I like the invites sent out as they seem to strike the right balance.
The question of consent is interesting & one I have discussed with several
of the National organisations (MIND, Sainsbury Centre for Mental health etc)
in my role as a clinical advisor to PRIMIS.
There are several aspects to this, but the main thrust of the NSF was about
improving the delivery of health care to a disadvantaged & vulnerable group
of the population.
To this end, the construction of a register was about identifying those
persons who were felt to be at increased risk because of their mental health
problems. They will, in reality, already have a severe mental health
diagnosis recorded on a practice' IT system. To this end, they are already
on a register of sorts at the practice, and without overt consent. What the
construction of a SMI register does, is focus attention on those most at
risk within the practice, for the benefit of those at risk. We all know of
the vagaries of Mental Health Coding, so the construction of the register
per se, is to achieve the function above. As the register does not go
outside the practice (on *current* systems - NPfIT?), and the patient is
already "labelled", you do not have to obtain consent to put the patient on
the register.
Further, because of the paranoid nature of some patients' illnesses, they
would decline to go on any register. On the other hand, this does not mean
that they will necessarily agree to follow up in any particular year, and
thus one can take the stance that they should not be on the register.
So one approach is the following. Construct the register based on those
patients the practice believe should be on it. Then invite them for a
physical check up & exempt them if they decline in any one year. That way,
one continues to focus on the highest risk patients in subsequent years,
using the register as the main practice based tool. This was felt by those
organisations I discussed the NSF with, to be the most appropriate way. They
were mindful of the "consent" issue, but equally felt, that as the registers
were purely practice based, consent to be on the register was not needed (&
in some cases would be negatively viewed), but that broadly the process may
help the provision of care.
Best wishes & Nadolig Llawen
Dai
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