Independent investigation: Kenneth Light, Leeds (2005)

The operational policy for the community mental health teams is more structured that that in place in 2004 – 2005, and now sets out the process for reviewing referrals and the timescales within which a response must be made. When its content is reviewed it is suggested that the following are considered for inclusion:
A clear definition of the roles of clinical and managerial
(cid:137)
leaders.
A clear definition of the roles and responsibilities of individual
(cid:137)
team members (to include clarity of differentiation between
the bands of CMHT workers).
Case load allocation and case mix.
(cid:137)
Collective CMHT caseload size, and the maximum case load
(cid:137)
for each team member.
CMHTs’ relationship with general practitioners (e.137) at least
(cid:137)
twice a year one or more of the CMHT members will meet
with the GP practice to look at issues of concern, referral
patterns etc, meeting more frequently if required) .
Systems for preceptorship and induction of new staff (to
(cid:137)
include how different bands of staff are managed and
supported).
Handover arrangements when a care coordinator leaves, or
(cid:137)
where care coordination responsibility is transferred between
services.

Although the response rate from GPs to the survey questionnaire circulated to all GP practices in Leeds (150 practices approximately
300 GPs) was very disappointing (13%), a number of key issues
emerged from the responses that were received. These were:
That 50% of respondents to the survey said that they
(cid:137)
‘sometimes’ felt that their concerns were respected when an
urgent referral is made to mental health services.
50% of respondents had concerns about the usefulness of
(cid:137)
information sent to GPs from the specialist mental health service
in Leeds following initial assessment and at the point of
discharge.
32% of respondents had concerns about the overall quality of
(cid:137)
information sent to GPs from specialist mental health services.
The Investigation Team does not believe it is appropriate to make
substantive recommendations on the basis of the above information i)
because of the low response rate and ii) because variables such as the
geographical placement of a GP practice, and interpersonal
relationships between CMHT members and staff at a GP practice or
health centre could alter the results of the survey considerably.
However, neither is it appropriate to ignore the messages collated as a
result of the survey. Therefore the Investigation Team suggests that the
Directorate of Adult Services considers how it can further explore these
issues on a sector by sector basis. In addition to aiding effective
communications between primary care and specialist mental health
services, further exploration of the stated concerns should inform the
development and design of current and future electronic
documentation.

It is recommended that the Trust ensures that its regular audits of
record keeping incorporate audit of the quality and clinical usefulness
of the documentation and do not focus solely whether or not particular
sections of a documentation tool are populated.
With regards to the audit of documents such as letters to GP following
an assessment of a service user, or after discharge back into the
community, clearly GPs will need to have an active stake in this
process.
Activities that are known to make a beneficial contribution to assessing
the quality of record keeping are:
Peer review audits.
(cid:137)
Clinical audit tools that seek qualitative as well as quantitative
(cid:137)
data (for this to have credibility the auditors would need to
establish their baseline so all are working to the same criteria
of quality assessment).
Clinical and management supervision.