South London and Maudsley connecting up physical and mental health
Clinicians are drawing on the expertise of their counterparts at neighbouring acute hospitals to improve the physical wellbeing of people who use our services.
In the first year after joining the Consultant Connect scheme last June, clinicians at South London and Maudsley NHS Foundation Trust (SLaM) sought advice and guidance more than 650 times from colleagues at Guy’s, St Thomas’s, King’s College and Lewisham hospitals. They used phones, tablets and an app to bypass busy hospital switchboards and bleeping systems.
In two-thirds of cases the conversation with a specialist meant the SLaM clinician could treat their patient’s physical health condition without the need for a hospital referral or admission. That has proved particularly important during the Covid-19 pandemic.
People diagnosed with a serious mental illness have worse physical health than the general population, resulting in reduced life expectancy of between 15 and 20 years. Integrating mental and physical health services through Consultant Connect is one of several steps SLaM is taking with support from the Maudsley Charity and the King’s Health Partners Mind & Body Programme to address that inequality.
The Consultant Connect system is widely used across the NHS – GPs and doctors in other settings have instant access to preliminary advice from specialists, often avoiding the need for referrals or emergency admissions.
However, SLaM is the first mental health provider to use the system. Trust clinicians can contact hospital doctors in more than 80 specialties – with around half the calls made to specialists in diabetes, endocrinology or cardiology.
The Trust was preparing to trial the partnership on one ward early last year but accelerated and expanded the plans in response to the new challenges of the pandemic. The Trust introduced the scheme across its 40-plus wards and home treatment teams simultaneously after addressing technical and information issues.
Ray McGrath, lead nurse with SLaM’s Integrating our Mental and Physical Healthcare Systems Project, says:
“We spoke to around 200 staff and quickly established that one of their primary concerns was spending so much time seeking advice from partners in physical healthcare when an issue could be resolved in just minutes by connecting with colleagues more easily.
“Many of our patients have multiple complex physical health conditions on top of their mental ill health. Our clinicians need to be able to support conditions such as diabetes, cardiovascular disease and chronic kidney disease – as well as meeting patients’ mental health needs. Connecting our clinicians to specialists in the acute hospitals means they can get advice quickly and, potentially, avoid a hospital admission or referral.”
Mr McGrath continued:
“Acute hospital are difficult settings to care for patients in mental health crisis but, during the Covid19 pandemic the potential of Consultant Connect really began to shine through because it became really important to avoid unnecessary transfers between hospitals due to increased infection risk.”
He adds that patients are only transferred when absolutely necessary and when this does happen the referring clinician is now well informed about this being the right course of action.
The scheme is being evaluated in collaboration with colleagues from King’s College London. Data collection is allowing the Trust and its partners to refine the system. As around half the cardiology calls involve electrocardiograms (ECGs), it is hoped that SLaM clinicians could soon send pictures of patients’ ECGs to the cardiology specialist as part of the rapid consultation. The Trust is also assessing the possibility of establishing an internal specialist dietician and nutrition advice line.
The partnership already includes an advice line for staff to access advice from consultants around Covid vaccination.
Analysis of the calls seeking specialist advice is also shaping training for SLaM staff delivered by a Consultant physician from King’s College Hospital NHS Foundation Trust, boosting the confidence of SLaM clinicians in responding to their patients’ physical health issues.
The initiative is part of the Integrating our Mental and Physical Healthcare Systems (IMPHS) project, funded with a grant from the Maudsley Charity. The IMPHS project is also equipping ‘health champions’ with coaching skills to support SLaM’s community users to improve their physical health. The IMPHS project has also funded the pilot of a weekly virtual physical health clinic for inpatients which will now be extended across the Trust. The clinic provides virtual appointments with a consultant and an advanced clinical practitioner from King’s College Hospital NHS Foundation Trust via phone, email or video.
