Feedback from doctors in training (DiT) through the Scottish Training Survey has highlighted poor trainee experience within Psychiatry at St. John's Hospital, Livingston. Research suggests that a healthy, happy and engaged workforce experiences lower levels of burnout and provides higher quality patient care. Our aim was to improve the experience of DiT working within the department and thereby improve patient care.

We utilised the Wellbeing, Conditions and Rota Evaluation (WeCaRE) framework. This is a user-friendly quality improvement (QI) framework designed to improve trainee experience. As part of WeCaRE, questionnaires and ‘what matters to you’ conversations were undertaken with ten DiT (foundation doctors, GP trainees, and core psychiatry trainees). From the issues raised, trainees were empowered to co-create change ideas and use Plan-Do-Study-Act (PDSA) cycles to address the issues. Finally, the questionnaire was repeated to complete the loop.

This approach created an open, listening environment with clear communication channels from trainees to consultants and management. This allowed us to identify themes for improvement. These included induction, education opportunities, clinical supervision and escalation policies.

In collaboration with trainees, three improvement teams were formed, each of which addressed an issue through a PDSA cycle. These were:

1. 1. Unclear referral pathway to Psychiatry resulting in inefficiency. The team co-created a flowchart identifying how to appropriately refer to Psychiatry, which has reduced the number of inappropriate bleeps.

2. 2. Unclear escalation policies and consultant cover. The trainees worked with the multidisciplinary team to generate a clear escalation pathway.

3. 3. Significant variation in content and documentation of clerking – the data collected helped drive change through the utilisation of an electronic clerking checklist.

During the five-month period those who experienced joy in work several times a week or more increased from 0%-86%. Those who always felt a valued member of the team increased from 29%- 86%. Those with overall job satisfaction increased from 0%-75%

DiT experience comprises more than rota compliance. It includes well-being, psychological support, professional development, teamship and more. This project has demonstrated considerable improvement in trainee experience through utilising the WeCaRE framework. This highlights the power of listening to, valuing and empowering trainees, whilst utilising data as a vehicle to drive change.

The Royal College of Psychiatrists has a specialist group called the Home Treatment Accreditation Scheme (HTAS) that has published a set of best practice recommendations for Home Treatment Crisis Response (HTCR) teams across the UK. As of yet, the HTCR team in the Southern Trust is not accredited. We decided to focus our project on antipsychotic monitoring. SMART aim: All patients (100%) within the HTCR team commenced on antipsychotics are receiving an appropriate level of blood and physical monitoring as recommended by guidelines and these are being documented correctly within 10 days of discharge.

PLAN

HTAS standards were reviewed alongside NICE guidelines on antipsychotic monitoring and a pro forma created. We collected baseline data on patients commenced on treatment dose antipsychotics in the HTCR team and assessed completion of bloods/ECGs/physical parameters and documentation.

DO

Our intervention for PSDA cycle 1 was to educate members of the multi- disciplinary team (MDT) via a presentation after the baseline data were analysed. We looked at correct documentation and how to fix common mistakes identified. We asked staff for their input on how to improve outcomes. Posters were printed off for guidance. We collected data after this intervention using the same pro forma.

STUDY

We analysed the results from PSDA cycle 1, comparing them to baseline results.

ACT

Our next step in PDSA cycle 2 would be to focus on continuing to improve poorer results such as prolactin levels and ECGs, with input from the MDT.

Baseline data showed between a 14% and 59% completion rate for various baseline bloods, 68–72% completion rate for heart rate (HR)/blood pressure (BP)/weight and a 36% completion rate for ECGs.

Following PDSA cycle 1, this improved to between a 55–100% completion rate for baseline bloods, a 91% completion rate for HR/BP/weight and a 64% completion rate for ECGs.

Baseline documentation of these parameters was correctly recorded between 9–68% of the time. This overall improved after PSDA cycle 1 to 18–73%.

Our intervention from PDSA cycle 1 improved completion of bloods, physical parameters and ECGs in the HTCR team. Documentation also improved in all domains.

Our next step in PDSA cycle 2 would be to focus on continuing to improve poorer results, looking at altering practicalities that may have affected those areas.

