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The Royal College of Psychiatrists Improving the lives of people with mental illness

Chair's Blog

July 2018

Joint Blog

Guest Bloggers Dr Emma Cunningham and Dr Niall Corrigan reflect on their year as Achieve Develop Explore Programme for Trainees (ADEPT) Clinical Fellows, August 2017 to August 2018

 

Dr Emma Cunningham Guest Blog:

Encompass

Encompass is the over-arching term used to describe the new Electronic Health Record (E.H.R.) that is due for implementation into Northern Ireland by 2021. My ADEPT clinical fellowship year involved working with the Encompass project team, socialising the concept of electronic health care and engaging staff in the design and delivery of the new system.

The transformation of health care provision in Northern Ireland strongly depends on the introduction of an E.H.R. An E.H.R. will create an outcome focused data base of information required to allocate resources appropriately and overall improve the quality of patient care, staff satisfaction and lower per capita the cost of health care.

As a Psychiatry trainee with limited knowledge of digitisation advances in health care, it really was an excellent opportunity for me to experience something different, embrace innovation and help instigate a change.

I decided to cultivate my project in such a way that it was ingrained within the staff at the front line. I wanted to gather feedback that highlighted current attitudes and perceptions professionals held towards electronic health care. Evidence suggests that implementation of E.H.R.s fail when staff are not involved. It was therefore important for me to create the feeling of ownership in the overall system development, for success to follow in Northern Ireland.

The reality of the current IT platform within our region is that it is made up of lots of different systems that are not interoperable, are old and in need of urgent replacement. Information is often duplicated and not always in the right place at the right time. The current Northern Ireland Electronic Care Record (NIECR) has, without a doubt, been revolutionary in how we source information. However, it is read-only and does not communicate with any of the other systems in place. As professionals, we appreciate that errors in health care may well result from a culture of fragmented communication that can lead to a fractured system.

The perceptions and attitudes of staff within Northern Ireland to the introduction of an E.H.R. have been similar to those expressed by professionals in other countries exposed to implementation. This is reassuring to recognise. Focus groups raised questions about the patient portal and how patients and/or carers will interpret results, consultations and management plans. There was concern that such a function will increase work-load and with already busy schedules, who would deal with this? Other feedback related to issues of confidentiality, cyber security, standardisation of pathways and potential loss of professional autotomy.

In the wake of change, staff are understandably uneasy. They want more training to enhance their existing IT skills. Education was a priority for my project. By embedding in education, adoption of E.H.R.s in working life is almost innate. With this in mind,  I designed a lecture for the QUB School of Medicine and Pharmacy which is delivered to the undergraduates, arming them within information prior to entering clinical life. The NIMDTA Generic Skills programme for Foundation Year 2 doctors has also made it part of their mandatory Quality Improvement teaching.

This year has made me appreciate that change of any kind must be relayed in an honest and transparent way. Leadership should be strong, unwavering and accountable. Interfaces undoubtedly exist between professionals and systems alike. There needs to be a focus on losing the ego, co-working and communication for something as huge as Encompass to succeed. The importance of creating support at the front line must not be overlooked, as the goal to achieve an E.H.R. for Northern Ireland will no doubt be met with many technical, cultural, social, political and legislative challenges ahead.

As an ADEPT Fellow you are forced to think outside the box, to make decisions based on what you believe to be right for all. Psychiatrists need to do this all the time. Being innovative and diverse in our thought processes is how we cope with the challenges that we meet every day.

Authored by Dr Emma Cunningham
ST4 Psychiatry

 

Dr Niall Corrigan Guest Blog:

 

Adept

 

 

 

 

 

 

 

 

 

 

 

2018 Adept Fellows at NIMDTA Educational Excellence Day with Niall second from right

This year, I have taken time out of Higher Training to pursue a Fellowship in Clinical Leadership under NIMDTA’s ADEPT programme. The ADEPT programme is now in its third year and is open to all Higher Trainees in any Specialty within Northern Ireland. There have been at least two psychiatry Trainees who have been successful in acquiring a Fellowship in each of the last three years. This year I was fortunate to obtain a fellowship alongside Dr Emma Cunningham, another General Adult Spr.

I was appointed to pursue my Fellowship in the Belfast Health and Social Care Trust (BHSCT) and I was allocated a project theme of ‘Reducing Harm from Medication’. In the last twelve months, I have been involved in leading Quality Improvement (QI) projects around improving medication safety within the Trust. One of my cardinal projects was psychiatry specific – using QI methodology to improve access to the Substitute Prescribing Service (SPT) in BHSCT. This project achieved a 50% reduction in waiting times for the service and I presented this at NIMDTA Education Excellence day at the La Mon Hotel on 22nd of June. I hope this project can leverage greater resources for the SPT service which is facing rising demands.

