Clinical Decision Making Skills for the Integrated Worker Essay

This assignment will define and analyse the get hold of for a chosen answer value inwardly the pathway of noetic substantiallyness, as well as evaluating the suggested emolument. Demonstrating how this service foundation inform and benefit incorporated practice, discussing the ways in which the agencys statutory obligations and responsibilities impact on both individual and group decision making. The chosen service improvement for this assignment is the introduction of a cordial wellness nurse into primary handle services, for example, a GP Surgery. Focusing on service users with psychogenic wellness issues in the connection and therefore in the c atomic number 18 of the local Primary veneration Trust (PCT). in that location is an obvious pauperism for movement towards better wellness and well-disposed direction for individuals with intellectual wellness unwellnessinesses in primary business organisation.No Health without psychogenic Health A Guide for General Practice ( subdivision of Health, DoH, 2012, online), sets out what General Practitioners (GPs) can do to improve psychical wellness and enhance rush and supporting offered to those with amiable wellness conditions in the confederation. This document also states that one in four GP consultations account for psychological health problems (DoH, 2012, pg8, online). Treatments for those with noetic health issues cost the NHS in the United Kingdom approximately 105 Billion per year (DoH, 2012, pg8, online). Primary dread plays a polar character in caring for those with psychic health illnesses in the community and in to the highest degree cases this falls into the responsibility of the local GP surgeries.Therefore GPs are ideally placed to identify signs of distress and those with risk factors for poor affable health (NHS Confederation, 2011, online). Primary do interpretrs, more specifically GPs are usually the primary point of call for an individual experiencing many form of psychological distress (DoH, 2012, pg13, online). It is essential there is early recognition and meanral to any specialist mental health services required, saving time, money and individual distress in the long-run.An area which remains problematic is the treatment of physical health feel for needs for those with mental health illnesses. Research continues tohighlight that the physical health of those with mental illnesses is frequently poor and nation with long-term physical conditions experience higher levels of mental health issues (Nash, 2010, pg2). It is ironic that a great deal of the research carried out is with individuals that are currently in contact with either health or social care services (Nash, 2010, pg2). This issue could be tackled indoors primary care services, as GPs eespecially can treat the whole mortal linking quite a than separating physical and mental health (Knapp, 2011, pg3, online).Professionals within the primary care sector could experienc e problems when trying to identify their role in relation to meeting the health needs of those with mental health issues, as well as offering interventions and support to those identified as high risk of developing mental health problems, such as, individuals with long-tem physical conditions (Nash, 2012, pg 10). Yamey (1999) found that a number of patients had actually been removed from GP registers at around point prior to aditing secondary mental health services. This causes suspicion that some mental health illnesses could be construed as a reason for world excluded from GP surgeries (Yamey, 1999). MIND (1996) carried out a survey which also showed that a oversized majority of individuals felt they had been treated unfairly by their GP due to their mental illness.This could be a consequence of lack of understanding and minimal study in the area of mental health in the primary care sector. Although this research is dated, it is relevant as Government white papers and initia tives currently being introduced are still recommending that more specialised training in mental health is required for schoolmasters throughout the primary care sector. Each of the initiatives head toward better interconnected deforms and lower hospital admissions due to deteriorating mental health by providing early access to services and early recognition of mental health issues in primary care. This highlights the importance of the chosen service improvement, non only for individuals with mental health issues but for those at risk of developing mental illness and the NHS as a whole.These recommendations are lay in No Health without psychological Health A Guide for General Practice (DoH, 2012, online), The NHS Outcomes Frame wee-wee 2012/13 (DoH, 2011, online), and numerous early(a)s. It remains clear that professionals within the primary care sector are notreceiving adequate training in mental health care. They do not have sufficient knowledge of mental health and many d o not possess the general skills required day to day when working with mental health service users (DoH, 2012, pg5, online). This is supported by close Medical Practice (2006),(General Medical Council, GMC) which sets out the principle guidance for GPs offers no mention of individuals with mental health issues, suggesting that this document is based solely on the general population and does not taking into account the differing needs of those with mental health issues.A computer program that was introduced in Wales in 2011 adds Mental Health First Aid Training to a large group of service rearrs including primary care. It teaches them to provide initial support to someone