Are the gates to be thrown open?

Mathers, Nigel; Mitchell, Caroline

doi:10.3399/bjgp10x484138

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…A key role of the GP is to act as a gatekeeper for access to secondary services, with one systematic review showing an inverse association between good quality primary care and avoidable hospitalisation (Rosano et al ., 2012). Good gate keeping in general practice is dependent on a strong doctor–patient relationship, understanding of the bio-psychosocial model as well as effective diagnostic and referral-making skills (Mathers and Mitchell, 2010). Optimal communication at the primary–secondary care interface is necessary to prevent delays in care, patient frustration and inaccurate information (Sampson et al ., 2015) and the importance of high-quality referral letters has been recognised (Ramanayake, 2013).…”

Section: Introductionmentioning

confidence: 99%

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

Tobin-Schnittger

O’Doherty

O’Connor

et al. 2017

Prim Health Care Res Dev

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Section: Introductionmentioning

confidence: 99%

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

Tobin-Schnittger

O’Doherty

O’Connor

et al. 2017

Prim Health Care Res Dev

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“…A lack of knowledge about the effectiveness and content of primary care psychological therapies and the gatekeeper burden of limited access have previously been described as factors that may influence the individual GP's decision to refer. 42,43 There has been a growing international consensus towards a shift from 'ad hoc' acute-episode management of depression to a 'systematic and structured' proactive approach to evidence-based primary care, using chronic disease-management templates of established value for other diseases such as asthma. 44,45 Unfortunately, enhanced treatment of acute depressive episodes in accordance with the 'Wagner criteria' of chronic disease management (by which the UK QOF falls short in ambition), 46 produced no better outcomes at 12 months than usual care.…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

Mitchell¹,

Dwyer²,

Hagan³

et al. 2011

Br J Gen Pract

Self Cite

102

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BackgroundThe National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and 'stepped care' for depression. AimTo explore primary care practitioner perspectives on the clinical utility of the NICE guideline and the impact of the QOF on diagnosis and management of depression in routine practice. Design and settingQualitative study using focus groups from four multidisciplinary practice teams with diverse populations in south Yorkshire. MethodFour focus groups were conducted, using a topic guide and audiotaping. There were 38 participants: GPs, nurses, doctors in training, mental health workers, and a manager. Data analysis was iterative and thematic. ResultsThe NICE guideline, with its embedded principles of holism and evidence-based practice, was viewed positively but its impact was compromised by resource and practitioner barriers to implementation. The perceived imposition of the screening questions and severity assessments (PHQ-9) with no responsive training had required practitioners to work hard to minimise negative impacts on their work, for example: constantly adapting consultations to tick boxes; avoiding triggering open displays of distress without the time to offer appropriate care; positively managing how their patients were labelled. Further confusion was experienced around the evolving content of psychological interventions for depression. ConclusionOrganisational barriers to the implementation of the NICE guideline and the limited scope of the QOF highlight the need for policy makers to work more effectively with the complex realities of general practice in order to systematically improve the quality and delivery of 'managed' care for depression.

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“…A criticism sometimes raised against self-referral systems has been that they primarily increase access for “articulate middle-class clients” [ 54 ] and therefore cement inequality. However, the participants in the sample presented here came from areas with a broad spread of relative deprivation.…”

Section: Discussionmentioning

confidence: 99%

A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study

Catanzano

Bennett

Tibber

et al. 2021

IJERPH

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Aim: This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. Methods: A mental health “booth” was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. Results: One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). Conclusions: A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions.

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Are the gates to be thrown open?

Cited by 4 publications

References 9 publications

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study

A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study

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