Clare Gerada

Review of literature on the mental health of doctors: Are specialist services needed?

Background. Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to the public, yet they are often reluctant to seek help. Aims. To review literature regarding risk factors and potential barriers to help-seeking unique to doctors; to consider the success of interventions by specialist services for doctors. Method: Key phrases regarding the ‘mental health of doctors’ were entered into internet searches and journal databases to identify relevant research. When key authors were identified, author-specific searches were carried out. Findings. There are contradictory reports about the prevalence of mental ill health in doctors but it is generally agreed that doctors face a large number of risk factors, both occupational and individual; and help-seeking is difficult due to complexities surrounding a doctor becoming a patient. Specialist services developed specifically for interventions for doctors with mental health problems tend to show promising results but further research is needed. Conclusions. The unique and complex situation of a doctor becoming a patient benefits from specialist services; such services should focus on early intervention and raising awareness.

Doctors vulnerable to psychological distress and addictions: Treatment from the Practitioner Health Programme

Background. The Practitioner Health Programme (PHP) is a service set up to provide expert assessment and support to health professionals with mental and physical health problems affecting their ability to work. Aims. The aim of this article is to examine the demographic and clinical characteristics of doctor-patients utilising PHP. Method. We report on scores for the CORE-OM, the Work and Social Adjustment Scale and the FAST for the first 200 patients seen by PHP. Results. Prevalent conditions included depression and alcohol dependence. Patients with co-morbid disorders showed severe distress and impairment of functioning. Ages ranged between 24 and 67, with 33.5% of the cohort aged between 30 and 39. Patients aged below 50 showed greater impairment of social functioning. Conclusions. The needs of doctors are profound, with young doctors particularly vulnerable. Measures should be put in place to ensure that doctors at an early stage of their careers are aware of help available to them. The results highlight the importance of a service such as PHP.

Psychosocial interventions and opioid detoxification for drug misuse: summary of NICE guidance.

Drug misuse is an increasing problem that not only impairs the physical and mental health of people who misuse drugs but also negatively affects their families and wider society (for example, in its association with crime). Recently expanded drug services in the United Kingdom involve general practitioners to a considerable degree, who care for at least a third of opioid misusers in treatment. Many clinicians remain pessimistic, however, about the possible benefits of any treatment and how to engage drug users in treatment.1 This article summarises two new NICE guidelines that identify the most effective, safe detoxification regimens for primary and secondary care, the most cost effective psychosocial interventions, and effective ways to promote patient engagement.2 3 NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*). ### Opioid detoxification #### General principles For all patients who are opioid dependent and have expressed an informed choice to become abstinent, services should:

Doctors and dentists with mental ill health and addictions: Outcomes of treatment from the Practitioner Health Programme

Background: The Practitioner Health Programme (PHP) was developed to provide expert assessment and support to practitioners (doctors and dentists) with mental and physical health problems affecting their ability to work. Aims: This paper examines the treatment outcomes of the practitioner–patients utilising PHP. Method: We assessed outcomes on consecutive patients using the PHP. The Clinical Outcomes in Routine Evaluation Outcome Measure and the Work and Social Adjustment Scale were completed at initial assessment, 8- and 26-week follow-up. We also report the percentages of practitioner–patients off work at each interval, and examine global improvement and satisfaction scores for both follow-up intervals. Results: Two hundred practitioner–patients entered PHP due to a mental health or substance abuse problem and subsequently completed questionnaires at baseline; 102 patients returned questionnaires after 8 weeks and 95 returned questionnaires after 26 weeks. Results suggested that patients reported less distress and less impairment of functioning at 8 and 26 weeks. Scores for satisfaction and global improvement were consistently high. Conclusions: The PHP is providing a valuable service to practitioner–patients, significantly helping to decrease levels of distress and improve work and social functioning.

The first5 concept.

The concept of First5 recognises the challenges faced by GPs at the end of training and comprises five pillars, which could help to support new GPs through the first 5 years of independent practice. The world of general practice is constantly changing and it is important that new GPs can be supported to develop the confidence and skills required to meet the demands of the new healthcare world.

The Consultancy Liaison Addiction Service - the first 5 years of an integrated, primary care-based community drug and alcohol team

Government policy, running through the 10-Year Drug Strategy, Tackling Drugs to Build a Better Britain (The Stationery Office, 1998) and the New Drug Misuse Clinical Guidelines (Department of Health, The Scottish Office, 1999) highlights the need for health authorities and now PCGs to invest in shared care mechanisms to support primary care in its task of caring for drug misusers. Primary Care Trusts, as freestanding NHS organizations, will in time be able to commission, purchase and provide these services themselves, using primary care expertise alongside specialists. This paper describes a model of primary care-based shared care service, the Consultancy Liaison Addiction Service, that has been in operation for 5 years in South London, that predates these changes in the NHS yet could be considered by PCGs or PCTs when planning services for drug misusers. The service comprises a team of drug and alcohol community psychiatric nurses, supported and managed by a principal in general practice. Together they have worked with 72 neighbouring general practices, supporting the treatment of alcohol-misusing and drug-misusing patients. The team has a separate identity from, but is closely integrated into the secondary specialist addiction service producing effective continuum of care.Government policy, running through the 10-Year Drug Strategy, Tackling Drugs to Build a Better Britain (The Stationery Office, 1998) and the New Drug Misuse Clinical Guidelines (Department of Health, The Scottish Office, 1999) highlights the need for health authorities and now PCGs to invest in shared care mechanisms to support primary care in its task of caring for drug misusers. Primary Care Trusts, as freestanding NHS organizations, will in time be able to commission, purchase and provide these services themselves, using primary care expertise alongside specialists. This paper describes a model of primary care-based shared care service, the Consultancy Liaison Addiction Service, that has been in operation for 5 years in South London, that predates these changes in the NHS yet could be considered by PCGs or PCTs when planning services for drug misusers. The service comprises a team of drug and alcohol community psychiatric nurses, supported and managed by a principal in general practice. Together they h...

