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Art for the patients' sake

Bringing arts into the lives of people with mental health problems is at the heart of the Arts and Minds Network in Leeds.

The network brings together artists, art therapists, occupational therapists, carers, patients, PCT staff, clinicians and experts from the voluntary sector, all with the aim of using the arts to help others.

Underlying their efforts is the proven benefit of involvement in the arts for mental health service users. Music, dance, sculpture, design and other art forms are all part of the network's remit.

The head of public and patient involvement with Leeds Mental Health Teaching Trust, Victoria Betton, has been part of

the project from its inception in 2003.

'One of the things we're most proud of is that we have brought so many people on board and made it so inclusive,' she said.

'Before we set up this network there was no clear way of bringing people together, but now we are able to offer very positive experiences to service users.

'Those service users and patients are the most important part of the whole set-up, and we can see how much it helps them.

'When we have events the feedback is that it is a means of self expression for them, which is very important.'

The recent 'Make Your Mark' event at the West Yorkshire Playhouse is an example of how the network is able to pool the resources of many different individuals and organisations.

'We ran it for service users and carers, and it was a day when they were able to try many different art forms,' said Victoria.

The network is also able to offer economic advantages, with central funding used to provide shared resources, such as multi-media facilities.

The network has made a bid for Arts Council funding for a three-year part-time position to be established to run the network, and it is in the process of setting up an arts time bank.

This latter project is a web-based system which enables artists to exchange skills rather than paying each other. A mental health service user will be managing the site, helped by a member of the Arts and Minds Network.

For more information on the Leeds Arts and Minds Network, contact Victoria Betton at:

• victoria.betton@leedsmh.nhs.uk (opens new window)

Nurses expand their role

As the traditionally sharp divide between hospital and community care has been relaxed, so too has the separation of duties between doctors and nurses. In the Chester area that is bringing tangible benefits for patients.

Some experienced nurses are taking on more responsibilities as nurse clinicians. The new role requires extra training at Masters level and permits the prescription of certain drugs and the treatment of a wider range of ailments.

Tony Mayled is a nurse clinician working from a GP surgery in the Chester area; he reports a tremendous response to the new concept.

'My role involves consulting with the patient, diagnostics, and managing acute minor illnesses ranging from sore throats, coughs, mental health problems and any undiagnosed acute illness,' he said.

'Patients get a choice of seeing a GP or a nurse clinician.

'Often they can see a nurse clinician faster than they can see the GP, which is important in the treatment of acute minor illness as we need to see them as quickly as possible.'

Tony has worked hard at developing his role, which has required a change in procedures at the surgery.

'I did some sessions with the staff at the surgery to explain what I can and can't do as a nurse clinician, and that helped a lot.'

Many patients now have a rapport with Tony and opt to see him in preference to a GP.

'It's all about patient choice. Some prefer not seeing a doctor for whatever reason, and we're providing that choice.

'We also have a practice nurse, who is another option for patients. It's not just me or the GP or the practice nurse, it's the whole team that works to make sure the patient can get the best care.'

For more information, e-mail Tony Mayled at:

• tony.mayled@gp-N81626.nhs.uk (opens new window)

Delivering care to substance misusers

The Your Health, Your Care, Your Say consultation found that ensuring services are open when the public want to use them is one of people's highest priorities.

For many years, general practices in Southend-on-Sea have struggled to cope with the needs of drug and alcohol misusers, some of whom could be disruptive to other patients and the smooth running of the practice.

Two years ago, Southend-on-Sea PCT established the Victoria Surgery in the central part of the town specifically to provide a GP surgery for this group of patients.

Patients identified as being in this group were offered the chance to move their registration to the new practice.

A GP from Suffolk with extensive experience in working with alcohol and drug misuse took on the practice and opening times were tailored to patients' needs, with sessions being offered from 2pm-9pm.

Associate director of primary care at the PCT Ian Stidston says results since the surgery was established have been excellent. 'We have found that by taking a holistic approach and ensuring patients are treated with dignity we gained their trust and respect,' he said.

