I record on my GP system all diagnoses, including Mental Health related
ones. I will not remove any Read coded entry from the computer unless that
can be shown to be in error, as to do so may compromise patient care and
would certainly compromise the integrity of the patient record. Our
Registers are simply documented records of those Read coded entries. To
remove a patient from a Register would compromise their medical care, and
would be medicolegally unsupportable in a court of law if the patient
subsequently suffered harm. We have not consented anyone to or from any
Register, and have no intention of doing so, whether it be for Mental Health
or any other reason.
It is an important principle which many GPs around this area (and perhaps
farther afield) have not understood, that good medical care does not
necessarily equate to what nGMS tells us to do. If there is a conflict, we
must do what is appropriate for the best medical care of the patient, NOT
what nGMS tells us to do. A classic example is the management of COPD, which
has moved on significantly from what nGMS tells us to do. Another example is
nGMS telling that Asthma and COPD cannot co-exist (when experts say they
can). Removal of a patient from an Asthma register because nGMS tells us to,
then killing the patient with a severe asthma attack when you prescribed a
beta blocker would be indefensible.
Laurie Miles
-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Declan Fox
Sent: 21 December 2004 05:03 pm
To: [log in to unmask]
Subject: Re: [GP-UK] Mental Health
Thanks everyone, a good discussion, esp the detail on consent. What puzzles
me is at what stage I do what? Way I see it, I can (or could, if I was a
principal) produce a list of people with say schizophrenia and BPAD. I could
then decide which patients on that list seem in need of the sort of care
specified in the MH sections. I then invite those patients to sign up. At
that stage I am setting up the register, as specified in the documents.
THose who agree I code 9H8. Those who refuse I tag 9H7. Those who sign up
and later change their minds, I could change the tag to 9H7. But should I
use 9h9% (I think that's the one on the latest ruleset from the DH website)
to exception report?
If I start with x pts on the register and six months later find two have
withdrawn, does my denominator for percentage achievement of reviews go down
to x minus 2? Or stay at x and therefore that cuts down my chance of getting
90% achievement?
Anyone still awake?
Declan
***************************************************************************
This e-mail is confidential and privileged. If you are not the intended
recipient please accept our apologies; please do not disclose, copy or
distribute information in this e-mail or take any action in reliance on its
contents: to do so is strictly prohibited and may be unlawful. Please
inform us that this message has gone astray before deleting it. Thank you
for your co-operation.
***************************************************************************
|