The National Institute for Health and Clinical Excellence (NICE) recommends that valid consent be sought for Electro Convulsive Therapy (ECT) in all instances where the individual has the capacity to provide or deny consent. Individuals should get comprehensive information on the general risks and potential advantages of ECT. When informed consent and decision-making are not possible, advance directives are fully considered, and the individual's advocate and caregiver are consulted. Additionally, patients should be informed that they can discontinue treatment at any moment. The purpose of this audit is to determine whether we are adhering to the NICE-recommended standards and recommendations.

This is a retrospective audit looking at case notes from the last 30 individuals who received ECT at University Hospital Wishaw. Individuals' electronic and paper light notes were analysed for data.

In informal patients, the aspects reviewed were:

1. 1. Documentation about adequate information given.

2. 2. Documentation of risks and benefits explained.

3. 3. Documentation of information given about withdrawing consent.

In Formal patients the aspects reviewed were:

1. 1. Number of cases who received urgent ECT under Mental Health Act (Scotland) with Record of notification on T4 form.

2. 2. Number of cases who received ECT under Mental Health Act (Scotland) with Certificate of the designated medical practitioner completing T3A form.

3. 3. Number of cases who regained capacity to consent for ECT during the course of treatment and had appropriate informed consent with Certificate of consent to treatment completed on T2 form.

4. 4. Did any of the cases have Advance Statement either for or against having ECT as a treatment option for them?

Observations of the data collected revealed that over 30% of cases lacked the documentation proposed by NICE standards. Only 25% of cases with complete documentation were informal patients, whereas the remaining 75% received ECT under the Mental Health Act Scotland.

Based on the observations, this audit establishes that our results do not meet generally accepted standards. The full results will be disseminated with appropriate recommendations to the prescribing Consultant Psychiatrists. This Audit process has also prompted us to redesign the ECT booklet to include the required documents in accordance with standards.

Supporting the mental health and well-being of psychiatrists impacts on the quality of patient care delivered, and crucially for trainees, on retention to the profession. Our aim was to survey core trainees to gauge their awareness, access and use of well-being resources.

111 core trainees in the West Midlands deanery were invited to complete an anonymous online survey during November 2020. Quantitative data were analysed using Google Forms and Microsoft Excel. Qualitative data were reviewed by all team members to identify relevant themes.

Only 14% of trainees felt well informed about the well-being resources available to them, 57% who attended local trust induction and 82% who attended deanery induction did not think nor recall if the topic had been covered. Despite this, trainees were aware of a range of resources, with the most known being BMA Wellbeing (58.3%), Psychiatrists’ Support Service (44.4%) and the local Peer Support Unit (30.6%). Just 14% of trainees reported using a well-being resource during their training.

Our results suggest that more work needs to be done at local trust and deanery level to make well-being a priority during induction and improve awareness of available resources. At least one trainee reported they would not seek help, due to concerns about the impact on their training progression, and stigma may be an under-reported barrier to accessing these resources.

We hope to use our results to improve signposting, and to collate a resource easily accessible and applicable to all trainees in the deanery.

The purpose of this quality improvement project was to improve the collection of outcomes in the Liaison Psychiatry (LP) department at the University College Hospital in London (UCLH). To achieve this, the Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) was used to gather data and evidence on clinical and other patient-related outcomes provided by the department. The FROM-LP was created to provide a consistent way to compare the quality and performance of Liaison Psychiatry services across the NHS. It was developed in 2015 and is based on the most widely used measurement frameworks for assessing quality and performance of services.

This project implemented the FROM-LP, using the Identify and Rate the Aim of the Contact (IRAC) tool and the Clinical Global Impression – Improvement scale (CGI-I) from September to November 2021 in the UCLH Liaison Psychiatry department. The PDSA (plan, do, study, and act) cycle was used to carry out this quality improvement project and the data were collected by two foundation year doctors.

The IRAC scale identified ten categories for the aim of contact by LP and a rating on whether the aim was fully achieved, partially achieved, or not achieved after patient contact. The CGI-I scale was used to rate whether a patient had improved upon discharge by LP. Data were also collected on the demographics of patients, the specialty teams that referred to LP, whether legal frameworks were used, and where patients were discharged to.

This project improved the collection of outcome data in the department from 0% to 98.16%, indicating an improvement of outcomes measurement by >98%. Other outcomes collected showed that patients were predominantly 21–30 years of age and referred to community mental health teams when discharged. The IRAC tool showed most patients were referred for assessment and diagnosis, with the majority of these aims marked as ‘fully achieved’. The CGI-I tool showed most patients were ‘much improved’ upon discharge.

