The Spotlight Project – what a difference a year could make?

Building on the foundations laid by the Clinical Priority Programme in Perinatal Mental Health, the RCGP is running a 1-year Spotlight Project focused on GP team education in this small but very important part of our work in General Practice. Educational resources to help GPs and their colleagues improve their care of patients with Perinatal Mental Health problems have been developed as part of the Clinical Priority Programme but general awareness of these amongst Team GP is low.
Projects such as the Perinatal Mental Health Toolkit http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx have been well received but remain underutilised and illustrate the challenge of cascading key messages from the innovative work in the RCGP to front line GPs.

The role of the GP Champion has been seen to work well in other areas such as Dementia, Physical Activity and Cancer but could this be an effective model for improving Mental Health care within General Practice? The potential reach and impact of a GP Champion in Perinatal Mental Health is therefore well worth exploring when up to 1:5 women and 1:10 men affected by problems during this time and up to 50% of cases go undetected.
This pilot is supported by Wessex Clinical Network and covers a region of 2.8 million patients served by almost 300 practices and 3000 GPs. The team have ambitious objectives to reach at least 50% of practices and at least 50% of the population with this work and this will be through a variety of communications and teaching methods. These include small group teaching, larger audience talks, e learning modules and even a webinar in January.
The team is being led by Dr Carrie Ladd, RCGP Clinical Champion in Perinatal Mental Health, and 4 regional GP Champions were recruited to the team over the summer – Dr Maddy Ford, Dr David Hogan, Dr Penny Wilson and Dr Jenny Rattray. The project has received much interest from stakeholders in the Wessex region as well as several areas outside Wessex so watch this space for further news of developments in this exciting project!
For more information contact: car.ladd@doctors.org.uk

Parenting in 2 words: Swimming Lessons.

funny-kids-swim-lesIf I ever find myself in some sort of tv-quiz-show-tiebreaker-situation and I’m asked to sum up the trials & tribulations of parenting in two words, I have already prepared my series winning answer: Swimming Lessons.

Having spent most Saturday mornings “poolside” for the last 4 years, I see many moments that are mini metaphors for my less than perfect maternal efforts looking after two reluctant tadpoles the rest of the time. I think back a few years to when we told our nearest and dearest we were expecting and very soon there was a question on which nursery they are booked into. (Sorry? You DON’T have your unborn child on the waiting list already?) The pressure to be “ahead of the game” starts early and as far as I can see, continues for the next 18 yrs. This means quite a bunfight to get a place on the “pre-schoolers swimming class” as soon as your little one has mastered the art of not wetting themselves in public. A more successful approach would have been to wait till a time when their attention span is longer than an episode of Hey Duggee. But hey, hindsight is a wonderful thing.

After enrolment, comes the choice of superhero trunks/luminous colour hat/techno goggles/all-in-one dinosaur towelling robe that can be critical in peer approval stakes, the parent peer approval stakes that is. Anything too glitzy for them/ too old for them/ too teeny for them/ too suggestive you go on holiday ALL THE TIME for them – raises an eyebrow from the viewing gallery. Who’d have thought choosing a swimming costume could be quite so high risk? It’s like the uni-sex recyclable changing bag dilemma all over again.

As with parenting in general, we may recall swimming lessons of our childhood so fondy we hope to recreate similar memories for our children. Only we falsely remember the hilarious malarkey of learning to swim in our dads pyjamas, when actually it was all verruca socks, embarrassment and cold open changing rooms.

Every swimming level my oldest child progresses through feels like another chapter of “How to parent your child” nailed. Even it takes 2 years for each one. But each week my youngest spends more time outside the pool and it feels like we are back to chapter one of that book. Or even the prologue. How to continue to be the supportive & loving parent you want to be when your child’s poor behaviour is commanding all the attention of his class teacher, the adjacent class teacher, the lifeguard and all other parents in the viewing gallery, is the chapter I want to read next.

The speed at which you can sink from dizzy heights of parental pride to parental shame, is a phenomenon all parents know, isn’t it? When the nursery teacher tells you your son has managed to write his own name for the first time, you smile broadly. Only to find out he’d written on someone else’s arm in permanent marker pen so you have to fill out an accident form and apologise profusely to the child’s mother at pick up. But back to the poolside shenanigans. One minute, your little darling manages to blow bubbles fearlessly in the water only to then escape the teachers gaze for a moment and soon be seen testing the integrity of the fire exit the next.

