry interesting do I’ve added a Trackback to it on my weblog :)…
But Tom - if the GPs start referring to your excellent rehab service, where will they take money from? They won’t have any extra cash. Neither will they have the necessary expertise to commission global health services, unless they call on the people who are doing it now, in the PCTs.
Perhaps I overstate the case against GP involvement in my current intemperate blog, but this looks to me like a coalition hastily retreating from the Tories’ pre-election committment to establish a body similar to the BBC to run the NHS at arm’s length from government. I suspect it is just a cynical attempt to set the GPs up as fall guys for the time when it turns out that health spending isn’t ring-fenced after all.
I remember only one thing I was taught during my House Surgeon job (1974) with the late Sir Alan Parkes PRCS (of “pouch” fame). He told me that when you are arguing with the ward sister, the first one who can manage to say, “Yes, but think of the patient” always wins. I have used this on many subsequent occassions in various disputes concerning the use of health resources.
I rest my case.
PS It is a little early for cynicism to set in to the current government; we need to wait at least 6 - 9 months for the self-righteousness to rub off.
Tom, I’m afraid I’m with the cynics, here. Someone has to point out the pitfalls as early as possible so that those in power don’t think that all are in favour of what they are doing Who knows - they might see the error of their ways and take advice from those on the coalface. And yes, I am thinking of the patient too!
As an Occupational physician, I see a lot of disabling psychological distress and mental health problems desperately needing relatively simple interventions such as Tom describes, not addressed by IAPT, and, despite being employed by a big acute Trust, my immediate reaction to the White Paper was to hope that the GP commissioners might divert some money to good mental health interventions. Yes it has to come from somewhere, but if these people got back to work UK plc would be better off. Yes, I also know that was what IAPT was for, but in my experience it’s not very effective.