The collection of these outcomes led to the creation of an outcomes measure form on the primary electronic software system (Carenotes) utilized by the department and local trust. This electronic form is now currently being used by the Liaison Psychiatry department at UCLH for their patients and makes this improvement sustainable while providing an easier means to continue collecting data. Ultimately, the collection of these outcomes will guide future changes and improvements for both the liaison psychiatry department and its patients.

To Improve the mental health of psychiatric inpatients and caregivers. To improve communication skills of postgraduate trainees.

Setting; Consented, monitoring and observation of communication skills during weekly, inpatient Psychoeducation sessions at Department of Psychiatry and Behavioural Sciences, JPMC, Karachi.

Data collection; Retrospective, communication skill records of postgraduate trainees from last 10 sessions from July 2019 to October, 2020. Based on a 13-items self-made questionnaire for communication skill. The overall communication skills of each postgraduate trainee were recorded from excellent, very good, good, improvement needed and lots of improvement needed category based on their performance.

Current practice showed that communication skills of 70% of postgraduate trainees were recorded as very good communication skill, 30% into excellent while none was noticed in another category.

: It was started soon after implementation of action plan from November, 2019 to January, 2020, with monitoring of weekly inpatient psychoeducation sessions similarly as done previously. The result of reaudit concluded significant improvement in individual and overall communication skill which were recorded as very good 50% and excellent 50% and none had other poorer categories of communications Skills.

Individual feedbacks to doctors immediately after the psychotherapy session according to the audit tool questionnaire to improve current communication skills.

The project aims to address the barriers faced by the acute hospital and the psychiatry department in the referral process for a psychiatric opinion, at Tameside General Hospital (TGH). The Care Quality Commission (CQC) undertook a review of how people's mental health needs were met in acute hospitals in 2017 and concluded that there were barriers to this, for multifactorial reasons. Examples included: acute hospital staff not feeling adequately prepared to treat mental health conditions and lack of mental health care services 24/7. The current referral process at TGH for the acute hospital doctors requesting a psychiatric opinion presents a challenge for the referring doctor and psychiatry doctor in receipt of the referral. Many at the acute hospital have found the process of referral unclear, and many in the psychiatric department have found that referrals seldom contain sufficient information to determine whether a psychiatric review is required and whether it needs to be prioritised.

To understand the specific difficulties encountered during the referral process, two questionnaires were created. One for TGH acute trust doctors and one for the psychiatry doctors, asking what the perceived barriers were and how these could be overcome. Data were collected between September and October 2021.

We obtained results from 17 acute trust doctors. The results revealed that most referring doctors found the referral process unclear. 100% agreed that they would benefit from guidance with the referral process e.g., a psychiatry specific referral form and/or a flow chart outlining the referral process. All responders wanted guidance around the roles and responsibilities of the psychiatric team in relation to the hospital setting.

We obtained results from 7 psychiatry doctors. Most were not satisfied with the referrals received. 100% would like to see a specific psychiatry referral form implemented in the acute hospital.

Key findings were: the referral process is unclear, acute trust doctors don't feel well enough equipped to manage mental health concerns, referrals don't contain sufficient patient information, and that the acute trust doctors don't know where to ask for help. The project reflected earlier CQC findings.

After discussion with the acute trust, our action plan includes creating a psychiatry-specific referral form, to be distributed together with a flow chart which directs acute trust doctors to the appropriate source for psychiatric opinions. We also aim to join departmental and junior doctor teachings regularly to distribute and educate on the process.

When a dependant opiate user seeks help from a substance misuse service, it is vital that some form of drug testing is conducted. This is commonly a urine test and will show the patient's drug use over recent days and is used as a basis to guide treatment. All patients should have a urine sample collected and tested on the same day as their initial appointment, however, we hypothesised that the switch to remote consultations would have reduced the number of urine tests conducted post-pandemic.

All the patients initially assessed by the substance misuse services for treatment of opiate addiction within the Sheffield Health and Social Care NHS Foundation Trust between 01/03/19 (1 year prior to the pandemic) and 01/03/21 (one year after the pandemic).

The resultant sample contained 1403 patients: 739 patients were referred to Sheffield substance misuse services prior to the start of the COVID-19 pandemic; 664 patients were referred to Sheffield substance misuse services during or after the start of the COVID-19 pandemic.

