Independent investigation: Lynda Lovatt, South Shields (2004)

The alcohol issue There was evidence that two GPs in one practice in South Tyneside and a number of clinicians working in South Tyneside failed to understand the significance of alcohol dependency or misuse in the assessment and treatment of mental health issues. This may well reflect a general problem in primary care services in particular. Current guidance is set out in the Alcohol Needs Assessment Research Project, 2005 and endorsed in Alcohol Misuse Interventions (Department of Health, 2005). The strategic health authority is recommended to consider these publications and implementation.

Evidence based practice Primary care services for mental health patients are relatively new. The inquiry considers that it is vitally important that the patient receives the most appropriate treatment available. This should be evidence based. In Craig Sexton’s case, when in 2001 he presented with anxiety and panic attacks he was offered client centred therapy whereas cognitive behavioural therapy had, in the National Service Framework for Mental Health, been identified as the more effective intervention. In order to ensure best practice which is evidence based, the strategic health authority is recommended to review the interventions which are offered to mental health patients and to consider the benefits that are offered by such interventions.

Recording and communication issues Record keeping by most agencies was good. The manual handwritten nature of the GP records could be considerably improved and should be with the benefit of computer technology. Practitioners should be more prepared to pick up the phone, particularly in urgent cases – rather than just relying on a letter. The importance of time recording attendances – particularly in respect of attendances for counselling and assessment has also been noted. The strategic health authority is recommended to remind practitioners of the guidelines of the Nursing and Midwifery Council. The inquiry was concerned that there was no satisfactory protocol between services to deal with the transfer of patients/clients who were involved with primary care mental health services. In secondary care, the existence of the care programme approach will ensure that there is continuity of service and treatment as and where appropriate. In mental health cases in primary care, as the present case illustrated, no such care programme approach exists. The strategic health authority is recommended to develop a transfer protocol for primary care mental health service users.

Crisis assessment and treatment service The inquiry was impressed with the crisis assessment and treatment service as and its clinical competence. The inquiry was concerned about some aspects of the prescribing policy whereby doctors could prescribe medication without having seen the patient and considered that for the benefit of all staff and patients a clear protocol should be considered. The strategic health authority is recommended to review prescribing practice in light of the guidance provided in ‘patient group directives’ (Department of Health, 2005). There is no benchmarking of the service against other similar organisations and crisis teams. The inquiry considers that it is important that organisations such as crisis assessment and treatment service and other innovative services should be critically evaluated. The strategic health authority is recommended to ensure that benchmarking of the crisis assessment and treatment service is commissioned. The strategic health authority is recommended that staff are reminded of the Nursing and Midwifery Council guidelines regarding record keeping.

Personal advisors service The quality of records and level of supervision in the personal advisors service was not up to expected standard. The strategic health authority is recommended to ensure that supervision arrangements are reviewed for personal advisors service trainees and junior staff.