experiencing mental health problems, deal with a crisis situation or the first signs of someone developing mental ill health and scat people towards appropriate help (MIND 2011, online). This shows some progress towards increasing knowledge and awareness of mental health illnesses in a wider range of healthca re providers.There is say to show that in GP practices without mental health professionals, brief training for primary care providers have substantial benefits for patients who are mentally ill (Ross et al, 2001). This supports the need for specialist training and the chosen service improvement, as a mental health nurse in a GP operating theatre would be specially trained to work with individuals with mental health illnesses and would have an awareness of the difficulties service users may face when accessing services.There are many aspects that could present a bar to mental health service users when accessing services. Communication difficulties can cause problems for individuals with mental health issues as they may not feel able to make themselves unsounded by healthcare professionals. They may suffer anxiety or panic disorders making it more difficult to communicate effectively. One of the most problematic areas in mental health and for those suffering mental health illness es is stigma (Nash, 2010, pg10). Discrimination is not just confined to the general population as research has shown that healthcare professionals can hold stereotypical views towards their clients (Nash, 2010, pg10). This could prevent individuals from seek help and support for both physical and mental health problems.Some service userswith mental health issues may have previously experienced some form of dissimilitude and had a negative experience when accessing primary care services. For example, experiences involving reception staff with knotty attitudes or individuals being made to believe the physical symptoms they are experiencing are part of their mental illness (Nash, 2012, pg12). This shows that individuals with mental health issues suffer from in par and discrimination regarding their healthcare reinforcing the need for improved access to primary care services. Previous negative experiences can cause individuals to hero-worship returning causing them to avoid seeking help for a physical condition. get aheadmore, if a person believes the may be mentally ill, they may avoid accessing any kind of support as they fear being labelled and discriminated against due to the stigma attached to having a mental health illness. Employing a mental health nurse in a GP surgery can bring services closer to eliminating barriers between primary care services and mental health, modify the healthcare of those in the general community suffering from some sort of mental illness.The proposed service improvement supports the need for reducing health inequalities and barriers to those with mental health issues wishing to access services. Barriers to healthcare specifically Primary care services can include communication difficulties, lack of understanding from both service user and professional perspective and there may be inadequate support available to mental health service users when accessing their local GP surgeries. GPs may lack the interpersonal skills required to manage some symptoms of mental illnesses. Such as inappropriate sexualised behaviour that can be expressed during psychotic episode (Norman & Ryrie, 2009, pg711).The professional may feel un golden and abash when examining an individual and unaware of how best to deal with this situation.Symptoms of mental illnesses can themselves often prevent individuals with a barrier to accessing services. An individual suffering depression will most likely lack motivation and volition (Norman & Ryrie, 2009, pg429) making it extremely difficult for them to self-refer or even care slightly their mental and/or physical health. Further supporting the need for the chosen service improvement as families, carers and friends of such individuals could support them in attending their local GP surgery enabling them to access specialist help at an initial stage of their illness. It may be necessary for a mental health nurse in a GPsurgery to be advertised as individuals cannot access services if they are unaware they exist. Booklets and leaflets could be made available to raise awareness of mental health issues and the support available to individuals, their friends and families informing the community that specialist help is available first hand within their local GP surgery.An other(a) barrier that is present in the provision of care by primary services and GP surgeries is the use of the medical model. The health professionals within a GP surgery engage a medical approach when treating their patients. This aims to treat the medical illness and reduce the total number or patients attending the surgery. Although this is necessary within a GP surgery setting there remains a need to consider social factors when adopting the medical approach (Barbour, 1995, pg2). There are limitations when using the medical model, moreover as it can prevent healthcare professionals from treating patients individually in a person centred manner, treating only the obvious medical condition (Barbou r, 1995, pg10). This could have a proficient detrimental effect on an individuals health and well-being, resulting in increased appointments with their GP causing more distress and prolonging their suffering.This in turn increases the likelihood of an individual requiring crisis intervention and ultimately costs the NHS more in the long-run (Norman & Ryrie, 2009, pg172). The Royal