 | Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA |
Kay Dunkley is a pharmacist who has worked in hospital and organisational pharmacy for over 20 years. She has a broad experience working in public hospitals and in providing support to health professionals through government funded bodies and professional organisations. Kay also has a strong interest in the health and well being of health professionals and especially the role of peer support. Kay first became involved as a volunteer with the Pharmacists’ Support Service, a group which has been providing telephone support for pharmacists in Victoria since 1995. In 2005 Kay became the Program Coordinator for the Pharmacists’ Support Service and has assisted the service to become an independent organisation which is currently seeking to expand to provide support to pharmacists throughout Australia. In 2007, when AMA Victoria approached the Pharmaceutical Society of Australia (Victorian Branch) with a view to establishing their own Peer Support Service; Kay accepted an invitation to assist. The AMA Victoria Peer Support Service commenced operation in February 2008. Kay currently coordinates both of these services and also works part-time as a consultant pharmacist in Residential Care Facilities. | |
In Australia the Pharmacists’ Support Service (PSS) provides a listening ear and support over the telephone to pharmacists in Victoria, Tasmania, South Australia and the Northern Territory and has plans for expansion to all states of Australia. The medical profession in Australia has a range of state based Doctors’ Health Advisory Services including the AMA Victoria Peer Support Service which provides peer support over the telephone. Victorian is the only state to have a state based health program for doctors; the Victorian Doctors Health Program (VDHP) The aim of the visit was to find out how these services support the health and well being of pharmacists and doctors, including the services provided and how they are funded. The support services visited were Pharmacist Support, including participation in a Listening Friends training weekend; the Royal Pharmaceutical Society; the Practitioner Health Programme; the Royal Medical Benevolent Fund; the British Medical Association Doctors for Doctors program and the National Clinical Assessment Service. In addition to obtain background material on the environment for health professionals in the United Kingdom visits were also made to the General Pharmaceutical Council; Manchester University School of Pharmacy and Pharmaceutical Sciences and the Pharmacy Department of the Central Manchester University Hospitals NHS Foundation Trust.
Funding from the Cyril Tonkin Fellowship enabled me to undertake a study tour of services which support pharmacists and doctors in the United Kingdom (UK) in March 2011.
This article is the second in a series reporting on my visit and will detail the services available to doctors and dentists living in London through the Practitioner Health Programme.
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The Practitioner Health Programme
The Practitioner Health Programme (PHP) is a free, confidential service for doctors and dentists living in London who have mental or physical health concerns and/or addiction problems.
Any medical or dental practitioner can use the service, where they have:
* a mental health or addiction concern (at any level of severity) and/or
* a physical health concern (where that concern may impact on the practitioner’s performance).
The PHP was initially established as a pilot with two years of funding from the Department of Health – £1.6M/year for two years. This was successful and PHP now has ongoing funding. The service is available to doctors and dentists in London and is based in a GP medical clinic. PHP has a multidisciplinary team including nurses, GP, psychiatrist, psychotherapist and a cognitive behavioural therapist. The clinical record is shared and the service provides very cost effective care. At the end of their third year PHP has treated approximately 510 patients, 2/3 with mental health issues and 1/3 with substance abuse issues and a very small number with a physical problem (e.g. deterioration in eye sight or cancer).
First contact is generally by telephone or email and is usually initiated by the patient (doctor or dentist) themselves. Initially PHP undertook widespread promotion of the service. PHP has approximately three to five new patients per week, with peaks at New Year and in September and with the new intakes of doctors in Spring and Autumn. Doctors often present when they are at points of transition in their career. Doctors are very driven and will hold together for a long time. PHP offers work placement support, family support and referral for financial advice. Massage is also used for relaxation and to facilitate doctors opening up and talking.
At initial contact the operations manager at PHP will talk through issues and make an appointment for the patient to see a clinician within about two days (always within a week). The service is open Monday to Friday including some evenings and Saturdays. The patient is required to complete a questionnaire and a registration form prior to seeing a clinician.
PHP has not seen many dentists. PHP services a population of 30,000 doctors and dentists of which approximately 26,000 are doctors. Those presenting use a mix of drugs including street drugs. Younger doctors are using “clubbing type drugs” now.
