1. Message from the
President
The election of my successor as President has
begun and details of the nomination process are available here. If there is more than one candidate, a
postal ballot will be held in November and I would strongly
encourage all members and fellows to vote. The turnout for
Presidential elections is usually greater than for other posts but
could be more – remember this is an opportunity for you to choose
the leader who will shape the direction of the College for the next
three years.
The Images of Psychiatry campaign is going
from strength to strength. Last week we considered 33
bids for funding to run a project on one of the campaign themes. We
will offer a grant to approximately a third of these including at
least one from every Division, and ranging in amount from a few
hundred pounds to 15,000 pounds. More information is available
about the campaign click here. The
steering group’s hopes that the campaign would be adopted locally
are being realised, and I am looking forward to presentations on
the progress of these diverse projects at the Annual Meeting in
London next year.
2. Payment by
Results
1. Background
Payment by Results (PbR) is the mechanism
through which all clinical services in England may in the future
receive payment for clinical work, based on a standard price
(national tariff) for the particular condition or activity.
The intention is to enable competition between a variety of
providers and an economic environment in which the most efficient
and/or effective organisations will be rewarded. PbR
facilitates patient choice as the patient can choose their
treatment centre and that centre receives the standard tariff for
the intervention or care package. In this way, it replaces
the current system of block contracts or cost and volume
contracts. For mental health services, it is essential that
the new system both reflects the cost of delivering complex care
packages and is in line with NICE guidance.
2. The Mental Health 'Payments by
Results' Programme
Informal contact from the DH in late August
suggests that, as anticipated:
- Of the two pilot projects conducted in 2006,
the 'care packages' approach commonly referred to as the 'northern
project' will continue. In that project, patients were
allocated if possible to one of 13 empirically-derived integrated
care packages which might be used as funding entities. The
two mental health PbR reports are available on the DH website at
http://www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Financeandplanning/NHSFinancialReforms/DH_4137762
- The next stage of development for most mental
health services needs to be designed but will include a
costing model for each care package.
- The first areas of mental health to be
included are likely to be psychological services and medium secure
units.
- There will be a preliminary meeting of a
steering group this month and also a reference group as before. The
membership of the groups is still to be agreed, and similarly the
governance.
- The implementation of a tariff-based system
for mental health services will take several years to achieve
routinely across the country, and so the interim mechanism for
funding is important and will comprise the 'model contract' which
is currently under development.
- Since a tariff-based system will require more
sophisticated and nationally-integrated IT support than is
currently available in most mental health units, it is worth noting
plans to appoint a national clinical lead for mental health to the
National Programme for IT. This post will be advertised in
the BMJ etc shortly.
- 'Assure' (Gateway reference number: 8649) is
the first of a series of quarterly national updates from the Audit
Commission, providing news on the delivery of PbR data
assurance framework. The newsletter outlines future
developments, emerging issues and best practice examples from the
national clinical coding audits. Mental health appears in the last
paragraph. http://www.audit-commission.gov.uk/health/pbr/issue1/issue1.asp
3. The College and Mental Health
Funding Mechanisms.
The College has contributed to the mental
health PbR project in the past through member representation on the
expert reference group and the working group. College Officers, the
English Policy Committee and the medical directors' group regard
this topic as a top priority.
- A College 'Statement of
Principles' on funding mechanisms has been drafted and
circulated to the working group. This document is a source of
information and ideas and may be continuously modified and
improved. Please contact the chair if you would like to see the
current version.
- The College working party prepared a
response to the DH consultation paper 'Options for the
Future of PbR' on behalf of the College which was
approved by the Central Executive Council. The response
comments on the consultation document in detail and is
available for use in future discussions with the DH.
- We await the decisions of the DH following
the consultation and our request for meetings.
- The organisation of a number of sub-groups of
the College working group with interests in various aspects of PbR
is a possibility, such as Faculty groups or to carry out specific
tasks. The organisational structure must match that set by the
DH.
- The Learning Disabilities Faculty has
prepared a document 'Healthcare Strategy for Learning
Disability Services' which is highly relevant to the adoption
of PbR.
4. Other Mental Health Organisations
and Payment by Results Current
Status:
The working group has established contact with
several organisations which have an active interest in the
field.
Other Resources
Background reading:
Department of Health (2006/7) Payment by
Results - Mental Health Factsheet No 1. http://www.dh.gov.uk/assetRoot/04/13/77/63/04137763.pdf
Mental Health Factsheet No 2. http://www.dh.gov.uk/assetRoot/04/13/77/64/04137764.pdf
Elphick, M (2007) Information-based
management: a two-stage proposal for improving funding mechanisms
and clinical governance in mental health. Psychiatric
Bulletin 31<-,44-48.
Fairbairn, A (2007) Payment by Results in
mental health: the current state of play in England.
Advances in Psychiatric Treatment 13: 3-6.
Parsonage, M. (2004) Payment by Results: what
does it mean for mental health? Primary Care Mental
Health, 2 (3-4), 183-198.
Martin Kanpp, David McDaid, Elias Mossialos,
Graham Thornicroft (2007) Mental Health Policy and Practice
Across Europe. Open University Press. ISBN10:
0335214681.