College of General Practitioners (RCPG) Roadmap (2007) document supports the need for adopting a model in which health and social care needs are considered in general practice (RCPG, 2007, pg1). There has been confusion around which professionals role it is to provide physical health care to the mental health population for many years (Phelan et al, 2001). Government constitution recognises the importance in considering physical health care needs of those with mental health illnesses in both primary and secondary care settings (Newell & Gournay, 2009, pg 322).General practice has transformed significantl y over the past decade and current government policy is aiming to improve access to and the choice of services available to patients, expanding the role of a GP and improve quality of care overall (Gregory, 2009, Pg3, online). Government policy is utilise in the structure of clinical judicature and is important inhighlighting improvements that are required in a wide range of services within the NHS including mental health and primary care (NHS Direct, 2011, pg12, online). Clinical organization is described as a system in which NHS organisations are accountable for continuously improving the quality of their services (Scally & Donaldson, 1998, online). It is a framework that retards professionals continuously develop and improve the quality of the services they provide. Clinical organisation involves the research and development, risk management, promotion of openness, learning and training for staff, clinical effectiveness and clinical auditing of services within the NHS.It is extremely important that high quality care is provided in healthcare and clinical governance ensures professionals are individually accountable for the quality of care they provide (South Tees NHS Trust, 2013, online). Buetow and Roland (1999, pg184, online) suggest there is a barrier between managerial, organisational and clinical approaches to quality of care denoting that the aim of clinical governance is to bridge the apparent gap by allowing all professionals within an organisation involvement and freedom from the domination of managerialism (Buetow & Roland, 1999, pg189, online). Although this suggests the aim is to promote equality throughout organisations when it comes to quality of care. There remains a need for one individual or a small group of people to accept the role and responsibility and puzzle the clinical governance lead or team (Buetow & Roland, 1999, pg189, online).In a primary care setting such as a GP surgery this would entail being responsible for a large n umber of professionals who may have had little reason to communicate with each other previously. This could cause conflict within an organisations culture if the quality of care professionals provide is questioned. The discussion section of Health (2008) stated the current system of NHS primary care does not ensure a consistent level of safety and represents insufficient quality across the country.Resulting in GPs becoming required to hold a indorse which is reviewed and renewed every five years and to register with the Care Quality Commission (CQC) from 2011 (GMC, 2009, online). This ensures up to date practice, competence and assures the provision of quality care. Clinical governance enables services to show how targets have been met within their organisation and how they meet the needs of their patients, supporting the decisions made by professionals and teams within the organisation (Buetow &Roland, 1999, pg187, online).All organisations have what is know as an organisational or agency culture. Agency culture is made up of numerous aspects including, values and beliefs, language and communication, policies and procedures and rituals and routines within an organisation. Each organisation has a wide-ranging culture with a diverse set of beliefs and norms. It could be a result of these norms that staff members may not be willing to embrace change or regaining time to attend extra training for specialist service user groups such as the mental health population. It may reckon that the service gains results and targets are met therefore may not want to change anything. This places organisations at risk of neglecting areas for improvement. shifts within agency culture can become a thought-provoking process especially when there is disruption to traditional working routines (NHS Direct, 2011, online). Staff within a GP surgery may have been led by one individual or a small group of the same GPs for a long period of time and may feel the services they provid e are sufficient.Newly qualified members of staff joining the workforce may feel their opinions and ideas are underappreciated or not even considered because the routines and procedures are already in place. An unwillingness to accept change could have detrimental effects on the mental health service user population. This is reflected in recommendations by government policy. No Health without Mental Health (DoH, 2012, online), Making it Happen (DoH, 2001, online) and Call to wreakion (DoH, 2011, online) each suggest recommendations for primary care services to develop the services provided to those with mental health illnesses and stress the importance of mental health promotion within primary care. The culture within a GP surgery may appear to be more superior to other NHS services as most GP surgeries are independently contracted and are not direct employees of the NHS (Gregory, 2009, pg 8, online). This enables them to provide enhanced services such as extended opening hours and specific services for those with learning difficulties (Gregory, 2009, pg 8, online).The