We have tried all sorts – positive reinforcement, practice sessions, bribery, iPad restrictions, chocolate. Shamefully, I even uttered the words “I’ll give you 50p if you just get IN THE WATER” last week. Even the super expensive swimming hat that promised to be water resistant for life hasn’t helped. I think in fact it has made him water-repellent.

How I wish another episode of norovirus might save me from next weeks trial by swimming lesson. But these days will not last forever and one day I might even be nostalgic for them. Each jump, each dive, each width swum is a tiny step they take forward in their life, towards independence and a 500m badge. Best get my sewing machine down from the loft. And there’s another blog piece just waiting to be written. The Christmas Present of Eternal Optimism and Patchwork Quilts.

My thoughts on GP in #GP150w

As I log off, I look around my cluttered desk and consider what sort of a day I have had. In between the piles of prescriptions and medical certificates, the answer lies in the form of coffee stained crockery.

I started the day with all the optimism and cheer of “Christmas Reindeer”, but as the triage phone call list lengthened and appointments became more scarce, “I’ve been to Dubai”, the largest drinking receptacle available, came into its own.

With no time for coffee room chat over lunch owing to a home visit to a recently widowed patient, I began afternoon surgery thirsty. Not only for fluids, but for conversation with my colleagues.

Keeping up with the next two hours of clinical conundrums and patient expectations was made hugely easier by the kindness of my colleague bringing my afternoon brew, especially when it was wrapped in star spangled mug labelled “SuperDoc”.

UK Maternal Mental Health Matters Awareness Week

elephant mum and baby

In 2017, the Internet offers us an infinite amount of information at our fingertips which gives us the potential to find an answer to almost any question we have. Although digital navigation skills were not taught when I started at medical school in 1998, I have learnt these since and now see the Internet as an integral part of my doctor’s bag, squashed between the more familiar items of stethoscope and digital thermometer. For GPs to take full advantage of all the Internet can offer to their consultation skills, they must be able to find what they are looking for with speed and be sure that source is accurate, up to date and where relevant, evidence based.

A typical day in GP may mean I communicate with over 60 patients; telephone calls, face to face consultations, email queries and home visits. The diverse range and presentation of clinical conundrums is one of the aspects of my job I enjoy the most although it means having to retain the broadest possible knowledge base. The fast changing rules and recommendations for all areas of general practice are a constant challenge to keep up with. Even before a quick mid-surgery coffee break, I may have used “Dr.Google” several times already. To check the time until driving is recommended after keyhole surgery for gallbladder removal or what tropical diseases a patient might have picked up from an insect bite on the edge of a river in South Africa.

Mental Health is an area where the use of digital technology can be hugely helpful but it is also an area where there are vast amounts of material, tools and platforms available to choose from. Deciding which one is most suitable is a challenge for both those personally affected, and those professionals supporting them. The Royal College of GPs (RCGP) has developed both a Perinatal Mental Health Toolkit as well as a Mental Health Toolkit which are free, open access collections of hundreds of resources to help with this challenge.

With this week being Maternal Mental Health Awareness week, it is a great opportunity to share a link to the Perinatal Mental Health Toolkit with a wider audience. For professionals, there are many useful links to help with prescribing issues and to give advice to women to help them make an informed choice about the safest choice of medication in pregnancy and breastfeeding. There are several Top Tip style documents about communication, red flag signs to identify more serious illness as well as links to further learning. For patients, there are links to many information leaflets, third sector organisations, online peer support groups, digital media sources of help amongst many others.

http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx

During Maternal Mental Health Matters Awareness Week, why not have a look at the RCGP PMH Toolkit and see how digital technology can help you with Perinatal Mental Health issues whether personally affected, or professionally supporting those who are?

