The Lancashire wide all age Eating Disorders service provides a welcoming, supportive and collaborative service to people struggling with eating disorders and their families. We follow NICE guidance and keep up with research into treatment with EDs, as treatment outcome is poor to take an active stance in developing treatments and widening the therapeutic offer in the service. We currently offer: CBT, CAT, Integrative psychology, narrative therapy, psychodynamic psychotherapy, systemic family therapy, IPT, parent groups, motivational groups
Webpage for service (if available): https://www.lancashirecare.nhs.uk/eating-disorder-service
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
The Lancashire wide all age Eating Disorders service provides a welcoming, supportive and collaborative service to people struggling with eating disorders and their families. We follow NICE guidance and keep up with research into treatment with EDs, as treatment outcome is poor to take an active stance in developing treatments and widening the therapeutic offer in the service. We currently offer: CBT, CAT, Integrative psychology, narrative therapy, psychodynamic psychotherapy, systemic family therapy, IPT, parent groups, motivational groups. We have been an all age service just over a year now. We focus on developing specialist expertise across Lancashire. Staff work across patches to ensure the therapies above are on offer to all. The focus of this submission in on an innovation we made in the team over the last couple of years has been to recruit a GP as part of the new central service. Local GPs were struggling to meet the demands of physical health monitoring for our service users, and lacked the specialist knowledge as they may only see one or two cases per year. We decided that it would be beneficial to have our own GP to enable us to fully manage the physical health, alongside psychological health of our service users with eating disorders. Our GP is able to review bloods, review ECGs and see the service users face-to-face that the team are worried about. This has reduced risks around communication between our service and GPs, and sped up the process of monitoring for our service users.
What makes your service stand out from others?
Our service stands out from others as it is an all age service and an innovation we made in the team over the last couple of years has been to recruit a GP as part of the new central service. This has reduced risks around communication between our service and GPs, and sped up the process of monitoring for our service users. The GP has enhanced his knowledge in eating disorders over the past 3 years in the team and is able to liaise with medical wards, as well as home GPs as and when needed. He has helped to develop skills in the team and also strengthened our pathways around medical monitoring – we no longer have to wait for GPs to send us blood results and review them. Safety wise, this has had the biggest impact. Time wise, service users have much less of an impact on their lives in that our service is a one stop shop. They can see the GP and also another member of the team on the same day. Using specialist GP brings a really innovative way to bring together the disparity between MH and physical health under one umbrella. Additionally, there is a money saving benefit, as GPsi’s can cover both areas of health needs of our population. Nick is involved in GP training, nurse training and will also link to paediatricians and receives supervision from psychiatry. He is knowledgeable on other physical health issues and knows the links for other specialists throughout the Lancashire area. He supports the MDT formulation of a client’s psychological needs and enhances this with a really good physical health overview.
How do you ensure an effective, safe, compassionate and sustainable workforce?
We make sure we continually upskill our staff, offer training opportunities and continued professional development. We value CPD for clinical staff to enhance skills and ensure offering best possible interventions. We also regular participate in national research trials – there are 2 ongoing at the moment and our staff continually contribute to local research. We also have regular team away days and wellbeing sessions for staff and continually promote in house training and other opportunities for development. We have excellent staff retention as staff feel valued as a member of the team. We ensure all supervisions happen regularly, this is monitored to ensure that it meets targets with the Trust, lots of different therapy supervisions on offer. Staff have access to peer supervision groups for reflective practice and staff have to opportunity to raise concerns or issues. Our GP helps to train out staff on various issues such as physical health and other specialist subjects. He also supports other GP colleagues to be trained on various issues relating to the service and our staff regularly facilitate this. This is great for our staff development and for strengthening relationships with the GPs we work with.
Who is in your team?
Our team is made up of the following professional disciplines: GP Psychiatry Psychology Paediatrics Nursing Dietitian Family therapy Psychotherapy Administration Support staff
How do you work with the wider system?
We work as part of a multi-disciplinary team – not just internally but with wider partners and stakeholders too. We work with GPs on a daily basis to keep people well and our in-house GP offers support and guidance on cases and liaises with other GP colleagues. He also provides is daily support on physical health issues and this helps to get people the right help quicker. We link in regularly with our internal community physical health and mental health teams and have offered support and guidance to other CCGs across country around our experiences of all. We are also part of the Eating Disorders Community of Practice North West for under 18s and this allows to share good practice, learn from other teams and network to continually improve the services we offer. We have resources in all of our teams of other support organisations and ensure that we offer that holistic support to our patients by signposting them to the right place at the right time. We attend events, keep up to date with services in the voluntary, community and faith sector to ensure our patients are getting the right information.
Do you use co-production approaches?
We have regular participation groups and support groups that our patients can access. When we set up our Saturday clinic we ensured that we co-produced that offer with young people as it was to enable them to access the service. They offered us feedback and we ensured that that the offer was fit for their needs. We engage with our service users regularly to help us design materials and make improvements to our website. Our GP offer was introduced as a result of feedback that we needed to amend our offer to ensure patients were getting medical input from the service and that they were able get the right help without having multiple appointments at an already difficult time for them. Involving professionals, people who use our services and their families and carers is crucial for us as a process as our people are at the heart of everything we do and we are committed to ensuring we keep co-producing to improve our services.