above are components of General Medical Services (GMS) whereas in-person Medical Services (PMS) enable GP surgeries to cater for the specific needs of the local population (Gregory, 2009, pg 5, online). This could include drug and alcohol services or mental health services if there were a large number of the localcommunity presenting to their GP surgery with these issues. The cultures within each of these types of GP surgeries could be different completely. In a PMS GPs could have received specialist training in the areas large numbers of patients require support, resulting in patients feeling more cute and respected as well as staff members. GP surgeries can be seen as providing a gateway to specialist care (Gregory, 2009, pg8, online). This view could be difficult to change. However by offering a wider range of services and treatment options, the gap between primary and secondary services a s well as both an individuals health and social care needs can be filled (Gregory, 2009, pg8, online).This service improvement aims to improve the health and social care needs of individuals with mental health illnesses in the community. However, not only are there barriers in place that service users must overmaster to access primary care services there remains a lack of collaborative working between health and social care services. This has consequences on the service user and other professionals involved in their care denying the individual of adequate holistic care. Professionals from different areas such as nursing and social work may be bound by differing statutory obligations which can affect their decision making and the care they provide. Starting with the professional body they are registered with as a professional such as the Royal College of Nursing (RCN) or the Health and Care Professions Council (HCPC), these give professionals a value base they must work from and dev elop continuously.Legislation also has a huge impact on a professionals decision making, for example the Mental Health Act (MHA, 2007). The law determines what a professional can and cannot do in a crisis situation. If a mental health nurse was based in a GP surgery they will have specialist training and awareness of the limits of their role determined by the MHA (2007), such as a patient being sectioned. They will be aware of who to contact if a patient is causing danger to themselves or others and need more suitable mental health care. If the mental health nurse was an Approved Mental Health Practitioner they could even have a role in detaining patients especially if a GP within the surgery was specially trained under the MHA (2007). This would save a lot of time and distress to individuals in crisis, members of the public and staff members.There are other perceptible difference between health and social care and thestandards of care provided. Social work would traditionally take a service-led approach to care whereas nursing has become more person-centred and individualised (SCIE, 2010, online). By using a person-centred approach the specific health and social care needs of patients with mental health issues are intercommunicate (Hall et al, 2010, pg178). The service user is the centre of focus and care and support is planned around their specific needs. This is essential when caring for an individual with mental health issues as each condition, symptom and experience is different. Enabling an individual to be fully involved in every aspect of their care and make fully aware decisions regarding their treatment and social options.Continuity of care and positive therapeutic relationships are essential when making an individual feel valued and at ease, allowing them to feel comfortable and more willing to engage with professionals. An individual with mental health issues may feel anxious about attending their GP surgery and may need motivation or encouragem ent to do so. Having a therapeutic relationship with a particular professional within that surgery could reduce a persons anxiety levels (Kettles et al, 2002, pg64). The chosen service improvement would be useful for this purpose as a mental health nurse based within a GP surgery could build positive relationships with patients enabling them to develop trust and engage with services and professionals.The mental health nurse would also take into account both the health and social care needs of the patients, decreasing the GPs workload and saving the practice money in the long run. They would also ensure the needs of the individual are fully met as satisfactorily as possible within primary care services or id required could refer them to the most suitable services available to them for their condition and needs. Whether they be health or social care needs. However this service improvement would only be successful with the cooperation and collaborationism from GPs within the surgery. Joint decision making would be required as well an equal union between GP and mental health nurse.The Personalisation Agenda (Social Care Institute for Excellence, 2010, online) (SCIE) emphasises the need for integrated working, and the need for involvement from a wide range of services, such as health, social care, housing, merchant vessels and leisure, to ensure service users receive aholistic, consistent and continuous care package (SCIE, 2010, online). The service user is put first rather than the service. This creates a person-centred rather than a service-led approach. A priority of the Health and Social Care Bill (2011) is improving integration within services. The Bill strives to provide better partnership, integration and collaboration across the government