Practitioner Patient FAQs

Why has this service been set up?

Doctors and dentists are like everyone else and encounter all types of health problems. The focus of this programme is on early intervention, to support the health of doctors and dentists so that wherever possible they can continue providing safe and valued care to their patients.

There is a tendency for doctors and dentists to manage their own health problems, to self-medicate, to chat informally to colleagues etc. rather than seek a proper consultation and treatment. For this reason many problems go unreported or unrecognised. This service seeks to provide a way that doctors and dentists can access support and advice that they need in a confidential and understanding environment.

This service is also a commitment of NHS England’s General Practice Forward View as part of a wider package of support to general practice.

 

Who can use the service?

The service is available for any registered doctor or dentist who has:

  • A mental health concern (at any level of severity)
  • An addiction problem (whether alcohol, drugs or other addictions)
  • A physical health concern (where that concern has raised a performance issue)
 

How does PHS work?

PHS has two key components:

  • A team of nationwide clinicians, providing local patient assessment and treatment.
  • A network of treatment providers, available via our bespoke bookings application, who can provide you with ongoing treatment, therapies and access to groups.
 

Does Practitioner Health replace existing health services?

No: Practitioner Health is designed to enhance rather than replace existing health services for practitioners by providing advice on access to local health services and prompt access to confidential treatment where local services are unable to meet their needs.

 

What are the aspects of PHS?

PHS has two key components:

  • An expert advice, consultation and case management function, provided from one centre within London
  • Rapid access to specialists for further assessment and treatment, where required
 

How do I know if I should contact the service?

If you are a registered doctor or dentist in England and are in doubt about whether we can help, please get in touch and we can talk through the issues with you.

Telephone:  or email us:  

 

Do I need to pay anything to access services?

Practitioner Health is an NHS service and free at the point of delivery.  We do make charges for written reports requested by, for example, defence organisations.  Please see fee schedule here: Report Fees 2019 

 

Do I need to tell my GP that I am coming?

No: This is a confidential service. You do not need to tell anyone you are contacting us. The very fact that you are using our service is because you do not feel able to use existing NHS services. If you want to let your general practitioner know you have attended then you may indicate this when you register with PHS and we can write to him/her with your consent. We hope that you have a general practitioner that you can trust with your problem, but sometimes this is not possible and we will always respect that. In some circumstances, not being able to communicate with your GP may limit the treatment options available for safety reasons e.g. prescribing.

 

Is the service confidential?

Individual practitioners approaching Practitioner Health for advice or treatment will be assured that their case will be handled on a confidential basis. Only in exceptional circumstances will confidentiality be breached. This will be where there are serious and unresolved concerns that the practitioner-patient may be putting their patients at risk.

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Will you tell my employers I am unwell?

Within the confines of the law the service we offer is confidential. Only in exceptional circumstances may we have to breach your confidentiality and this will only ever be as a last resort. For example, there may be instances where we have a duty to inform the DVLA or if we think that your behaviour is putting children or vulnerable adults at risk. There may be exceptional cases where we think that you are putting patients at serious risk because of your behaviour. We then have a duty to let the GMC/GDC or your employer know about this. However this is seldom necessary.

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Can I use a pseudonym?

Yes you can use a pseudonym for telephone advice or enquiries if this is what you prefer to do. We will also arrange for pseudonyms to be used if a PHS clinician knows you or alternatively arrange treatment via one of our preferred providers. The important issue is that you feel confident in being able to approach PHS for help.

 

Is the Practitioner Health service an occupational health service?

No, it is not an occupational health service.

The NHS Practitioner Health Service is a health services for doctors and dentists who have mental health, addiction or physical health problems that affect their ability to work.

However, the Practitioner Health team may work with employers, Occupational Health departments and others to develop and implement return to work programmes.

 

Does PHS offer repeat prescriptions?

Practitioner Health is able to prescribe to patients. However, if prescriptions are required for any length of time we request that you ask your GP to do this. If this is not possible, then of course we can arrange to continue prescribing. However, the more complex the medication regime, the more we will try and have this done by your own GP since this is in your own best interests. We do not have a Repeat Prescribing process (as for example in a GP surgery).

We prefer to see every patient for review before we issue another prescription.  There is some flexibility but on the whole if you require medicines from us, we prefer to see you in person.

 

What if I come through GMC/GDC procedures?

It may be the case that the GMC/GDC have recommended that you approach PHS as they think you may benefit from the services we can offer you rather than being part of any restrictions or undertakings on your practice. Your contact with PHS is therefore purely voluntary on your part and the GMC/GDC will have NO further involvement and your care will be entirely confidential.

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For some health professionals a condition of continuing practice might be that restrictions are placed on registration, known as undertakings or conditions.

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These doctors/dentists often have a substance misuse or dependency diagnosis, and in these circumstances the GMC/GDC will appoint their own medical supervisors. Medical supervisors report back to the GMC/GDC on the doctor/dentist’s progress under treatment and also engage with the workplace and clinicians or others involved in the health professional’s care. GMC/GDC medical supervisors do not provide ongoing treatment to the doctor patient. Some doctors/dentists in this category who contact PHS may want reports on their progress from PHS to form part of the GMC/GDC medical supervision process. However if the doctor/dentist does not give consent for PHS to share details of their health with the GMC/GDC then PHS will not do so (unless it appears that patient safety is compromised).