Dr Martin Elphick
Chair, Payment by Results Working
Group
3. Scottish Division:
Getting mental health on the political agenda in
Scotland
The Scottish Division is embarking on a
programme of engagement with the new Scottish Government. The Cross
Party Group for Mental Health restarted in September with new
office bearers. The Division provides the secretariat for
this group. For the first time, the Division will have a College
stand at Scottish Party Political Conferences, starting with the
SNP Conference taking place in Aviemore at the end of October.
The Scottish Division officers are due to meet
Shona Robison MSP, Minister for Public Health in November. Topics
to discuss at this meeting include
- dementia services
- child and adolescent psychiatry
- acute inpatient units
- access to psychological therapies
The Scottish Division and its members are
involved in a number of ways with Delivering For Mental
Health, the national mental health policy
http://www.scotland.gov.uk/Topics/Health/health/mental-health/servicespolicy/DFMH
which takes a broad ranging approach to health promotion,
prevention, treatment and recovery.
4. Consultation on
the English Code of Practice for the Mental Health Act
2007
The English Code of Practice for the Mental
Health Act 2007 is due out for consultation in the autumn for three
months (there will be a different code for Wales). The
Registrar has asked the Westminster Parliamentary Committee to lead
on the College response, and we will be asking for views from all
Faculties, Special Interest Groups and English Divisions. In
the meantime we have had some discussions about the Code with
officials in the Department of Health.
Areas where members' views will be
particularly important include the interpretation of the new
Supervised Community Treatment provisions, safeguards for children,
and detail on the expectations of the new professional roles.
Please contact me via nbalmer@rcpsych.ac.uk
at the College once the consultation is open
if you have any views you would like to feed into the College
response.
Dr Ian Hall, Chair, Westminster
Parliamentary Committee
5. New leaflets from
our award-winning series
The RCPsych Help is at Hand leaflet
series was again recognised as one of the best sources of mental
health information available; the
Self-Harm leaflet was Highly Commended in the BMA Book Awards
2007.
We have released two new titles this month,
with updates of our popular leaflets
Physical Illness and Mental Health and
Post-natal Depression. An update on the Bipolar Disorder
leaflet is nearing completion and also a new title,
Personality Disorder. We are grateful to the Charitable Monies
Allocation Committee of St Andrew's Hospital, Northampton
for helping to fund the production of the Personality Disorder
leaflet and for their help with the marketing of the College's
Help is at Hand series.
6. BMA Medical Book
Awards
Two new College publications were also Highly
Commended at the recent BMA Medical Book Awards 2007. These
were:
- Enabling Recovery: The Principles and
Practice of Rehabilitation edited by Glenn Roberts, Sarah
Davenport, Frank Holloway and Theresa Tattan.
- Research Methods in Psychiatry,
3rd Edition, edited by Chris Freeman and Peter
Tyrer.
7. Department for
Work and Pensions (DWP): GPs reconsider advice to patients on sick
leave
A new survey of 1500 GPs has found that
two-thirds (64%) are unaware of the evidence that work is
beneficial for physical and mental health. However, nearly 90% said
that if they knew of this evidence it would affect the advice they
give to their patients.
The survey, carried out by Doctors.Net on
behalf of the DWP, was revealed by Lord McKenzie this month at a
British Medical Association Conference which brought together 100
leading doctors to discuss the growing medical evidence that work
is good for people's health.
In his speech Lord McKenzie stated "The
recognition that there is evidence that work is good for
people's health is, I believe, that powerful. Because it means
staying in work or returning to work could actually be part of the
solution to ill-health -no longer be seen as part of the
problem.
"Obstacles often arise from myths and
misunderstandings. Doctors' advice can have a powerful impact - for
good or harm. Wrong words can reinforce or even create myths.
Challenging patients' misconceptions and providing evidence-based
advice is an effective way of overcoming these barriers.
"But all of us - whether Government,
employers, the medical profession or even individuals themselves -
must consider how we can go further in responding to the evidence
of the links between health and work if we are to meet the
challenges of tackling ill-health in the working age
population."
Work and Pensions Secretary Peter Hain and
Health Secretary Alan Johnson have asked Dame Carol Black, the
Government's first National Director for Health and Work, to carry
out an extensive review of the health of the working age
population.
http://www.dwp.gov.uk/aboutus/2007/05-09-07.asp
Events
Volunteers' Forum.
Tuesday 9th October 2007 at the
Royal College of Psychiatrists, 17 Belgrave Square, London SW1X
8PG.
The aim of the forum will be to raise the
profile of the volunteer programme and to update everyone on the
progress of the programme since its conception in 2001.
There will be various presentations from
psychiatrists at different stages in their career who have all
volunteered overseas.
There will also be workshops to discuss the
future development of the programme and how and where we can help
overseas. Your input and experience will be invaluable to us and we
would appreciate your attendance.
The event is free of charge and lunch and
refreshments in the morning and afternoon will be provided.
For more information and the registration form
see
http://www.rcpsych.ac.uk/college/boardofinternationalaffairs/volunteersforum.aspx
One day conference for new trainees in
psychiatry – Friday 26th October 2007 at
the MIC Hotel & Conference Centre, 81-103 Euston Street, London
NW1 2EZ, The conference will welcome and introduce trainees
to the College, give trainees a taster and information about
the different specialties and provide information about all aspects
of training and the MRCPsych examinations. Speakers include the
President, Chief of Examinations, Dean, and Faculty Chairs. The
event is free of charge.
For further information and the registration
form see http://www.rcpsych.ac.uk/events/collegediary.aspx
or contact DelaGoka dgoka@rcpsych.ac.uk.