An algorithm was developed to allow interrogation of the electronic notes to record whether or not urine samples were taken and recorded in the relevant section of the patient's electronic record. This information was then transferred to an Excel spreadsheet.

The proportion of patients who had a urine test on the same day as their initial appointment was significantly higher in the year prior to the pandemic (79.0%) than the subsequent year (35.8%).

36% of the sample in the year subsequent to the pandemic had a urine test the day after their initial assessment, rather than on the same day. This delay in urine analysis can be attributed to the large number of initial appointments being conducted via telephone during the COVID-19 pandemic. This led to a delay in getting patients into clinic to give a urine sample. However, the remaining 64% of patients had no sample recorded in their notes in the appropriate proforma. Suggestions for improvement are to include a session on urinalysis as part of the weekly CPD to drive an improvement in this score back to pre-pandemic levels.

An existing transfer document at FVRH recognised that patients presenting to one specialty may require transfer to another depending on the changing needs of that patient. This document was not often used prior to the COVID-19 pandemic however demands for medical beds resulting in prompt return of patients to psychiatry highlighted the need to adhere to a safe transfer process. Unlike many psychiatry units where physically unwell patients are taken to ED, the MHU for Forth Valley is attached to the general hospital. This results in the view that physically unwell patients can be managed for longer before requiring transfer. Despite the proximity to the medical wards however, the unit is not equipped to manage physically deteriorating patients. This QI project aimed to improve communication between psychiatry and medical staff to improve patient safety.

Patients transferred during their admission between the MHU and medical or surgical wards in May 2020, or in Oct-Dec 2021 were identified from 5 psychiatry wards. Electronic and paper notes were checked for a transfer form for each stage of transfer. Medications prior to transfer, on return and changes during admission were cross checked on Hepma, ECS and care partner as well as within documentation from medicine/surgery.

In May 2020, no patients admitted from medical wards had a transfer form completed, 62.5% transferred to medicine and 57.1% returned from medical wards had forms. 20% of transfers had medication errors Identified. After making the transfer form electronic and following hospital wide changes to the Trakcare and Hepma systems, 27.8% of patients admitted from medical wards had forms, 75.9% transferred to medicine and 72% of those returned from medicine had forms. There were no further medication errors identified. During the timeframes studied only 1 patient was transferred due to COVID-19 but 29 transfers were carried out for other acute physical issues.

Changing the documentation process to make it as easy as possible for psychiatry juniors to document treatment plans for transferred patients improved continuity of care and decreased medication errors. This also ensured that patients were medically fit to return to psychiatry wards. The range of physical comorbidities that psychiatry trainees were expected to manage extends beyond caring for patients who contract COVID -19.

This project details the development of a Quality Improvement Project aiming to review and improve the management of behavioural and psychological symptoms of dementia (BPSD) on an old age psychiatry ward. BPSD refers to a constellation of non-cognitive symptoms and signs which arise in people with dementia, including disturbed perception, thought content, mood or behaviour. Examples include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and socially inappropriate behaviours. BPSD arise in 5/6 of people with dementia over the course of their illness and are associated with a deterioration in cognition and progression in dementia plus secondary harms such as falls and hospitalisation. Pyrland Two ward is a mixed gender specialised organic old age psychiatry inpatient unit serving the county of Somerset. Most patients have a diagnosis of dementia, are being cared for using either MHA or MCA legislation and exhibit one or more BPSD. There was no structured or formalised approach to the management of BPSD at inception.

1. 1. A point-in-time audit was conducted to produce baseline measurements of BPSD management on the ward, measured against NICE criteria.

2. 2. Plan-Do-Study-Act (PDSA) methodology was employed to incorporate incremental quality improvement interventions such as a ward-round checklist and staff education.

• • Baseline: (n = 14) 4/14 formally diagnosed with BPSD. 6/14 were prescribed antipsychotic medications, of which 1/6 fully met NICE standards. 2/14 had structured assessment tools used.

• • Results following introduction of improvement methods: (n = 8) 8/8 formally diagnosed with BPSD. 7/8 were prescribed antipsychotic medications, of which 4/7 fully met NICE standards. 7/8 had structured assessment tools used.

It was possible to see modest improvements in the ward-based management of BPSD using quality improvement methodology, including more favourable psychotropic prescribing. However, total patient numbers are small and further interventions, such as more PDSA cycles, may add value and encourage sustainability.