It may be the case that a complaint has been sent to the GMC/GDC and as yet the GMC/GDC has not completed their investigation or, or having investigated the complaint has decided to refer it to a Fitness to Practise panel. This might be the case where for example you have been referred to the GMC/GDC following a drink-drive offence. We can help you deal with your problem ahead of the GMC/GDC process and put you in a much better position when the case is eventually heard. This will especially be the case where you are able to demonstrate insight into your problem and benefit from the support and help that PHS is able to provide.

 

If I am dependent on alcohol and approach PHS do you have to tell the GMC/GDC?

No. If there is no risk to patients (for example turning up for work intoxicated) then there is no reason for the GMC/GDC to be involved at all.

 

If I am dependent on illicit drugs (e.g. heroin, cocaine) do you have to tell the GMC/GDC?

We have set up an agreement with the GMC and the GDC that allows us to see and treat practitioner patients without informing them of individual cases. The exceptions to this are where patient safety is at risk, where a practitioner is not complying with assessment or treatment, not heeding advice to take leave from work, or where there is a significant on-going misconduct issue, or where, even though abstinent, there is a serious risk of relapse. Ongoing criminal activity would constitute such an issue. If such a situation were to occur, we would contact the GMC/GDC with your knowledge – we would try everything possible to not go behind your back to discuss or refer a named individual. Therefore, whilst in the majority of cases we would have no need to involve the Regulator but we will always advise you that any use of illicit drugs is a breach of your Regulatory requirements and on-going illegal activity needs to be reported to the Regulator.

If you are in any doubt please contact us for a confidential and anonymous discussion.

 

If I am dependent on prescribed drugs (such as diazepam) do you have to tell the GMC/GDC?

No, as long as there are no patient safety issues.

 

Where is the service provided? 

The NHS Practitioner Health Service is discretely based within an existing general practice surgery. Practitioner-patients should be reassured that they will be unidentifiable from other patients attending the practice for “normal” primary care services. Where available you will be able to select clinicians and therapists close to your home or work location. We hope that you will be able to access a clinician or therapist with experience in treating healthcare professionals no further than 1-2 hours travel time.

 

How do I book and change appointments?

We have produced the guide below to help you to use our award-winning appointment booking application, which works on all Android phones and iPhones.

Booking App Guidance

 

What happens when I come to the assessment appointment?

When you first contact the service you will be booked in for a short telephone assessment. This helps us understand your issues and identify the best way to support you. You will then be invited to book an appointment with one of our experienced health professionals for about an hour (but it may take up to 90mins) who will assess what your problem is. We will ask you to fill in some health and/or screening questionnaires and we may carry out a physical examination and/or blood tests. What happens next depends on the findings of the initial assessment and what sort of help you want. It may be the case that we can provide you with some information and that you don’t need to see us again. Alternatively, we might refer you immediately to a specialist practitioner or invite you to come to another appointment so that we can continue with a more detailed assessment.

Please expect your first appointment to last around 1 1/2 to 2 hours.

 

How will I book follow-up appointments?

After your assessment, if it is decided that you would benefit from further treatment, you will be sent a download link to our bespoke bookings app.  You will then be fully in control of your own attendance at PHS.  All follow-up bookings should be made by you using this smartphone application, allowing you 24 hours a day, 365 days a year access to our bookings system.  Full guidance in using the app. will be provided but you can also call our administrative team on 0300 030 33 00 for help.

The app currently runs only on iPhone and Android platforms.  If you do not have a phone running one of these operating systems, call 0300 030 33 00 and we will assist you.

 

What Treatment does PHS Provide?

As well as case management of patients by one our in-house clinicians, PHS offers CBT (cognitive behavioural therapy), group therapy attendance and residential detox for drug and alcohol addiction, as well as signposting and referral to other appropriate services.  We do not currently provide CAT (cognitive analytical therapy) and only provide limited access to psycho dynamic psychotherapy (individual).

 

Can PHS provide ongoing support and case management?

Yes: PHS will provide case management support for practitioners who have complex issues. PHS can also arrange for the therapeutic monitoring of practitioners who have been referred on for treatment of addictions.

 

What if I need a referral to a Specialist Practitioner?

The Practitioner Health Service (PHS) has a number of specially commissioned external specialist providers within and outside the London area. These providers have been chosen because they have expertise in managing sick health professionals and have robust systems for ensuring confidentiality. The PHS team will try to find the right service for you depending on your needs, preferred location and other factors. The external providers include:

  • In-patient detoxification services for drug and/or alcohol dependence
  • In-patient mental health services
  • In and out-patient rehabilitation services
  • Psychotherapy
 

What if I need psychological therapy?

We can offer you a specified number of therapy sessions, dependent upon need. We have experts within the team who can provide cognitive behaviour therapy or other psychotherapies (family, group, individuals). We have arrangements with a network of cognitive behaviour and other psychotherapists.

