Practitioner Health Programme

Updated 26 March 2019

Practitioner Health Programme (PHP) provides a hybrid service, combining aspects of both primary and secondary care level treatment to doctors and dentists who are experiencing mental health and addiction problems. The service was set up in 2008, following the inquiry into the death of psychiatrist Dr Daksha Emson, who had died alongside her 3-month old daughter in 2000 as the result of an extended suicide, prompted by Dr Emson’s poor mental health. The inquiry highlighted the need to develop services for doctors with mental illness, who often feel unable to seek help from their own GP, due to fears about confidentiality and the potential impact on their careers.

The service is provided by Hurley Clinic Partnership who hold a contract with NHS England to provide a service to GPs located throughout England, and has local commissioning arrangements in place to provide a service to doctors from all other specialisms, and to dentists, who are located in London.

The service is located at:

Riverside Medical Centre

Hobart House

St George’s Wharf

Wandsworth Road

Vauxhall

SW8 2JB

Consultations are provided from this address to patients who are able to access this site. For patients who are located outside of London, the service is provided via a network of remote locations.

The service is delivered by a multi-disciplinary team, comprising of GPs, psychiatrists, psychiatric nurses and cognitive behavioural therapists. Patients are seen individually, but also have the option of attending group therapy sessions, facilitated by a member of the PHP clinical team. At the time of the inspection, the service was being used by approximately 1,500 patients per year.

The clinical team is supported by an administrative team, comprising of a Chief Operating Officer, service development and operations managers, and administrators.

PHP is registered with the Care Quality Commission for the regulated activities of Diagnostic and screening procedures, and Treatment of disease, disorder or injury.

Updated 26 March 2019

This service is rated as Outstanding overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Practitioner Health Programme on 14 January 2019 as part of our inspection programme.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided; this included developing data sets, and forming networks with comparable organisations internationally in order to gather benchmarking data. The service ensured that care and treatment was delivered according to evidence-based guidelines; this included developing its own guidance for areas where no appropriate established guidance existed.
• Staff involved and treated people with compassion, kindness, dignity and respect; the service was acutely aware of the sensitivities around patient confidentiality, and this was taken very seriously, with associated policies in place.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs. The service had developed an online appointment booking app, which allowed patients to book appointments with a member of staff of their choice, and keep track of the appointments available to them.
• The service was committed to identifying groups of patients with particular needs and providing resources for them; they ran a number of therapy groups, including groups for patients in “hard to reach” groups.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The service had an active Patient Participation Group, and we saw evidence that the input of this group was considered a valued resource.

We rated the practice as outstanding for providing effective services because:

• In the absence of any specific tools and guidance on how to treat “practitioner patients”, the service had developed their own resources, including developing a risk rating system, treatment guidance, and services such as “wrap-around care” (which enabled patients who were too ill to be treated by the service primarily, to access some of the specific services offered by PHP (such as support in dealing with regulators)).
• As a unique service, with no equivalent in the UK against which the service could compare their performance and measure their effectiveness, the service had adopted and developed a number of measures in order to indicate whether the treatments provided were effective; for example, they had also collected and compared data from other services with similar functions internationally, and in so doing had developed a European Network, aimed at sharing learning and resources and developing comparable data going forward. Information collected to date showed that PHP provided both the widest range of services and the best value for money compared to their international equivalents.
• The service had ensured effective staffing by developing a staff competency framework in order to identify the set of competencies required for the unique role the service provided, and ensuring staff they recruited were appropriately skilled and experienced. The impact of their work on the mental and emotional health of staff was recognised, and arrangements were in place to ensure that staff attended regular individual and group sessions to talk about areas they found difficult.

We rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• The practice had identified areas where there were gaps in provision and had taken steps to address them; in some cases this involved providing services (such as training) which was outside of the requirements of their NHS contract.

We rated the practice as outstanding for providing well led services because:

• The service was led by a management team who had identified the need for this resource and had personally dedicated themselves to ensuring that this need was recognised and addressed by stakeholders. The management team had taken great care to ensure that the needs and wellbeing of patients was at the heart of everything they did.
• The culture of the service and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.
• The service had an established culture and values, which formed the foundation of their strategy. There was a strong commitment to sharing learning externally, including engaging with regulators, Royal Colleges and employers, in order to highlight areas where practitioners needed additional support. They also frequently contributed to research, working groups, and media interviews to reduce the stigma suffered by practitioners who experienced mental health illness and addiction.

The areas where the provider should make improvements are:

• Put processes in place to regularly monitor that safety checks have been completed at remote sites.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care