'If you talk to patients down at the surgery they say things like 'there's never been anything like this'.

'It enables us to reach out and engage people we've never reached before,' he said.

'Many of these patients weren't being looked after and we had a serious gap in services, which is why we found funding for a specialist GP surgery.'

Following the implementation of the practice, waiting times for patients to access substance misuse services fell dramatically. Over 400 patients are now accessing the services from the Victoria practice.

The original GP has now reached the end of his initial full-time contract, and the past two years have been used to train local GPs in working with this type of patient and continue the successful work.

A key White Paper commitment is that, in future, practice opening hours will be agreed with PCTs, and various primary care contracts will provide more incentives for new and existing providers to offer better opening hours.

To contact Ian Stidston, e-mail ian.stidston@southend-pct.nhs.uk

To contact the Victoria Surgery, call 01702 615953.

• ian.stidston@southend-pct.nhs.uk (opens new window)

Faster access to hand clinics

A scheme in Nottingham makes use of two GPs with a special interest in hand conditions to improve the treatment of hand and wrist conditions.

The system is built around two weekly hand clinics which cover the four Nottingham PCTs, with a weekly review of all patients who have been referred for hand conditions. Those who are suitable for the community service are then referred to the clinics, thus reducing the number of patients that have to attend hospital.

Broxtowe & Hucknall PCT primary care development manager Lucy Davidson said it was important to establish which patients should be referred to the hand clinics.

'There is a lot of work done ensuring conditions that could be treated by the community clinics are identified,' she said.

The result is that patients with conditions such as carpal tunnel syndrome, Dupuytrens, trigger finger/thumb and ganglions can be assessed in the community clinic, receive treatment if required and may not need to be treated in hospital.

'We ran a patient feedback survey and the results were very positive. More than 90 per cent of respondents said they would recommend the service,' she said.

The programme began in May 2005 as part of the push to make services more accessible to patients in the community.

'We realised that we had certain GPs whose skills could be utilised in the community, and that it would be beneficial to have them working there.

'It was a significant step as primary and secondary care worked together to identify certain conditions that could be treated in the community and helped in reducing waiting times for patients,' said Lucy, who has been with the PCT for two years.

'There is certainly a feeling that this is all part of making things more patient-led than ever before.'

The next step for the programme is to set up more clinics to further improve patient access.

For more information on the hand clinics, contact Lucy Davidson at:

• lucy.davidson@broxtowehucknall-pct.nhs.uk (opens new window)

Emergency care practitioners reduce hospital visits

Norfolk is benefiting from the increased number of emergency care practitioners in the East Anglia Ambulance Trust and the trust's operation of the local primary care out-of-hours service.

The growth in the number of emergency care practitioners (ECPs) has been a major change in recent years, as they bring greater skills into the emergency care team and thus greater quality of care to patients, says the trust's assistant medical director, Scott Turner.

'These more skilled ECPs can treat the initial presentation but can also provide ongoing treatment and referral if necessary,' he says.

Being able to prescribe certain drugs and treat more complex conditions means fewer patients need to be taken to hospital.

'Ultimately it's all about what's best for the patient, because not all patients need to be in hospital, and conveying the patient has knock on effects across the whole health care system. It avoids a needless trip for the patient and frees up that ambulance for more urgent calls,' he says.

And an extra advantage has been introduced in Norfolk with the ambulance trust running the primary care out-of-hours service.

This unites the primary and acute care services under one communications system during the out-of-hours period, and a good example of the benefit to patients is in the case of an asthma attack.

'All paramedics are trained in recognition of asthma and stabilisation of an asthma attack,' says Scott.

'So if a paramedic is called out to an asthma attack and stabilises the patient, they can then be referred to the out-of-hours provider where a doctor, ECP or nurse practitioner can see the patient, providing further treatment.

'They can also arrange and help to monitor the treatment in the next few days.'

Ultimately, this means patients are less likely to have to be taken to hospital and their care is more efficient and well co-ordinated.

For more information contact Scott Turner at:

• scott.turner@eaamb.nhs.uk (opens new window)