To improve timeliness of response and provide a committed plan to referrals received by the liaison service for older adults in Croydon University Hospital. Background: A quality improvement project in 2019 aimed to evaluate effectiveness of the liaison referral pathway. A questionnaire distributed to ward staff revealed some comments regarding ‘non-committal advice’ given by the liaison team.

Data were collected from 44 referrals received by the liaison team in June 2021. Variables included referral date, reason for referral, date of first assessment, plan documented in the notes, date and details of committed plan of action.

Multi-disciplinary team (MDT) discussion identified that more committed advice could be provided by the following, which were implemented at the start of September 2021.

1. 1. Huddle at the start of each day to triage and allocate referrals to appropriate members of MDT.

   1. a. Prompt discussions with senior members of the team following assessment to discuss diagnosis and management.

   2. b. Team teaching sessions were organised once a week, in the form of case-based discussions and role play, to improve communication skills, confidence and history-taking.

Of the 44 patients in June, average time taken from point of referral to assessment was 1.27 days and to providing a concrete plan 1.80 days.

Of the 48 patients between end of September and October, average time to assessment was 1.31 days and to providing a concrete plan 1.88 days.

In June, 75% of patients were seen on same day or within one day and 50% had a concrete plan within one day.

In September/October, 65% of patients were seen on same day or within one day and 52% had a concrete plan within one day.

These results highlight that assessments by older adult liaison service require detailed collateral history, investigations and MDT discussions.

While ‘obtain collateral history’ may not seem as committed a plan as prescribing medication, it remains an important part of old age psychiatry.

Given the rapid turnover of patients and increased pressures during the pandemic, it is the responsibility of the liaison team to communicate effectively with the wards and offer a timeline for completion of plan.

Following above changes, another questionnaire has been sent to request feedback on effectiveness of the liaison team.

Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) previously developed some methods of learning lessons following serious incidents. However, despite various systems available, frontline junior doctors were not regularly exposed to important learning opportunities. This potentially resulted in doctors not being aware of learning from serious incidents, and not feeling embedded within the organisation, with potential effects on their training experience. As we identified an unmet need within the Trust in learning lessons from serious incidents amongst junior doctors, we aimed to improve access and confidence in learning from serious incidents by starting a Quality Improvement project on this theme.

The current approach involved a comprehensive quarterly bulletin circulated by email to staff. An initial survey confirmed that this was not very effective in delivering learning lessons information to junior doctors.

Using a QI driver diagram, we identified potential areas for change. Selected change ideas were sequentially trialled including shortened email bulletins, supervision templates and remote learning lessons sessions. Initial PDSAs highlighted difficulties with communication via email, with many trainees failing to read/engage with this format.

The use of remote interactive learning sessions yielded positive results, with improvement in the confidence in learning from Serious incidents. We therefore continued to refine this method to wider groups.

During the COVID-19 pandemic we experienced multiple setbacks and created a timeline tosupport team morale, maintain team energy, visualise progress and motivate the team. We therefore managed to persevere and strengthened the group by recruiting members to the team and complete the project.

The team have been able to create a sustainable, effective and interactive short teaching session which has shown to be effective in engaging trainees in this vital area and help us meet our aim. This format further has the potential to be refined and implemented locally and nationally.

The main focus of this QIP was to improve the documentation of NEWS (National early warning scores) and subsequent escalation as appropriate in an Old Age Psychiatric Ward setting. This would in turn lead to improved Physical health outcomes, especially in the COVID-19 pandemic.

The NEWS chart is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, when patients present to, or are being monitored in hospital. This will ensure that patients who are deteriorating, or at risk of deteriorating, will have a timely initial assessment. This should supplement clinical judgement in assessing the patient's condition.

Early detection and escalation of deteriorating NEWS leads to improved patient outcomes and referral to the appropriate specialties, for subsequent management.

The initial phase of the QIP comprised of retrospective data collection surrounding the recognition and documentation of NEWS on an 18-bedded Old age Psychiatric ward. This period spanned the 2nd wave of the pandemic, from November- December.

Potential interventions were implemented in the form of raising NEWS awareness by educating nursing staff via teaching sessions, displaying posters all over the ward and nursing station. Team also reviewed all NEWS charts everyday during ward management rounds which served as a daily reminder for the staff measuring the observations.

NEWS of & greater than 3 was defined as the threshold for escalation.

