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Research and Audit Results The results were entered into a database and simple comparisons were made between the results for each category over the 3 periods of data collection. The Chart 1 Comparison of results from 2005-2008 50 45 40 35 30 25 20 15 10 5 0 DNA New Assessment Discharge appointment psychiatrists were allowed to select, none, one, or more than one of the fifteen categories for each case that they saw. Eight of the categories registered any results over the assessment periods. The results are shown in Chart 1 below. Medication review/prescribing Mental state examination/diagnosic assessment Reassurance and support Assessments 2005/2006 Assessments 2007 Assessments 2008 Risk assessment/ risk montoring Some notable trends were seen in the data collected over the 3 years. Crisis planning/ crisis resolution The percentage of medication review and prescribing increased year on year, from 27% in 2005/06, to 34% in 2007, and then to 46% in 2008. There was a marked increase in mental state examination and diagnostic appointments in the 2008 period (43%) compared to the years before, 18% in 2007 and 20% in 2005/06. The percentage of appointments for reassurance and support remained at a similar level in each of the assessment periods. Risk assessment/monitoring appointments initially decreased in 2007 (1%) from the previous period but then markedly increased in the 2008 (14%) period. Discussion The authors felt that some really encouraging results were collected over the past 3 years indicating one aspect of the NWW movement that had greatly altered practice. We believe that the increase in the proportion of medication review and prescribing is a result of the appointments with the psychiatrists utilising their skills appropriately. Team members have seemly felt more able to arrange for the patients they care coordinate to attend for this specific advice. Mental state examination and diagnostic should a substantial increase in the last period and again the authors believe that this is an appropriate use of time for the psychiatrist in the team and would benefit patient care. Also with increased need for coding and monitoring of service this allowed accurate accounting of illnesses treated within the team. Risk assessments have increased markedly increased in the past year and is perhaps a marker of the increased concern in the present climate about serious incidents related to mental health. This could be seen as a retrograde step towards doctors 22 Surrey and Borders Online Journal www.sabp.nhs.uk/journal
having clinical responsibility for all of the patients within the team, instead of this being devolved to the respective care coordinator. Further research could establish what happens with the information gathered at this time to establish whether risk information adds to the care coordinators management plan in an appropriate manner. Appointments offering reassurance and support have remained at a low level throughout the assessment period this shows that despite changes to the service there is an appropriate level of this that should be offered by the psychiatrists. The authors believe that were this to be eliminated from their role then this would be to the detriment of patient care and job satisfaction. A reduction in the DNA rate over the 3 periods of assessment could be seen to be a sign that patients appreciate the change in the nature of appointments that has occurred over time. The authors recognise that this surrogate marker for patient satisfaction may not be a true reflection of patients’ views. Future audits of this nature within the team will include more direct measures of patient satisfaction. Changes within the team that have facilitated this evolution are sometimes hard to pinpoint. As the population covered by the team have not changed and neither has the demographics of the people living in the area so the change has been within the team. The authors believe that increased and more effective supervision of the MDT has been a major factor and resulted in requests for fewer outpatient appointments. Conclusion Debate in the psychiatric literature continues about how the NWW movement impacts upon the psychiatrists’ role, job satisfaction and even recruitment 2,3,4,5 This literature has undoubtedly uncovered strong feelings that the majority feel that this process acts to the detriment of the psychiatrists’ practice. The authors believe that the audit shows that an evolutionary change in the service need not be a tremendous upheaval if managed well, and could improve psychiatrists’ working practices. The authors recognise that the process of change can only be attempted if others in the team are willing to take on new responsibilities. We believe that more effective and regular supervision from medical staff to non medical staff in the team has facilitated this change within our team. We are aware that our audit does not take into respect their view points and further work will address this as well as more direct measures of patient satisfaction. References 1. Department of Health; Final report from the National Steering Group. New ways of working for psychiatrists: Enhancing effective, person-centred services through new ways of working in multidisciplinary and multiagency contexts. Department of Health; 31 October 2005 67. 2. Craddock N, Antebi D, Attenburrow M-J, et al. Wake-up call for British psychiatry. The British Journal of Psychiatry 2008 July 1, 2008;193(1):6-9. 3. Dale J, Milner G. New Ways not working? Psychiatrists' attitudes. Psychiatr Bull 2009 June 1, 2009;33(6):204-7. 4. St John-Smith P, McQueen D, Michael A, et al. The trouble with NHS psychiatry in England. Psychiatr Bull 2009 June 1, 2009;33(6):219-25. 5. Vize C, Humphries S, Brandling J, et al. New Ways of Working: time to get off the fence. Psychiatr Bull 2008 February 1, 2008;32(2):44-5. Research and Audit Surrey and Borders Online Journal www.sabp.nhs.uk/journal 23
Page 1 and 2: Issue 1 Summer 2010 Surrey and Bord
Page 3 and 4: Do you ever wonder why you agree to
Page 5 and 6: We are not so aware of the hidden f
Page 7 and 8: esorting too soon to complex statis
Page 9 and 10: Bipolar Disorder: how effective is
Page 11 and 12: Research Method The study was condu
Page 13 and 14: Screened for Hypomania Yes No Total
Page 15 and 16: In our sample the GPs screening met
Page 17 and 18: Audit of risk assessment documentat
Page 19 and 20: Fig. 2 Re-audit May 2009 - distribu
Page 21: An evolving service - results of a
Page 25 and 26: school exposure to psychiatry as an
Page 27 and 28: The measures outlined above will ho
Page 29 and 30: Interview with Fiona Edwards, Chief
Page 31 and 32: Q. Very topical to that is the appo

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