We need to talk about GP appointments...

Hot on the heels of the mental health debate in the Welsh Assembly Government last week, Health & Social Services Minister Mark Drakeford took the opportunity yesterday to announce an additional £650,000 of funding for psychological therapies in Wales. How that will pan out on the ground to help out with waiting lists of up to 6 months in some areas has yet to be seen, but it is, nevertheless, a good news story.…

However, another news report, with a somewhat bleaker outlook, also caught my attention this week. Dr Paul Myers, chair of the Royal College of GPs, said that “the GP profession in Wales is at risk of crumbling in just five years unless greater investment is put into the system….” He added that issues with workforce and recruitment, as well as increasing workloads for GPs, meant morale was at rock bottom and some practices were facing closure.

Dr Myers warns that unless there is an increase in NHS funding for the profession from 7.8% to 11%, general practice in Wales could fall apart in a matter of years. This is not the first news story to highlight the crisis in the Welsh GP service… ITV reported in April this year that many GPs are reaching retirement age, and recruitment is proving challenging particularly in rural areas of Wales. Retired GP Roger Burns from Pembrokeshire drew attention to some of the issues, including this most recent story, on NHS Reality.

When people experiencing mental distress for the first time (or those close to them) contact us at our Information Service, one of the first options we suggest is that they make an appointment to see their GP. But these days that process might in itself provide a barrier to recovery.

When I have needed to see a GP in the last twelve months I have rung and been told that there is a two week wait. Last week a PAVO colleague was informed that it would take a month to see the GP of her choice! So, when I know I really need to see a GP quickly I follow a regular routine, especially if it is a Friday or Monday. I make sure I am up and by the phone at 8.30am when the surgery opens. And then I start ringing. Usually the line is engaged. Everyone else is probably doing the same! We are, in effect, competing to win the very few appointments – usually cancellations – that might still be available on that day. I might press redial fifty times before I eventually get through…but whether I will be lucky enough to get an appointment that day is another matter…

I can’t help wondering to myself… but what if the other people who are trying to get through to the surgery switchboard have a really serious problem they need to talk to their GP about… maybe they are older… or have a young child… who decides who should be seen first? No one! It is a complete lottery!

When we do get an appointment there is more waiting involved… This business of looking after our health and wellbeing is truly a waiting game.  Last time I sat for 45 minutes after the time my appointment was scheduled, in a GP surgery absolutely bursting at the seams, before I saw a GP. And once I’m in there for my snatched five minute consulation I almost feel guilty for taking time out of the busy GP’s life… S/he has to see about 59 other patients that day after all…

And if you are emotionally distressed, where will just five minutes with a GP get you? Especially if you are told that the waiting time for psychological therapies could be many, many months?

So, really I’m not at all surprised to read Dr Myers’ comments… or to note that Dr Charlotte Jones, chair of the British Medical Association’s Welsh General Practitioners Committee, warned last month that general practice in Wales was in “intensive care”.

According to the Royal College of GPs - due to the sheer volume of GP workloads, in this year alone, patients will have to wait longer than a week to see their GP on at least 27 million occasions.

In another online article this week, it was reported that nurses at the Royal College of Nurses’ annual conference suggested that: "patients should be charged up to £10 a time to see their GP to deter "time-wasters" and those with minor symptoms". (On the same webpage is a link to a video called “Self diagnose illness with new apps”…..)

Would you be willing to pay £10 to see a GP if it cut down on appointment waiting times?

There is a petition – calling to save general practice Wales – on the Royal College of GPs’ website here.

Mental Health (Wales) Measure – how is it measuring up?

Late on Tuesday afternoon this week I tuned in to the live debate on Improving mental health and wellbeing in the Welsh Assembly’s debating chamber in the Senedd. (You can watch archive video of the debate here 2hr 52min in or read the plenary notes here, at 16.21). In the debate, Assembly Minister Janet Finch-Saunders commented:

Today’s debate on mental health looks at an issue that can affect any member of our society, from the very wealthy to those living in poverty, male or female, young or old. Our mental health is not static and it certainly does not discriminate. Those who have been well all of their lives can suddenly find that a turn of events or a change in circumstances can affect their own mental health wellbeing. It can show itself in a variety of manners, from depression or mild anxiety to post-traumatic stress disorder and/or severe psychotic problems. Minister, I have to say that probably one of the hardest jobs for me as an Assembly Member has been when someone has presented and I find them, quite literally, crying out for help, for support, and yet feeling, you know, that nothing can be done.

Health & Social Services Minister Mark Drakeford introduced the motion, which proposed that the National Assembly for Wales notes Welsh Government action to improve mental health and wellbeing in Wales. He said:

Here in Wales……. change is happening, and it is making a significant and positive difference for those whose lives are affected by mental health problems. The basis for all this is, of course, the Mental Health (Wales) Measure 2010, the Assembly’s groundbreaking legislation.

The Mental Health Measure, which became law in 2010, introduced legislation around mental health for people in Wales which is quite different to that in the rest of the UK. We highlighted 10 interesting facts about the Mental Health Measure in October 2012 and provided further information, including videos, on our website here.

But is it working?

That question is being asked both formally and informally in Powys (and all around Wales) right now. People who have been in contact with services, those close to them, and those providing the services, are being surveyed, are meeting in focus groups, and sometimes contacting politicians such as Assembly Minister Kirsty Williams to represent their views in the Senedd debates (including this one, see 17.09 in, for an update on Brecon).

We thought we would write about elements of this review process on the blog over the coming months to highlight some of the issues that are coming to the fore.