The initial consultation and assessment takes about two hours and is usually with a general practitioner or an addiction specialist nurse (prefer primary care level initially) but is sometimes with a psychiatrist.
Confidentiality is a big issue and a separate computer server and system and records are used. PHP has a memorandum of understanding with the General Medical Council (GMC) and the General Dental Council (GDC) which are the registration bodies for doctors and dentists respectively. PHP has a good working relationship with the GMC.
Community detoxification is used with a daily visit to the nurse, followed up by admission to Clouds House (a service of Action on Addiction) for about six weeks. Aftercare includes a case management program with PHP and monitoring with the results being sent to GMC. GMC has a supervising psychiatrist in addition to a treating psychiatrist.
Mental health presentations involve inpatient care and day programs with one of the three preferred providers (Clouds House, Maudsley and a private hospital in London) and involve multidisciplinary teams.
Assessment for risk is a multidisciplinary group team decision. For the first month each doctor or dentist under treatment is classified as red and are contacted at least weekly, then amber for two weeks and green for 56 days. All patients with bipolar disorder remain classified as red.
All patients are allocated a lead and a back-up clinician.
Funding limits expansion to pharmacists. The Royal College of Nursing provides nursing counselling services. However the service is willing to provide services to anyone requiring a confidential service. The service is limited to London. PHP as a specialist service can assist other organisations to develop similar services and is looking to expand. There was nothing similar to PHP elsewhere in the UK at the time of the visit.
The Practitioner Health Programme provides an excellent model of co-ordinated care for health professionals (doctors and dentists) that is funded by the UK government through the NHS. It would seem that this model has been developed as a pilot in response to the significant cost to the NHS of the ill health of doctors. In my opinion this type of service should be established for health professionals in Australia. However as the income of most Australian health professionals is from private fees (compared to the NHS where the majority of doctors are salaried) our Australian government has little incentive to fund such a service. However in the absence of government funding in Australia how can such services be funded? It would seem that the registration boards under AHPRA would have an interest in protecting the public from impaired practitioners but this does not necessarily translate into providing services for health professionals. It can even be said that such regulatory bodies may have a conflict of interest in assisting impaired health professionals when their duty is to protect the public. Certainly in this era of mandatory reporting very few health professionals would feel comfortable approaching their registration body for assistance. Thus this leaves the responsibility for provision of support services for health professions with the professions themselves.
The medical profession in Australia has a range of state based Doctors’ Health Advisory Services including the AMA Victoria Peer Support Service which provides peer support over the telephone. Victorian is the only state to have a state based health program for doctors; the Victorian Doctors Health Program (VDHP). The VDHP was previously funded by a levy on registration through the former Medical Practitioners Board of Victoria (but operated independently), however since national registration this funding is no longer available and with the assistance of interim funding from the Victorian State Government they are currently seeking an alternative funding mechanism. It is most likely that this funding will come from the medical profession.
My vision for the Pharmacists’ Support Service in Australia includes:
* National telephone and online support for pharmacists.
* Face-to-face support for pharmacists in all states of Australia.
* National Benevolent Fund for all Australian pharmacists.
* Referral service for pharmacists to mental health, drug and alcohol services in all states of Australia.
For the Pharmacists’ Support Service to further expand in Australia we need to secure adequate ongoing funding. The pharmacy profession can assist the Pharmacists’ Support Service to meet the needs of pharmacists throughout Australia through tax deductible donations. Anyone wishing to support the work of the Pharmacists’ Support Service by making a donation should direct their donation to Pharmacists’ Support Service c/o 381 Royal Pde, Parkville 3052. Donations can also be made over the phone using a credit card through the PSA (Victorian Branch) office on (03) 9389 4000 or by direct deposit into the Pharmacists’ Support Service bank account BSB 083155 and account number 481820199 (please include a name and contact details so that a receipt can be issued).
Pharmacists requiring assistance can contact the Pharmacists’ Support Service for anonymous and discreet support on 1300 244 910 between 8.00 am and 11.00 pm every day of the year.