Do you share your work with others? If so, please tell us how.
We have shared our works of good practice regularly with internal teams and with the Eating Disorders Community of Practice which a regional body. We promote the work we do and in particular our GP project has been talked about at various GP forums, Quality Improvement conferences and service redesign meetings as a successful improvement which has led to better outcomes.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The Outcomes of this particular GP project are more qualitative and lead to better outcomes for our patients and some of these include; • Physical Health monitoring • Providing Specialist knowledge • Referral into the service and stepping patients down improved and happens quicker • Reduced Risk • Local GPs are confident referring into the service • Excellent feedback received on a regular basis about the medical input
Has your service been evaluated (by peer or academic review)?
How will you ensure that your service continues to deliver good mental health care?
We are monitored regularly through our performance targets and work with commissioners to ensure the service is right for the people of Lancashire. The GP project has been very successful this integration within the team will continue as the outcomes have been significant for our teams and for the people receiving the service. Our local commissioners are very pleased with the outcomes – this project has been running for 18 months and due to the success there is a commitment that will continue.
What aspects of your service would you share with people who want to learn from you?
Prior to having a GP with our team, we encountered challenges in making sure our GP colleagues were able to complete regular physical assessments. Often relationships were difficult and this would have an impact on the patient as often they would be waiting and not receive a timely service. Since we have introduced the GP within out team, this has improved considerably as our GP is able to complete baseline physical assessments regularly, support us with providing psychological support and instil confidence in our other GPs. We have shared the success of this GP project through the Community of Practice forums and through our Networks regionally. We have shared positive stories from our patients and our GP and other professional colleagues about the impact this has made as an example of good practice.
The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.
How many people do you see?
The referrals into the service can vary year on year. Our GP see high risk patients and does baseline review assessments for all the people he sees. We promote our service via our website and through our internal and external professional, community and voluntary networks.
How do people access the service?
Our referral sources are: Direct Referral to CYP EDS from professionals, Self referral and School referral. Self- referral is promoted so that people who feel like they need the service can access it directly without having to go and see someone. The service is promoted through website and through our networks and internal and external stakeholders. We also have evening clinics, early morning appointments, Saturday morning groups and respond to the need of the people who are needing the service.
How long do people wait to start receiving care?
Our target is to get young people into treatment within 4 weeks of the referral. This is in line with local access standards.
How do you ensure you provide timely access?
Through our robust screening and triage process, we ensure that people who need the service are in treatment within 4 weeks. Using specialist GP brings a really innovative way to bring together the disparity between MH and physical health under one umbrella. Additionally, there is a money saving benefit, as GPsi’s can cover both areas of health needs of our population. He supports the MDT formulation of a client’s psychological needs and enhances this with a really good physical health overview.
What inequalities have you identified regarding access to, and receipt and experience of, mental health care?
We work with our learning disability teams daily as our teams are co-located and we provide consultancy and shared working with these teams and all other teams that we and our patients come into contact with. We ensure that all our information is accessible and that we access interpreters if needed. We work with schools to identify issues and work with the Gender Identity service to support people who may be going through gender issues. Our staff attend regular training and we access training to ensure we identify any gaps in our service provision.
What is your service doing to address and advance equality?
As explained above, we work with many stakeholders to ensure our service is available and accessible to all the people who may need it.
How do you identify the needs of a person using the service (such as their physical, psychological and social needs)?
How do you meet the needs of people using the service and how could you improve on this?
Having a GP in our team has reduced risks around communication between our service and GPs, and sped up the process of monitoring for our service users. This means that patients can be stepped down earlier if needed or stepped up. It also means that our pathways around medical monitoring are strengthened – we no longer have to wait for GPs to send us blood results and review them. Safety wise, this has had the biggest impact. Time wise, service users have much less of an impact on their lives in that our service is a one stop shop. They can see the GP and also another member of the team on the same day. Using specialist GP brings a really innovative way to bring together the disparity between MH and physical health under one umbrella. He supports the MDT formulation of a client’s psychological needs and enhances this with a really good physical health overview.
What support do you offer families and carers? (where family/carers are not the service users)
We have local carers support groups that our families can access and we signpost to these on a regular basis. We have regular conversations with our carers about the care we are providing and provide them with any resources they may need. We also have a website that we signpost people to for information.
Brief description of population (e.g. urban, age, socioeconomic status):
Across Lancashire for all ages
Size of population and localities covered:
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
Commissioned by the 8 CCGs of Lancashire – Morecambe Bay, Blackpool, Fylde & Wyre, Chorley and South Ribble, Central, West Lancahsire, East Lancashire and Blackburn with Darwen
Provided by (e.g. name of NHS trust) or your organisation: *
Lancashire Care NHS Foundation Trust
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