Healthy Doctors, Safer Patients

1
Healthy Doctors, Safer Patients

• NHS Practitioner
• Health Programme
• Drug and Alcohol Rehabilitation

2
PHP

• Launched in November 2008
• Accepted referrals from September 2008
• PHP is largely an integrated service (PHP1
  PHP2)
• PHP is NOT an occupational health service
• MOU with GMC, GDC and NCAS

3
PHP

• Located in an established GP surgery
• Anonymous
• Separate IT systems
• Separate staff
• Separate rooms

4
PHP Integrated Team
We have created a team of primary and secondary
care practitioners who work together on a single
site, carrying out joint assessments, learning
together, using the same electronic record and
meet weekly to discuss all new patients and
complicated follow-ups. This team is referred
to as the PHP Integrated Team. The PHP2
practitioners also see patients outside the
Integrated service, allowing for enhanced shared
care.
5
PHP Integrated pathway
6
Headlines at 12 months

• 175 practitioner-patients seen in the service
• Over 250 contacted the service
• 54 Men, 46 Women
• 89 doctors, 11 dentists (2 nurses)
• Age range 24 - 65 years, more younger women and
  older men
• At presentation, 100/175 (57) working, 70/175
  (40) not working, 5/175 No info
• 30 at presentation involved in some form with
  GMC/GDC or Disciplinary process

7
Types of Problems Seen
8
Mental Health (105/175)
9
Substance Misuse
10
Gender Vs Substance
11
RAG Risk status
12
Clinical pathway

• Telephone triage (1/2 hour)
• Assessment at PHP1 (3-6 hours)
• Admission to Capio (1 week) Email
  contact Admission to Clouds (4-6 weeks)
  visit to unit
• Discharge to PHP
• Weekly appointment with lead clinician (10
  sessions)
• CBT (10-12 sessions)
• Group sessions (12 sessions) plus Capio/Clouds
  groups
• Monthly reviews ongoing plus blood tests,
  medication etc

Dependent patients
13
Plus

• Reports
• Case management
• Visits to hearings
• Contact with GDC/GMC supervisor
• Financial advice
• Blood tests
• Urine hair testing

Regulatory involvement
14
Outcomes

• 19 treatment episodes (17 patients) admitted to
  Clouds House
• 2 patients admitted Hope House long term rehab
• 14 patients admitted to in -patient at
  Capio-Nightingale

15
Alcohol Dependence

• 4/51 lost to follow-up
• 4/51 still drinking
• 42/51 (82) Currently Abstinent and
  attending PHP on a regular basis

16
Drug Dependence

• 1/17 now living abroad (benzodiazepine user)
• 1/17 lost to follow-up, dentist not on GDC
  register
• 15/17 (88) currently abstinent from
  illicit drugs
• 2 of these patients with multiple
  addiction now abstinent
• 2 patients on substitute medication

17
Work

• Of those not working at presentation, 33/70 (47)
  have returned to work
• 7 due to return to work in next few weeks
• 6 Advised to contact Regulator
• 5 removed themselves from the workplace on advice
  from PHP
• 2 Patients DNA first appointment (All the rest
  early!)
• One patient walked out mid assessment

18
Other

• Severe and complex problems
• Some specialty groups more vulnerable
  (psychiatrists - addiction, paediatrician -
  mental health) but beware cause vs. effect
• Alcohol plays a major role
• Shift working a problem as is loss of traditional
  Firm structure
• Lack of support for new employees
• Doctors still asked to take gardening leave
• Regulatory process can be lengthy

19
GMC Good Medical Practice

• You should be registered with a general
  practitioner outside your family to ensure that
  you have access to independent and objective
  medical care.
• You should not treat yourself
• If you know that you have, or think that you
  might have, a serious condition that you could
  pass on to patients, or if your judgement or
  performance could be affected by a condition or
  its treatment, you must consult a suitably
  qualified colleague.
• You must ask for and follow their advice about
  investigations, treatment and changes to your
  practice that they consider necessary. You must
  not rely on your own assessment of the risk you
  pose to patients.

20
Self declaration
21
Health and Revalidation
22
Difficulties identified

• Isolation whilst off work
• No access to resources/information
• Miss out on updates information
• Lack of support
• Fear of judgement

23
Any questions?
www.php.nhs.uk