 

Dr Carrie Ladd

@LaddCar

maternalMHmatters – Maternal Mental Health Awareness Week

guinea-pigs-playing-ping-pong

Monday 1st May 2017

In 2017, the Internet offers us an infinite amount of information at our fingertips which gives us the potential to find an answer to almost any question we have. Although digital navigation skills were not taught when I started at medical school in 1998, I have learnt these since and now see the Internet as an integral part of my doctor’s bag, squashed between the more familiar items of stethoscope and digital thermometer. For GPs to take full advantage of all the Internet can offer to their consultation skills, they must be able to find what they are looking for with speed and be sure that source is accurate, up to date and where relevant, evidence based.

A typical day in GP may mean I communicate with over 60 patients; telephone calls, face to face consultations, email queries and home visits. The diverse range and presentation of clinical conundrums is one of the aspects of my job I enjoy the most although it means having to retain the broadest possible knowledge base. The fast changing rules and recommendations for all areas of general practice are a constant challenge to keep up with. Even before a quick mid-surgery coffee break, I may have used “Dr.Google” several times already. To check the time until driving is recommended after keyhole surgery for gallbladder removal or what tropical diseases a patient might have picked up from an insect bite on the edge of a river in South Africa.

Mental Health is an area where the use of digital technology can be hugely helpful but it is also an area where there are vast amounts of material, tools and platforms available to choose from. Deciding which one is most suitable is a challenge for both those personally affected, and those professionals supporting them. With this week being Maternal Mental Health Awareness week, it is a great opportunity to share a link to the RCGP Perinatal Mental Health Toolkit with a wider audience.

This is a free, open access collection of over 400 resources to help with this challenge in the important area of Perinatal Mental Health which affects up to 1:5 women and 1: 10 men during the period of pregnancy and the first year after birth. For professionals, there are many useful links to help with prescribing issues and to give advice to women to help them make an informed choice about the safest choice of medication in pregnancy and breastfeeding. There are several Top Tip style documents about communication, red flag signs to identify more serious illness as well as links to further learning. For patients, there are links to many useful information leaflets, many brilliant third sector organisations, online peer support groups and digital media sources of help amongst many others.

http://www.rcgp.org.uk/clinical-and-research/toolkits/perinatal-mental-health-toolkit.aspx

During Maternal Mental Health Matters Awareness Week, why not have a look at the RCGP PMH Toolkit and see how digital technology can help with Perinatal Mental Health issues whether you are personally affected, or professionally supporting those who are?

Dr Carrie Ladd, 1st May 2017

@LaddCar

What a difference an hour can make – Training GPs in Perinatal Mental Health

guinea-pigs-playing-ping-pong      Thursday 9th February 2017

Guinea Pigs playing Ping Pong. Not an image I have used in my power point presentations before but it certainly caught people’s attention. Let me explain…

Discussions have been happening for a while between the team at MABIM and Dr Judy Shakespeare (RCGP PMH Clinical Champion) and towards the end of last year things started to take shape. The idea was to develop a training package for GPs and other practice staff in Perinatal Mental Health (PMH) with a view to rolling out the package over the 4 locations in which they work – Blackpool, Gloucester and Haringey & Southend.

PMH has been a priority area for the RCGP for the last 3 years and so Judy and myself (RCGP PMH Clinical Fellow) set about designing the session with the first location being Southend, 7th February. We realised quickly that there was a limit to what we could fit into 1 hour and deciding what to leave out was the tricky part. However, we both passionately believe that by learning a little more, asking questions slightly differently and being aware of the issues around perinatal mental illness, GPs can hugely improve their practice. This will lead to picking up more cases earlier and prompt treatment sooner, meaning less women slip through the net. We know that most women prefer to disclose mental health symptoms to their GP therefore a GP education session really is a golden opportunity for us to encourage behaviour change leading to positive impact, even in just one hour.

The 10 minute slots we had split the session into merged together well and we covered many aspects of perinatal mental illness including discussing 3 case histories (antenatal depression, postpartum psychosis and perinatal OCD). Barriers to diagnoses were suggested on post it stickers and collated to form a helpful discussion of those relevant to women and those to professionals. It was interesting to see many of these matched the findings of the Falling Through The Gaps report.

