Using Care and Treatment Reviews to focus on medicines, physical health and communication in Derbyshire

Case study summary

Derbyshire Transforming Care Partnership (TCP) have enhanced their care treatment reviews (CTRs) for people with a learning disability and/or autism to have an extra focus on medicines, physical health and making information accessible.

 

  • Derbyshire Transforming Care Partnership has enhanced their care treatment reviews (CTRs) for people with a learning disability and/or autism to have an extra focus on medicines, physical health and making information accessible.
  • They distribute forms ahead of each CTR asking for extra information on each of these three topics.
  • People come to the meeting prepared and they can be used to structure the conversation.

To help deliver the national Learning Disability programme, Derbyshire Transforming Care Partnership (TCP) have enhanced their care treatment reviews (CTRs) for people with a learning disability and/or autism to have an extra focus on medicines, physical health and making information accessible.

Senior Clinical Lead Rani Gosal works with an administrator who distributes three forms ahead of each CTR asking for extra information on each of these three topics.

Collecting this information in advance gives the meeting a real focus on that individual. “This means that people come to the meeting prepared and they can be used to structure the conversation,” says Rani.

Reviewing the person’s medication

The psychotropic medicines review form asks for details of current medication, rationale for prescription and the short and long term plans for reduction. The person completing it – usually the lead medic – also has to describe how the patient has been involved in these decisions, or alternatively whether there has been a best interest decision. It also includes NHS England’s algorithm for the review, reduction or stopping of psychotropic drugs in people with a learning disability.

Rani also uses this process as an opportunity to raise awareness of the national Stopping Over-Medication of People with a Learning Disability (STOMP) campaign to review and where appropriate reduce the person’s medication. For Rani this is an important message. “When people are admitted to hospital, very often psychotropic medicine use goes up and when they’re discharged they stay on it forever and a day,” she says.

The team are now trying to improve how they follow-up to check if that person’s medication has actually been reviewed. “If it’s not appropriate to review the person’s medication right away, I will recommend that the medication reduction plan should be passed to the receiving medic, usually their GP or community psychiatrist,” says Rani. “The CTRs can influence it but they don’t have an authority to make things happen.”

A focus on physical health

More recently, the team have added two further forms to the pre-CTR process. The physical health review form takes a holistic look at the person’s physical health. This asks whether the person has had an annual health check from their GP, whether they have been given a care plan as a result, and what physical health needs they might have such as constipation, pain and dental care.

Communicating with the person

The third form asks how the person would like to be communicated with. This includes environmental factors, such as the arrangement of the room, the best way to communicate and engage with that person and how they would like to receive information after the review – such as large print or verbally.

The form explores whether the person has consented to the CTR or whether a best interest decision has been made, what additional support needs they might have – such as an interpreter – and how family and carers have been involved.

To make the person being reviewed feel at ease Rani sends them a picture of herself and other members of the panel, so that the person can see in advance who they will be talking to.

“You cannot isolate a medicines review from physical health checks and communication. We cannot say that a patient’s fully engaged if we’ve not connected it to communication,” says Rani.

“To help the person stay well, the information has to be accessible for them. There’s no standard format because it’s personal to the individual so they can own it. It might also be complemented by an academically written one for the clinicians involved.”

A joint CTR team for people of all ages

Derbyshire have expanded their CTR process to also cover children and young people, so that CTRs for people of all ages are delivered as part of one joint team.

“Having one clinician to lead on all CTRs for children and young people creates consistency, makes follow up easier and gives local ownership. You are preventing crisis for children and young people and preventing admissions.”

These forms are now a core part of the CTR process in Derbyshire. “People are saying they’re finding it really useful,” says Rani. “One of the nurses in the trust told me that they’ve distributed it to all the nurses to say ‘you should use this.’ The consultants say it’s useful to them because it goes into their notes.”

Contact

Email: Rani.Gosal@hardwickccg.nhs.uk