As an ADEPT Fellow, one is also expected to complete a Level 7 certificate in Project Management with the Institute of Leadership and Management. This was facilitated by the HSC Leadership Centre and was an invaluable experience in how to deliver change in a complex, resource stretched environment such as HSC.

Beyond the projects and formal courses, the ADEPT programme offers Higher Trainees the opportunity to witness and experience leadership in action within our local health system. Shadowing the Medical Director, attending a Medical Leaders’ forum in the Department of Health and sitting in on Serious Adverse Incident working groups – these are the experiences and learning which I will take with me in my future career.  Furthermore, as often the only Trainee at management meetings, Leaders looked to you to speak for the Trainee body -and with that comes influence and responsibility. Reflecting on the year, at times learning experiences were not immediately overt or tangible. However, I soon realised that a carefully delivered phrase or point delivered at a meeting by a Leader, whilst not immediately significant to my ears at the time, carried huge importance months down the line.  

ADEPT also provides psychiatry Trainees with a chance to branch out beyond our speciality and make meaningful connections with other medical colleagues and disciplines. Merely by being in the room, by collaborating on QI work, I feel we are going some way to reduce the stigma that is still exhibited towards psychiatry from other branches of the health care system.

I hope to bring back some of the learning from my ADEPT year to my work as Psychiatry Registrar to improve services and deliver better care for our patients. The ADEPT year is an opportunity for Psychiatry Registrars to gain invaluable leadership and systems’ management experience.  It forced me to become more circumspect and evaluate whether we can do things better. For example, can we collaborate with other disciplines to get ‘upstream’ of some of the challenges in psychiatric practice?

The tradition of Psychiatry Regs taking up ADEPT Fellowships continues – with 5 Fellows in the 2018/2019 ADEPT cohort! Long may this continue…

Authored by Dr Niall Corrigan
ST6 Psychiatry

June 2018

ICThe College’s International Congress which was held in Birmingham from 24-27 June 2018 entitled “Psychiatry – New Horizons” will, I think, be judged as a success. It attracted a large number of delegates, the venue was excellent and the presentations were wide-ranging, varied and eclectic. There were several poster presentations by Trainees from Northern Ireland, which was good to see. There was also plenty of opportunity to discuss controversial topics, with a particularly energetic and thoughtful intervention from Dr Philip McGarry on the controversial issue of the UK Government’s ‘Prevent’ strategy!

Gerry

Baroness Hale, in the keynote address on mental health legislation, seemed to be very much emphasising the centrality of capacity in any reform and there was plenty of interest in the Mental Capacity Act (NI) 2016 during a session on mental health legislation across the jurisdictions.

We also had a useful ‘4 nations’ meeting. With health and social care fully devolved here, it is clear that the College presence in the devolved nations needs to have the resources and autonomy to shape the agenda and respond to issues that are most important to them, whilst at the same time continuing to benefit from the strength, unity and resources of a UK wide College; it’s all about balance.

Next year’s International Congress is once again back in London - who knows, maybe sometime soon in Belfast??

Gerry

May 2018

The fantastic weather during the month hasn’t reduced the pace of activity here in the College - if anything, this has been one of our busiest months and thanks, once again, to all those members who’ve worked so hard to raise the profile of the profession and ensured that our voice is heard.  Have a look at this month’s report and please feel free to comment on anything that captures your interest; better still, get involved!

MCA

I know I’ve been going on about the Mental Capacity Act , but it really is very important that Clinicians who’ll be working the Act turn their minds to the practical clinical implications of the new legislation. I’d love to hear from Clinicians about their concerns, particularly in the form of clinical scenarios. We intend to have at least one further meeting with DoH officials as the Code of Practice goes out to formal consultation. The DoJ has finally begun to work on the Code of Practice for the Criminal Justice provisions of the Act, and my thanks to Dr Adrian East for undertaking to work with them on this. 

You’ll see from the report and, no doubt, will have seen/heard on the news about the additional investment going into primary care. There is now a commitment from the Department to include mental health workers within the integrated primary care multidisciplinary teams. Although this recognises the importance that primary care puts on mental illness, there are many potential pitfalls and possible unintended consequences to be wary of, not least the potential increase in demand (as more unmet need is recognised) and the diversion of resource and skilled personnel away from secondary care. Dr James Nelson and I had a meeting recently with Dr Geraldine Strathdee and David Bingham, who are advising the GP Federations on mental health services, and it was encouraging to see that the Federations recognise the potential complexities; it’s not as simple as placing a CPN in a primary care team or moving an outpatient clinic to a health centre. 

Anyway, plenty to think about over the summer months; you might also want to turn your mind to 2019 and the theme for the All Ireland conference – to be held here in Northern Ireland !

Gerry

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