These Questions were raised by GPs at the last Enfield PCA session. Responses are shown below, grouped by theme.
For all Trust contact details please see the Referral, Information and Advice Sheet in the packs
NEW BOOKABLE GP CLINICAL ADVICE LINE - 020 8702 3997 (9-5 Mon-Fri)
In response to GP feedback, the Trust has set up a bookable GP Advice Line for 10m. telephone advice sessions (15m. on request).
To book a telephone conversation with a senior psychiatrist, call the above number.
§ Requests before 1.00pm - receive a call back between 1.00pm to 2.00pm the same day.
§ Requests after 1.00 pm – receive a telephone appointment the following day between 1.00pm and 2.00pm.
RECONFIGURATION OF ACCESS ARRANGEMENTS TO ROUTINE AND CRISIS SERVICES
In response to GP feedback, the Trust is reviewing clinical accountability for patients at different stages of the pathway and will provide further detail at future Academy sessions and via CCG communications.
1. ACCESS
Q. Why is there not just one safe number in hours and out of hours?
A. Please see referral and advice information in the packs for the relevant numbers
2. BENEFITS ISSUES
Q. Patients who are clearly not fit for work being signed off for work by benefits office
A. The relevant Certificates are issued by GP. However, ATOS has been reviewing patients and sometimes finding them fit for work. There are appeals policies in place. GPs and service users can get advice and assistance re appeals from Enfield Disability Action www.e-d-a.org.uk/eapp.php 020 8373 6330 or
3. CLINICAL PRACTICE
Q. How can GPs ensure shared decision-making on medication?
A. This resource provides a great deal of information for service users about medication and should be useful in this process: http://www.choiceandmedication.org/behmht/
4. COMMUNITY SERVICES
a) Q. How can GPs obtain signposting information to services?
A. The Trust is updating its information on community services and seeking clarity for commissioning leads at LB Enfield about eligibility, charging and referral arrangements. See the pack for the list we have of community services currently.
b) Q. Do Enfield Clubhouse, Ebony and MIND in Enfield accept self referrals and do they charge.
A. We rang these providers and obtained the following information
Enfield Clubhouse – which works to the international clubhouse model of workbased rehabilitation, is no longer funded by the local authority and is only currently operating on Wednesdays and Fridays.
Referral: Referrals are needed from social services for patients with personal budgets only.
Charge: dependent on social care assessment
Contact Details: www.enfieldclubhouse.org.uk; 07551 993 910;
Room 10, Community Hse, 311 Fore Street, Edmonton, N9 0PZ
Hanlon Centre – an open access centre providing activities and services for vulnerable people including those with mental health problems. Open Mon to Thurs.
Referral: No referral necessary but information about someone’s mental health problem might be useful to ensure they get the right level of support.
Charge: 50p
Contact Details: www.hanloncentre.com; 0208 807 9744;
Hanlon Centre, St Johns Church Hall, Dysons Rd. Edmonton N18 2DS
Ebony: offers culturally sensitive services to Black, Asian and ethnic minority groups with mental health problems and their carers
Referral: some services are free access
Charge: small charge
Contact Details: www.ebonypeople.org.uk; 020 88032200;
215 Fore St. Edmonton N18 2TZ
MIND in Enfield
Referral: no referral necessary but a risk assessment may be required
Charge: some services are free and for others is there is a very small charge
Contact Details: www.mind-in-enfield.org.uk; 020 8887 1480;
275 Fore Street Edmonton N9 0PD
5. CRISIS SERVICES
In response to GP feedback and commissioner requests the Trust is introducing a new crisis resolution and home treatment (CHRT) service for urgent referrals and a new triage service for routine referrals. See attached for more information
a) Q. How do GPs access Crisis support and what is the difference between INTAKE role and Crisis service?
A. See Referral and Advice information in the packs
b) Q. Can GPs refer direct to HTT?
A. – Referrals can now be made direct to the new interim Crisis and Home Treatment Team (CRHT), as well as routine referrals to INTAKE as usual. The interim CRHT runs from 9am to 9pm. The full service will be accessible 24 hours 7 days a week and will be established within the next couple of months. Information about this will be provided via the CCG communication leads.
c) Q. New patients will often register with GPs in a crisis, so they do not know their history
If the patient is known to the Trust, their details will be known to the CRHT and will be accessed on referral.
d) Q. What should be done for older people in crisis?
A. Older people (over 65) in crisis with a functional mental illness will be seen by the Interim CRHT team This Interim service will be replaced by a 24 hour service in the next few weeks and information will be provided through the CCG. Older people with dementia in crisis can be seen by the vulnerable adults team. Such patients can be referred for assessment and treatment to our Dementia and Cognitive Impairment service by referral through INTAKE.
e) Q. How do GPs escalate a patient who is deteriorating?
For clinical advice about a new patient, call the Clinical Advice Line
For clinical advice about a patient already under the Trust’s care, call the key worker whose details appear on communications from the Trust about the patient
In a crisis call the (Interim) Urgent Care Service.
6. CULTURAL DIVERSITY
Q. How do GPs meet needs of a diverse patient population that does not speak English (e.g. Turkish, Somali, Kurdish)?
A. See the pack for details for elearning on cultural appropriateness and local and national community suppo rt services. The Academy is planning a separate session on cultural appropriateness.
7. SHARED CARE
a) Q. If a patient in secondary care asks the GP to change their medication because of side effects, should the GP do so?
A. The patient’s key worker can be consulted by the GP. Their contact details will be on Trust communications about the patient. The Clinical Advice line can also be used for help in these circumstances
b) Q. – How can a GP check that patient is taking their medication?
A. Straightforward questioning is the best approach. It is also possible to check service users have been collecting repeat scripts on time or to ask them to bring boxes to their appointment to check the date and numbers left. Asking relatives or friends is another option. Dispensing medication from pharmacist in a Dossett box may also help.
c) Q. What is the protocol for depot injections and who is liable?
A. The Trust has a protocol for depot injections. We are checking the most up to date position with the CCG.
8. LINKWORKERS
Q. – Why can practices not have linkworkers?
A. The cessation of the linkworker pilot was a commissioning decision. Building on the lessons of the pilot, stronger links are being established with GP practices through such initiatives as the Clinical Advice Line and the Primary care Academy.
EM V3 23.09.13 www.behmht.nhs.uk/GPsandReferrers