and all NHS services (DoH, 2011, pg1, online). There is exhibit to suggest that integrating health and social care services saves a substantial hail of money (DoH, 2011, pg2, online). However in the current governmen t climate there are financial pressures which may cause a barrier to effective integrated working (DoH, 2011, pg1, online). All aspects of the patient journey could benefit from effective integrated working resulting in a positive experience and all needs being met.The suggested service improvement of a mental health nurse in a GP surgery supports integration as there would be a variety of professionals within one building making multi-disciplinary team meeting easier to arrange and joint decisions could be made quickly. However there are barriers to integrated working including the breakdown of communication between staff and different organisations having a detrimental effect on patients (Trevithick, 2009, pg123). However by working in partnership there is a reduced need for specialist services ultimately cutting costs and having a positive effect on many other aspects of an organisation. Such as boosting staff moral and enhancing patient experience (Erstroff, 2010).If barriers to integrated working can be overcome more adequate care can be provided overall. A dual qualified practitioner in a GP surgery would be ideal allowing both health and social care needs to be addressed working in partnership with outside agencies and with patients to gain the best results, without the need for two professionals. It has been stated that services need to come across early signs of individual distress by working closely with primary care (Norman & Ryrie, 2009, pg172-173). By integrating the skills required in a mental health nurse and a social worker a more holistic approach can be taken.The introduction of community care impacted on various professions including general practitioners, social workers and nurses (Malin et al, 1999, pg158). Nurses have become increasingly empowered over time and have become more involved in direction alongside GPs. Within General practice more of apurchase/provide relationship has been established (Malin et al, 1999, pg 159). GPs now hav e more power and control with funding and choice in the care they provide. However social workers may have felt deskilled by the purchase/provide divide (Malin et at, 1999, pg 159). The cultures of each professionals organisation could cause conflict among a team. Employing a dual qualified social worker and mental health nurse in a GP surgery would eliminate the chance of conflict. It would become the responsibility of the dual qualified worker and the GP to work in partnership. There is evidence to support the need for the chosen service improvement. Mental health services are improving and developing continuously despite government cuts to funding, reflected in No decisions about us without us (DoH, 2012, pg6, online).The document states that primary care services, specifically GPs who play a part in supporting those with mental health issues are not making a difference to the mental health of their local communities. This creates an opportunity for the role of a mental health nu rse to develop. The Care Services service Partnership (CSIP, 2006) suggest that nurses are capable of delivering services within primary care settings as they have acquired the specialist knowledge to do so (Norman & Ryrie, 2009, pg 651). There is a need to modernise, develop and integrate services, primary care being a target area. The suggested service improvement would be cost effective and would provide early community intervention also lowering individual and family distress. Integrated working is an essential component in developing health and social care services (Trevithick, 2009, pg109).In conclusion there remains a need for improvements in the health care provided by primary care services to those with mental health issues. Statistics show that primary care services are the first point of contact for many individuals developing a physical or psychiatric condition (DoH, 2012, pg 6, online). The introduction of a mental health nurse into a GP surgery promotes integrated pra ctice and modernises NHS services (DoH Factsheet, 2011, pg1, online), enhancing patient experience. There is evidence to show that this is an already effective role.Primary mental health workers have been introduced in Children and Adolescent Mental Health Teams (CAMHS) supporting colleagues in primary care services providing crisis intervention and contacts to specialist services (Norman & Ryrie,2009, pg543). Primary care mental health Graduates have also been implemented in parts of London providing a range of interventions (Norman & Ryrie, 2009, pg 457). The suggested service improvement of a mental health nurse in a GP surgery would benefit the mental health service user population enormously. If the National Service Framework mental health standards (NSF, 2012, online) are to be met mental health promotion within primary care must be a focus (Newell& Gournay, 2009, pg 257).ReferencesBarbour, A. (1995) Caring for Patients A Critique of the Medical Model. California, Sanford Univ ersity Press.Estroff, J. (2010) Effective teamwork Practical lessons from organisational research. London Blackwell Publishing.Hall, A. Wren, M & Kirby, S. (2010) Care planning in mental health Promoting recovery. Blackwell Publishing. Oxford.Kettles, A. Woods, P & Collins, M. (2002) Therapeutic interventions for forensic mental health nurses. London Jessica Kingsley Publications.Malin, N. Manthorpe, J, Race. 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