We discussed the educational resources we have produced with the RCGP including the RCGP PMH Toolkit .  Also  the e-learning for health 5 module series and the NICE Top Tips summary document  http://www.rcgp.org.uk/clinical-and-research/toolkits/~/media/92F73D8AA0014DEAB37B55CDF7F2CE2B.ashx

As many readers will know I am fairly busy on Twitter in the mornings mostly thanks to an early rising pre-schooler. I have met several of my twitter contacts in person and was excited when I saw that this first MABIM session was going to be in Southend as I knew Laura (Clark) (@butterflymum83) and Sarah (Wood) (@LotusPetalPND) lived nearby. I was delighted when they agreed to come and talk to the group. I was also interested to hear more about how  they had set up their own peer support group in conjunction with the local PMH services.. The voices of women with lived experience can be incredibly powerful in improving health services and today was no exception. Laura and Sarah brought to life the slides, case histories and theory we had been presenting by their honest and moving stories. To see two women who had been so unwell a few years ago now having the confidence, passion and motivation to use their experience to help others was truly inspiring and I am sure the audience will remember their words for a long time.

And so to the guinea pigs…We explained at the start of the session that this was a pilot session and so we were trialling several learning methods and tools to see what worked for the audience. Feedback was encouraged via feedback forms and through the usual channels used by Southend CCG –an online survey I understand. Overall we think it went well with a good level of dialogue between speakers and audience, some great questions and a distinct lack of people leaving early/to go to the toilet/to fetch a drink. Perhaps a roving mic would have been helpful as the amp wire nearly caught me out a few times! As many will know, GPs often have a healthy competitive streak and so a quiz was introduced on each table with only eight questions which had one word answers – the first table to complete won a box of chocolates which seemed to be go down well, as did the image of guinea pigs playing pingpong!

@LaddCar

It can be difficult, being super-mum.

Before you raise your expertly plucked eyebrow, please understand I mean that ironically. No-one else expects me to be that toned, honed, all achieving gladiator of a woman, except me. I know I am far from alone in wanting to succeed, to exceed in fact, at everything I do. But despite an 8th day being on my Christmas wish list, last time I checked there were only 7 days in the week.

Successfully combining my role as a part-time NHS GP with being a full-time mum is a challenge and at times, feels harder than it should.  I never considered my life as a binary choice in terms of being a mother or having a career and made naive presumption that one day I would have both. Now that I am in that fortunate position, I have to fit a whole week of being 1400 people’s GP into just 3 days and a whole week of being 2 people’s mum into the rest of the time. It’s easy to feel that you are not giving either audience your full attention.

Much more helpful than a sense of under achievement for me and other GP parents is the notion of collaboration between these two roles.  My experience as a parent gives me valuable insight into the challenges of parenting and provides some practical information too which can make all the difference in the consulting room when building trust and rapport with parents. Understanding how frustrating it is when a 6month  breastfed baby refuses to take a bottle of milk or what devilish tricks or chocolate buttons are needed to persuade a stubborn toddler to take his penicillin helps you understand better the situation being discussed.

My medical knowledge as a GP is useful, of course, when my own children complain of various coughs and colds as I know how to safely manage most things myself. Also useful when reassuring my husband that our son’s momentous tantrums are well within the normal range for a 2-year-old. More importantly, I come home with a sense of gratitude. I hear a whole lot of life in my consultations, talking to up to 60 patients a day and it makes bedtime stories even more precious.

And so the two roles can enable each other to flourish – synergy if you like.

There are times during my working day, when the triage call list extends off my screen, the electronic prescription requests reach treble figures and my coffee is stone cold that I wonder, would I rather be a stay-at-home mum?  One advantage of working part-time, is that you never have too many consecutive days to consider this question. In fact, it was approximately 08.15am when I heard a crash and went into the lounge to find my youngest jumping on the coffee table, my tax return papers all over the floor and peeking out from under them – my laptop. I had my answer.

It is important to recognise the limits and the opportunities being a GP parent offers and learn to say yes when it matters, and more importantly – no when it doesn’t. You don’t need to join the PTA the first term your child starts school but for the same reasons, you don’t have to complete that extra dermatology qualification in your first few years of being a GP. By accepting occasional mediocrity in both your macaroni cheese and your medical knowledge of malaria, you give yourself a more realistic chance of success in finding that star-spangled Lycra fits you and your mum-tum.