 

What service does Efficacy provide?

Information for Practitioner Patients being referred to Efficacy

Efficacy and Practitioner Health have worked together for 6 years to treat GPs requiring psychological therapies. The Efficacy and PHS partnership has now been widened to encompass all NHS PHS referrals.

Efficacy offers a range of treatment options for patients, all following NICE guidance for evidence-based treatments. This includes remote delivery of therapies as well as face to face appointments. The remote models have been designed with busy doctors in mind, understanding that they require not just consistently high quality therapy delivered by accredited senior therapists but also anonymity and schedule flexibility.  Each of these service options is discussed in person during a telephone-based assessment with a Senior Efficacy Clinician to make sure the patient makes a choice that is clinically appropriate and suits their personal needs.

The options that have been designed for the NHS GP Health service are as follows:

 
Supported Computerised CBT

Efficacy piloted and tested a selection of software-based NICE approved treatment programmes to identify that which has the best outcomes, was most true to the CBT model and offered a clinician-led option of contacts that allowed for a personalized and supported treatment. Efficacy chose SilverCloud and achieves exceptional outcomes for their patients in excess of published outcome data which is in itself very positive:

“SilverCloud, which was tested in the UK for people with depression, in addition to showing improvement on the primary depression measure, demonstrated significant improvements on the secondary anxiety measures” (Richards et al. 2015)

 
How it works:
  • A programme link is sent via email to the patient that includes modules that are suitable for the initial diagnosis. (Depression, Anxiety disorders – selection, Managing Stress)
  • Efficacy calls the patient to book them in with the first senior therapist telephone appointment
  • The patient works through exercises and records thoughts and feelings and behaviours
  • The patient has a weekly telephone appointment with their BABCP accredited senior clinician to discuss their work and records of the week and support their progress
  • The patient has 12 months’ access to their own confidential SilverCloud platform and can review lessons and relapse plans to support staying well for the future
 
Telephone-based CBT

In their work with GPs, Efficacy has recognized that there is a demand amongst some patients to be treated rapidly and with the flexibility that a remote service can provide. This permits patients to manage their treatment around shiftwork, family life and other commitments. It can also offer the anonymity that GPs require out of their local area.

 
How it works:
  • The patient is contacted to set up the first telephone appointment
  • The Patient has a weekly 50 minutes call on the telephone or Skype (as per their preference) with their treatment
  • The Patient continues to be treated weekly via telephone or Skype for as many sessions as are clinically indicated (based on NICE guidance).
 
Face to face CBT

Efficacy has delivered face to face CBT nationwide for more than ten years and has a rigorous selection and nurturing of their CBT therapists who treat patients face to face and remotely. All clinicians are BABCP accredited, referenced and checked to deliver high standards of care.

 
How it works
  • The patient is contacted to set up the first appointment based on their local Efficacy clinician’s diary availability
  • The Patient has a weekly 50 minutes appointment face to face
  • The Patient continues to be treated weekly face to face for as many sessions as are clinically indicated (based on NICE guidance).

For more information contact Efficacy Ltd: 020 79297911

 

What if I need admission for my problem?

If you need admission for a mental health or addiction problem we can arrange this for you. We have agreement with a small number of inpatient mental health and addiction services across and outside London. We will talk with you about where is best for you. This service is free to you.

 

How do I obtain help out-of-hours?

The Practitioner Health Service is not an out of hours service, we are open Monday to Friday, 9am – 5pm. – will all admin still be located in the London office? Should it be 8am-8pm and 8am-2pm on Saturdays

Our clinicians and therapists will choose their own working hours so you may be able to find evening or weekend slots in your locaility using our bespoke bookings application (made available to you when you register with PHS).

OTHER SOURCES OF HELP

 

How are records kept?

All details will be kept on a separate confidential computer record. This record will only be accessible by PHS staff and will not be “uploaded” to any shared medical record system. This means that the record will not form part of the NHS shared electronic record.

 

How long will you see me for?

We can continue to see you at the service until you feel able to be discharged. This may be when you feel better or where you are able to talk about your problem with your general practitioner.

 

What if I need rehabilitation services?

If you need rehabilitation we have a preferred provider agreement with a residential service based outside of London. A number of doctors and dentists have received residential treatment there, through PHS, since 2008. In exceptional circumstances where the service would not be appropriate we would discuss with you and see if arrangements with an alternative provider could be made.

 

What other organisations can I contact?

Our web site gives a list and contact details for a large number of organisations that can help you. Some of these are telephone advice services only and others can offer you face-to-face counselling. 

OTHER SOURCES OF HELP

 

How do I make a complaint about the care I have received with Practitioner Health?

If you have a complaint or concern about the service you have received from a clinician or any member of staff working at the Practitioner Health Services please let us know.  We operate a Practice Complaints Procedure and the leaflet can be downloaded here: 

PHS Complaints Leaflet

This of course does not affect your right to approach The Parliamentary & Health Service Ombudsman if you feel you cannot raise your complaint with us or you are not satisfied with the outcome of an investigation.

The Parliamentary and Health Service Ombudsman

 

What is your chaperone policy?

To view our chaperone policy, click here