Practitioner Health offers a range of talking therapies, CBT and Brief Psychotherapy. These sessions are usually between 8-12 sessions. There are occasions when therapy can be extended but this will need to be agreed with a clinician and your appointed therapist.
Once the econsult registration forms have been completed, a clinician will screen your referral and review whether talking therapy would be suitable
The vast majority of people who self-refer to PHS have some form of case management. This is follow up with the person who conducted your initial assessment and will be your lead clinician throughout your care journey with PHS. This can be supportive and therapeutic and is a good way for patients to get a more objective opinion on how their treatment is going. Case management can run alongside any of the more formal interventions, such as CBT, brief intervention psychotherapy or any group therapy.
Cognitive behavioural therapy
CBT is a form of treatment that many of you may be familiar with. It is a psychological approach based on scientific principles, which research has shown to be effective for a wide range of problems. Patients and therapists work together, once a therapeutic alliance has been formed, to identify and understand problems. It is based on the idea that thoughts, feelings and behaviour are related and that changing one response, such as behaviour, usually results in change in another response, such as mood. The approach usually focuses on difficulties in the “here and now”, and relies on the therapist and patient developing a shared view of the problem.
The mainstay of treatment within PHS is CBT and in combination with the therapists directly employed by the service, a large provider, Efficacy, is also commissioned to help with the delivery of CBT across the country.
There are three types of CBT offered within practitioner health: Supported, computerised CBT, telephone-based CBT and Face-to-face CBT.
Supported, computerised CBT
This uses SilverCloud which is a range of online modules that guides patients through CBT techniques. Once a patient is assigned this form of therapy, they receive a link via email including the modules suitable for the initial diagnosis discussed with a Practitioner Health clinician at their first assessment. The patient then has weekly telephone calls with their therapist and the patient is then able to discuss their records of the week and have their progress supported throughout their treatment. 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.
Patient experience “I found the online course very helpful because I feel I could be honest. This was because I had the time to work through the questions and be true to myself. There also wasn’t the pressure to ‘keep up appearances’ face to face.”
This is popular amongst patients who want the flexibility that a remote service can provide. This permits patients to manage their treatment around shift work, family life and other commitments. It can also offer the anonymity of treatment being delivered out of their local area.
The patient is contacted to set up the first telephone appointment and then has a weekly 50 minute phone or skype call with their therapist (patient can choose their preference). The patient continues to have their treatment via weekly calls for as many sessions as are clinically indicated.
Patient experience “I would recommend this approach because it offers a very approachable and effective service, accommodating around work schedules where needed.”
This is the mainstay of treatment modality and allows the practitioner-patient to work through their issues with the therapist and follow up with homework between sessions. Initially, the patient is contacted to set up the first appointment based on their local clinician’s availability and then has weekly 50 minute appointments in person. The patient continues weekly treatment for as many sessions as are clinically indicated. As a patient’s circumstances or illness changes, they are able to move through the different modalities if indicated?
Brief intervention psychotherapy is time limited, to an absolute maximum of 12 sessions. This can be used for a number of different reasons but it often used to help patients through a difficult or transition period in their life.
Group support(group psychotherapy)
This is a form of therapy in which one or more therapists treat a small number of patients together as a group. Referral to group psychotherapy can be within PHS or outside of our service. This is something that can be discussed with your lead clinician. Outside the service, group work is provided for PHS largely through the Institute of Group Analysis (www.groupanalysis.org). Practitioner Health also provides access to Balint groups (www.balint.co.uk) which provide structured, facilitator-led, reflective groups based on psychoanalytical concepts exploring the doctor-patient relationship.
Groups help to reduce the isolation of sick doctors and allow them to overcome the barriers to becoming a patient and of disclosing their issues. Once in a group, doctors find them extremely beneficial and therapeutic.
There are a range of different types of group interventions offered at PHS including:
- Slow-open or closed groups : these last for a year. The patient is interviewed by agroup therapist prior to starting the group and may receive up to 6 individual sessions before they start the group. The group has 6-8 members, meets weekly for 90 mins for 40 weeks and is led by someone trained in group psychotherapy. Slow-open means members can join if there are spaces and closed means that no new members can join once the group is formed.
- Drop-in groups: weekly groups with an open invite to all eligible doctors/ dentists. This intervention is supportive in nature and the facilitator tends to offer some psychoeducation solutions.
- Time-limited groups: goal-orientated groups for specific cohorts with similar issues or those wanting to learn a new therapeutic approach (such as mindfulness). These typically last 8 weeks.
- Specific groups: groups for specific issues are occasionally held. Examples of groups that have been held in the past are one for International Medical Graduates and another for those bereaved by a doctor’s suicide.
- Monthly support groups: long-term groups offering mutual support and guidance for patients experiencing similar issues (e.g. a group for suspended doctors).
Treatment for addiction
PHS has the ability to admit patients to an inpatient rehabilitation and detox programme. This is a 6 week admission and we have a couple of different sites across the country that offer this intervention. If you think this might be appropriate for you it is something that could be discussed in your initial assessment or in your case management sessions. In almost all cases, your presenting problem will be dealt with by your lead clinician. Your lead clinician may want to have some brief input from some other members of the team who might have a more specialist interest in that area but your lead clinician will remain constant throughout your care at PHS.
Interventions that can be used for addictions include general support, guidance, working towards abstinence and in some cases interventions such as substitute prescribing.
Within the service, there is the ability for us to prescribe for you, ideally with your GP’s knowledge and consent. However this is not always essential and you can discuss your prescribing needs with your lead clinician.
Links with OH
Practitioner Health is not an occupational health service or a replacement for occupational health, it is an additional service. At PHS, we will liaise with the relevant Occupational Health team regarding a patient’s role in work, time off work or their return to work where appropriate and only with the consent of the patient.
Practitioner Health can provide reports for patients, however this will be with the explicit consent and approval of the practitioner-patient. PHS can provide reports to employers, Trusts, or to the GMC or GDC. Normally these will be short, confirmation of fact reports.
PHS does charge for reports in some circumstances. Charges are only applicable where the report request originates with a third party (or payment is being made by? What is the rule here) e.g. GMC, GDC, or a Defence Organisation. We will not charge for reports where the cost would be incurred by the practitioner patient.
All report fees are reinvested in PHS for service development or the improvement of existing services for practitioner-patients.
Please contact the office for details of report fees.