Dr Louise Cumming - Consultant General Adult Psychiatrist
"Development of working relationships between community psychiatrists and primary care"
The project was linked with the10 point LCFT GP charter which has been in place since 2011 with the focus on improving the relationship between LCFT and GP’s. It also linked with my own clinical experience as community Consultant psychiatrist trying to engage with GP’s and anecdotal feedback from GP’s highlighting desire for access to Consultant psychiatrists
The objectives were
- To investigate current working relationships between community psychiatrists and primary care through development of a survey and Identification of GP surgeries to target
- To develop my skills as a change leader to develop a shared vision for change
- To identify and plan changes in working relationships using information gathered from stakeholders and in line with the Community Mental Health Redesign
I developed a survey and arranged face to face visits with GP practices, along with the community mental health team leader, to improve participation before analysing the information into key themes, identifying changes to be made to current working relationships and implementing these changes. The theme of the feedback was that the GP’s preference would be a telephone number to call for any discussions with the Consultant Psychiatrist.
The course enabled me to understand the stages of change and team development, to develop my leadership to effect change and to understand and develop my influencing skills as part of this process.
The outcomes have included improved relationships with the GP practices we have visited so far due to setting up more regular telephone discussion. It has also linked with the community mental health service redesign as we have key workers allocated to each GP cluster to make these relationships closer and enable more regular conversations with the GP practices.
We are continuing to roll out the process with the other GP practices in our catchment area with the end objective being that all have personal relationships with permanent staff in each cluster. We collect referral and discharge information in order that the effect of the changes made to the relationships with GP’s can be analysed once these have all been put in place.
You can always email Dr Cumming with any questions you might have
Dr Mark Worthington - Consultant Older Adult Psychiatrist
“Delivering a Memory Clinic in Primary Care”
This project was undertaken as part of my trust-sponsored medical leadership programme.
I was very keen to develop a memory service that is more integrated with primary care to improve the quality of care provided to patients and reduce silos within our local health service as well as increase the rate of dementia diagnosis. There are examples of memory clinics throughout the UK that have already taken these steps. However, I was keen to develop this model further and engage GPs in making diagnoses of dementia independently.
I initially developed a proposal and model for how this new service may look. I identified a neighbourhood team within our clinical commissioning group (CCG ) whose patients were disadvantaged most by having to a attend a secondary care based clinic. My aim was to provide care closer to home. After developing my proposal I engaged in discussions with the CCG to sell the vision and further refine the proposals. I also needed to assemble a project team which included my local service manager, memory service team leader and members of the CCG.
The project plan was developed and I was able to build on my theoretical learning from the leadership course and utilised tools such as stakeholder analysis and Gantt charts to plan and monitor the project. Some aspects of the project plan didn’t run smoothly and so targets had to be amended. We identified a site in which to develop this new model which was based around a neighbourhood hub and the new location of two GP practices within that neighbourhood. The idea is that patients from any practice within that neighbourhood could attend the centre for assessment and diagnosis.
As part of the project planning we identified our indicators of success such as increase in dementia diagnosis prevalence, time to diagnosis, rates of DNAs and patient experience (PREMs). We also secured access to primary care record systems through information sharing agreements.
Our initial programme roll out has been successful in offering care closer to home and meeting a number of our objectives. However not all aims have as yet been achieved with further work needed to make us truly integrated with primary care and increase GP confidence in making the diagnosis of dementia!
Dr Ayesha Rahim - Consultant General Adult Psychiatrist
"Developing a Service User & Carer Feedback Forum"
My leadership project was to develop a local service user and carer feedback forum in my area. The preparation for this involved a large amount of exploration of what was already in place in other areas, but also familiarising myself with different models of service user involvement. I learned a great deal about the “ladder of participation” and how we can challenge our own assumptions of the limits of patient engagement. As a result my own view of authentic engagement has broadened further.
One of the most enjoyable parts of the whole leadership course was actually attending meetings with an existing service user group (the Experts by Experience group in Preston), and seeing people in practice having complete ownership of their forum and hearing what their priorities for engagement were. We also worked collaboratively on an idea to develop a patient feedback survey based on the six Trust Values.
Although the local forum itself is not up and running, there are other ideas which I would still like to take forward, and certainly by sharing my experiences, I expect the profile of the existing group will risk so that we can all embed service user feedback in the running and development of our services. Had I not been fortunate enough to attend the leadership course I may not have had the same exposure to this area of the Trust’s work.