Earlier this year, in April, the Welsh Government published the findings of a review of progress made so far against the aims of the Measure as part of an early Scoping Study carried out by Opinion Research Services (conducting Research to support the Duty to review the Mental Health (Wales) Measure 2010). With regard to Care and Treatment Plans (for people receiving secondary mental health services such as seeing a psychiatrist or community psychiatric nurse) the report highlighted that: Many consultees argued that the Measure persists with a medical model of care which in practice is neither recovery nor outcome focused and which takes little account of the social care needs of service users. To make the recovery process work as embodied in the Measure, there is a need to take positive risks with service users by allowing them to lead the process. However, this requires a complete change of culture.

The Royal College of Psychiatrists had already conducted an independent review looking at the impact of the Measure from the psychiatrists’ point of view, publishing the results of their findings in late 2013. 48.5% of respondents (out of 121 – a 20% response rate for the survey overall) said they noticed a negative change in the care given to patients since the Measure was implemented. They pointed out issues including: increased workload but reduced patient care, potential risks of patients slipping through the net, early discharge of patients, and concerns regarding legal implications of increased bureaucracy.

My colleague Freda Lacey has recently been involved in some local focus group sessions in Newtown and Brecon where people have looked at their experience of changes in provision of mental health services since the Measure became law. This research is again being carried out by Opinion Research Services with Freda’s support and a short report on the focus groups will be available soon.

In the meantime, have you been in contact with mental health services? Perhaps you have attended a GP surgery and tried to access counselling via your Local Primary Mental Health Support Services (LPMHSS)? Or you may have been referred to see a Community Psychiatric Nurse who works as part of a Community Mental Health Team? Do you understand what the Measure means to you, and have you any feedback about the way it’s working? Let us know what you think by commenting below.

Play and mental health: mucky is good!

My colleague, Yvonne Owen-Newns, is the Children & Young People’s Facilitator at PAVO.  As part of her role she focuses on play, lucky person! I am seriously envious! Is she out playing Please Mr Crocodile, Freeze Tag or What’s the time Mr Wolf? while I’m busy emailing everyone the June issue of our mental health ebulletin….? I’m going to ask Laura if we can have play breaks in our team!

Anyway, Yvonne actually takes her work with play very seriously. She looks at the importance of play to children’s health and wellbeing, and works closely with a myriad of other organisations to ensure that the children of Powys have genuine opportunities to play. She recently went to Wrexham to check out some of the amazing children’s playgrounds they have developed there… they are more like the wild dens out in the woods that I recall playing in with such freedom and enthusiasm as a child… Lucky children of Wrexham!

Yvonne is helping to organise a conference on play on 25 June in Llanelwedd at the Royal Welsh Showground, and reading about the content of the day made me think more about the importance of play to children’s emotional wellbeing.

In 2012 Play Wales produced a report outlining the relevance of play to both physical and emotional wellbeing, with recommendations for the role of public health professionals in promoting play opportunities.

How playing contributes to children’s emotional well-being:

• Creating and encountering risky or uncertain play opportunities develops children’s resilience and adaptability – and can contribute to their confidence and self-esteem.
• Socialising with their friends on their own terms gives children opportunities to build emotional resilience, to have fun and to relax.
• Fantasy play allows for imagination and creativity, but it can also be a way of children making sense of and ‘working through’ difficult and distressing aspects of their lives. 

There is an increasing realisation of the importance of outdoor and what we might now think of as “risky” play…. How many parents would allow their youngsters to do as I did as a child – head off on my bike with my mates into a nearby wild woodland area with a large lake and build tree dens unsupervised? Instead young people sit in front of their electronic devices for hours on end… In the recently promoted Children’s Outdoor Charter of Rights there is a section on risk-taking which states: "Children have the right to learn from challenge, to experience failure as learning and to become confident and adventurous explorers of the environment. Safety concerns therefore need to be balanced with the child’s need to experiment and grow."

Journalist Rob Parr asked why fun is not taken more seriously in The importance of play in a recent Times Educational Supplement article. His piece outlines studies around play which “found that play-deprived children manifest responses on a scale ranging from unhappiness to aggression.” Several studies show clear links to criminality and reduced creativity, and Research Professor Peter Gray from Boston in the United States states: “what I think is the most dramatic effect of the play deficit: the increase in childhood depression and anxiety, and decrease in self-control…over the past half-century.”

And it seems play is, indeed, not just about having fun… it is a serious business, it’s about learning the skills for life, as outlined, again by Peter Gray, on Psychology Today in 2009. “A lively outdoor group game may be physical play, language play, exploratory play, constructive play, social play, and fantasy play all at once. Play, in all its forms combined, works to build us into fully functioning, effective human beings.” And children “playing strive to perform well, because performing well is an intrinsic goal of play, but they know that if they fail there will be no serious, real-world consequences, so they feel free to experiment, to take risks in ways that are crucial to learning."

                                                                                                                               

So… what plans are afoot in Powys to further develop play opportunities? Powys County Council has a statutory duty to “provide sufficient play opportunities” and to promote them. There is already a Powys Play Partnership which “aims to become a wide network of organisations and agencies (from statutory and voluntary sectors) who work with the communities in Powys and have an interest in developing more child led play for more families.” The partnership developed the Powys Play Pledge in 2013.

This latest conference will look at how agencies and groups can incorporate play into their services “using simple techniques and methods which will benefit the residents and visitors of Powys”. It will also address the subject of ‘Risk in Play’ – the myths, the issues, the barriers and the solutions.

Can you contribute and make a difference to play opportunities in Powys? And what do you think about the importance of play to children and young people’s emotional wellbeing?

Wednesday 25 June Play Conference: Managing Risk Playing More