Barriers, facilitators, and survival strategies for GPs seeking treatment for distress: a qualitative study

BACKGROUND GPs are under increasing pressure due to a lack of resources, a diminishing workforce, and rising patient demand. As a result, they may feel stressed, burnt out, anxious, or depressed. AIM To establish what might help or hinder GPs experiencing mental distress as they consider seeking help for their symptoms, and to explore potential survival strategies. DESIGN AND SETTING The authors recruited 47 GP participants via e-mails to doctors attending a specialist service, adverts to local medical committees (LMCs) nationally and in GP publications, social media, and snowballing. Participants self-identified as either currently living with mental distress, returning to work following treatment, off sick or retired early as a result of mental distress, or without experience of mental distress. Interviews were conducted face to face or over the telephone. METHOD Transcripts were uploaded to NVivo 11 and analysed using thematic analysis. RESULTS Barriers and facilitators were related to work, stigma, and symptoms. Specifically, GPs discussed feeling a need to attend work, the stigma surrounding mental ill health, and issues around time, confidentiality, and privacy. Participants also reported difficulties accessing good-quality treatment. GPs also talked about cutting down or varying work content, or asserting boundaries to protect themselves. CONCLUSION Systemic changes, such as further information about specialist services designed to help GPs, are needed to support individual GPs and protect the profession from further damage.

Mandatory submission of patient identifiable information to third parties: FGM now, what next?

The government has done much to tackle female genital mutilation (FGM),1 2 3 but the planned rollout of FGM Enhanced Data Collection across the NHS in October 2015 is ill considered. All healthcare professionals will be legally obliged to submit highly sensitive, patient identifiable information on every woman with FGM attending the NHS for whatever reason. A woeful consultation preceded the ministerial direction, which also says patient consent is not …

The 2022 GP: our profession, our patients, our future

Clare Gerada and Ben Riley. ‘Primary health care offers the best way of coping with the ills of life in the 21st century: the globalisation of unhealthy lifestyles, rapid unplanned urbanisation, and the ageing of populations.’ Margaret Chan, director general, World Health Organization, 2008.1 The value of the GP has been demonstrated over many decades; research in the UK, Europe, and in the US has shown that having more GPs per head of population is associated with better health outcomes, cheaper services, and better patient experience.2 Despite this, our workforce is under growing pressure from a rising age profile and a fall in the proportion of new entrants to the profession and those returning to work.3 As a profession, general practice is under constant threat. Barely a week goes by without another report implying that GPs have failed in some way: by not diagnosing cancer early enough, not prescribing safely enough, not providing sufficient care for patients with dementia, and so forth. The number of complaints against GPs has risen, so that those against us now represent nearly half of all complaints made to the General Medical Council.4 Groups with particular interests routinely announce that GPs need more training in the areas relating to those interests, yet rarely do they acknowledge that GPs in the UK have one of the shortest specialty training periods in Europe5 — nor do they acknowledge that …

RCGP William Pickles Lecture 2017: A new kind of doctor

For the last decade, I’ve been a doctors’ doctor, leading a confidential service for doctors with mental health problems, the Practitioner Health Programme (www.php.nhs.uk). In caring for my own kind, I’ve tried to understand why I’m seeing growing numbers of mentally ill doctors. I will suggest, as Julian Tudor Hart did in the 1980s,1 that we need to train ‘A new kind of doctor’. During my life, three GPs have been important influences. The first is my father. An immigrant to the UK in the 1960s, he was a single-handed GP in the East of England. Our home was his surgery; our front room doubled as the patients’ waiting room and our dining room as his consulting room. From an early age, I saw first hand the relationship my Dad had with his patients. His dedication, his authority — and his love. When I was a young girl, he would take me with him on home visits — and I was enthralled as he explained what the house call was all about. He enthused me with a love of medicine and, more importantly, a love of general practice. The second is William Pickles, the first president of the RCGP. Pickles was the archetypal family doctor.2 He too lived above the shop — in the doctor’s house with his practice partner, an old friend from medical school. Like my father, he was known for his kindness and knowledge of his patients. By the time he died, at the end of the 1960s, he’d already become part of general practice’s mythology. To these two I add a third, Dr John Sassall, who was the protagonist of John Berger’s 1967 book A Fortunate Man: the Story of a Country Doctor .3 Sassall worked in the Forest of Dean, and, in …