Patient Pathway 

 

  • Practitioner Health is a self-referral service, although we are able to provide general advice to family members and employers. The act of self-referral is key as this acknowledges recognition of need, preparedness to trust the service and willingness to engage in treatment.
  •  Healthcare professionals can contact the service via text, phone (0300 0303 300), email (prac.health@nhs.net),  web (www.practitionerhealth.nhs.uk), or letter (NHSPH, Riverside Medical Centre, St George Wharf, Wandsworth Road, London SW8 2JB). We are also available via social media sites – Twitter, Facebook and Instagram.
  • An online registration form is available on our website See Accessing the service (add weblink) and our phoneline is open between 8am to 8pm weekdays (excluding Bank Holidays) and between 8am and 2pm Saturdays.
  • The registration form includes several wellbeing assessment questionnaires which enable us to identify an early risk assessment including clinical factors for the patient and those that might affect the wider services of health and social care, including risk of harm to patient/client.
  • At registration we also ask for an In-Case-of-Emergency (ICE) contact (must be someone residing in the UK), which will only ever be used in exceptional circumstances. We also ask for consent for us to communicate with the patient’s general practitioner.
  • Once registered the patients are then given access to an NHSPH bespoke booking app which passes control passes to the patient with respect to who they see, and where and when they are seen for the first in-depth assessment. This gets over the problem of the patient accidently being booked in with a friend, relative or work colleague. This means patients can directly book with the clinician of their choice. The app allows patients to cancel and reschedule appointments to suit them and to directly message their clinician or therapists regarding the appointment arrangements. See Booking appoitments https://www.practitionerhealth.nhs.uk/booking-appointments

Assessment and Case Management

  • Each patient will have a 60-90-minute initial consultation where a detailed history and examination would be undertaken. Even though many of our patients present with illnesses similar to those of non-practitioners (depression, anxiety, post-traumatic stress disorder), the context in which their problems sit is different. So often the underlying cause of their illness is due to a combination of work-related stresses, family difficulties, a recent life event, a complaint or adverse outcome at work. As such we take a detailed history of a patient’s work, training and other professional issues. At the end of the assessment we formulate what the issues are, taking into account any predisposing, precipitating, perpetuating and protective factors there might be for each individual patient.
  • The clinical presentation and professional issues identified are presented by the case-clinician to the next available MDT meeting (these are held daily) consisting of lead clinicians, psychiatry and therapeutic practitioners. Together, the case-clinician along with the MDT, would agree the diagnoses, treatment plan and case management parameters. The MDT would also support decisions concerning discharge or onward referral as needed. Following MDT the lead clinician will contact the patient with an update and arrange access to therapy, or ongoing care as appropriate.
  • The MDT also discuss the level of risk the patient is posing – to themselves, their own patients or their organisation. Depending on the problem and severity, patients are risk-rated as either green (lowest), amber or red (greatest). The risk category determines how often the patient is seen and how proactive we are at following them up. The process of ascribing a risk-status to our patients ensures that we look in depth at each patients individual issues and how these might impact on their behaviour and the support they need (e.g. suicide risk or risk of breaking down at work).

 

Treatment and Care Options

  • Practitioner Health has a number of options available to support and treat the patients who access the service. https://www.practitionerhealth.nhs.uk/treatment This could include:
  • Ongoing case management
  • Initiating prescribing (usually with the involvement of the patient’s own GP) https://www.practitionerhealth.nhs.uk/prescription-requests
  • Issuing a Fit note to enable time to recuperate
  • Talking therapies - cognitive behaviour therapy, relapse prevention, brief psychotherapy
  • Therapeutic Group support – topic or profession based
  • Specialist psychiatric assessment
  • Access to in-patient addiction detoxification and rehabilitation (sites in England and Scotland)
  • Therapeutic blood or urine monitoring as part of treatment
  • Relapse prevention group
  • Peer support

 

  1. Occasionally the clinical needs of a patient are outside the capability of the service (e.g. complex eating disorders). In these cases the service would seek to liaise involvement with an appropriate specialist clinician.
  2. Patients who are acutely unwell or in crisis are connected with local CMHT/psychiatry services although Practitioner Health is sometimes able to continue to provide wrap around care.
  3. The service does not intend to replace the role of occupational health. Where patients would benefit from work related adjustments or other work-related support, the service would encourage patients to engage with the relevant occupational service.
  4. The service would support patients until appropriate to discharge or it is possible for them to engage with the local services in ways acceptable to them.