Wednesday, 31 October 2007

Composition of the MDT

We've been having discussions, of late.

I thought it'd be pistols at dawn, but it's been the typical reasoned and affable banter that thankfully seems to pervade our neck of the woods. The issue has been, who should we have in the Community Mental Health Teams (CMHT) as they expand?

Now, everyone has an opinion, with most folk are suggesting some or more of their discipline. Apart from me, since although we're below Royal College recommendations for Consultant Psychiatrist numbers given our patient populations, in truth we've enough medical time to get the work done well so I can't really justify arguing for more.

Within each CMHT at the moment we've got 1.8 to 3 qualified nurses (all at band 6 or band 7 with many having CBT and non-medical prescribing training), 1 Support Time Recovery worker, 1 social worker, 0.5 occupational therapist, 0.2 OT technical instructor and 1 Consultant Psychiatrist (potentially with some Staff Grade and ST1 junior doctor support but in practice they're supranumerary and there just for training). One team has 0.2 of a pharmacist. We've access to a Nurse Consultant and to psychology who work more widely than just with the CMHTs. We've sessional input from a physiotherapist. We've service level agreements for dietetic and Speech Therapy input.

As activity rises and we've extra cash to invest in the community, what should we invest in?

The crunch is that every discipline can contribute something useful, there's no startling unmet need we have to address, instead we're rather looking at improving quality of care further (even though the Healthcare Commission again rated us as Excellent, yay!) and generating extra capacity for the future.

My gut instinct is that a Community Psychiatric Nurse (CPN, erm, or whatever they fashionably call themselves now) wins almost each and every time but the physios and OTs and pharmacists clearly want to expand their corner with psychology jumping up and down too. All add something useful but with rationed resources we need "the biggest bang for the buck" which principally is quality of care rather than purely volume of activity (since currently we've sufficient resources to see and sort all referrals, with no wait beyond 10 days).

In such a community team, would you have any views on what should be prioritised?


Calavera said...

0.2 of a pharmacist? Eh??

And where on earth is the clueless medical student in this group??

Spirit of 1976 said...

Medical students? I'd presume that, if they're anything like the nursing students, they'd be supernumerary.

The Shrink said...

These are Whole Time Equivalents, so 1.8 nurses is one nurse full time and one nurse working 4 days a week. 0.2 pharmacists is 20% of the working week, i.e. one day a week of a pharmacist.

Medical students
1) They're only here episodically so aren't a core part of the CMHT.
2) When they are here, they've so much stuff to fit in that Old Age Psychiatry gets just 6 hours in the whole placement . . . ho hum.
3) They're wholly supranumerary.
4) They're not part of the CMHT, they experience a flavour of in-patient and out-patient work too.

So much for them to do, so little time :-)

Calavera said...

Oh, ok, whole time equivalents - it makes much more sense now, I was a bit confused after reading your entry.

And the medical students bit was a joke!


Oh, and the first chapter is up, I'll have you know! Creative juices flowing nicely!