Following change implementation, data were collected to capture the progress made over a month.

Analysis of data pre and post- interventions displayed a significant improvement in escalation of unwell patients from 26% to 60%.

Improved outcomes and early detection of potentially deteriorating patients, leading to early transfer of patients to an Acute Medical setting and better overall management.

Raised awareness and understanding of physical health management in Mental Health nurses.

The QIP was presented at the Trust QI Forum meeting and was met by and overwhelmingly positive response. In order to enhance NEWS recording an electronic format is now being adapted. There is also a consideration around providing regular NEWS teaching sessions to all inpatient staff across the trust.

Lambeth Home Treatment Team (LHTT) provides short-term intensive community psychiatric care to a diverse South London population. The high turnover of patients requires a streamlined process to review and discuss their progress. We aimed to discuss patients in more frequent, targeted and shorter meetings, and to improve continuity of medical care using a ‘named doctor’ system. We assessed impact on length of stay with LHTT, on staff time as well as on both patient and staff satisfaction.

The system of once-weekly day-long discussions of entire caseload was replaced by twice-weekly discussions of new and concerning patients only. The system of medical reviews was changed from ad hoc to MDT-agreed allocation to a specific doctor for the duration of LHTT stay.

Data on duration of treatment and caseload size were taken from regular LHTT statistical reports. Staff and patient questionnaires assessed impact on satisfaction and time spent in review discussions.

Qualitative reports of staff experience revealed that the new system was felt to provide better continuity of care, better time efficiency (less time spent learning about new patients) and improved learning experiences for doctors in training. Downsides included lack of ‘automatic second opinion’ when a patient was reviewed by a different doctor, felt to be mitigated by more frequent discussions in MDT reviews when needed.

Patient feedback showed no significant change was noted in overall experience of LHTT, although patients were more likely to feel involved in their care (88% said ‘definitely’ compared to 68% before the change).

Time spent discussing patients in clinical review meetings reduced from an average of 38.5 to 28.5 person-hours per week.

Average caseload reduced from 57 to 42. However, duration of treatment increased from 18.8 days to 20.4 days.

The reduction in staff time in reviews suggests that the system had been appropriately streamlined. While caseload size reduced, duration of stay slightly increased, so the new system was not found to have had a significant impact on objective measures of patient care.

Staff feedback was generally favourable, highlighting continuity of care and time efficiency. Patient feedback, while good both before and after our change, suggested a greater feeling of involvement in their care, possibly due to clearer communication and discussion of plan from the start of LHTT care.

The aim of this audit is to improve the monitoring of appropriate parameters in patients within the health board who are prescribed lithium, including lithium level, urea and electrolytes, thyroid function tests, calcium. It will also look at whether the same patients are appropriately referred to renal services.

A retrospective review of electronic patient records of 100% of the patients in Forth Valley Health Board who have collected a lithium prescription in the 6 months between March and August 2020.

69% of patients had a lithium level checked within the time period set out in the NICE guideline. Only 43% complied with the guideline on renal referral and 63% on calcium. Compliance with assessment of urea and electrolytes was better at 90%, and thyroid function tests at 85%.

Part of the decline in compliance with guidelines is likely in relation to the availability of face-to-face appointments during the pandemic, and reduction in outpatient appointments. As a result of this there is a planned further audit looking at how lithium monitoring is reviewed in outpatient psychiatry. This is intended to increase the involvement of psychiatry and the patient in ensuring appropriate monitoring is completed rather than relying solely on the GP.

People with severe mental health illnesses experience multiple adverse physical health outcomes, in part caused by difficulties accessing, engaging with health promoting behaviour, treatment and recovery strategies. As oral health is a major contributor to physical and mental wellbeing, obstacles to care, prevention, and therapy play an important role in the oral health of individuals with mental illnesses. Psychiatric medications are known to predispose to oral health pathologies, including sialorrhea and dental caries, electroconvulsive therapy (ECT) may rarely result in dental fractures, and substance misuse may contribute to poor dental health. Unsurprisingly, COVID-19 has been more acutely noticed by those already at risk of worse oral health outcomes, including people with mental health conditions.

We address the interplay between mental health and dental care, outline evidence behind the vital importance of collaborative working, and advocate for a joint approach between mental health and dental teams utilising harm reviews adapted to assessing the impact of delay dental care upon patients and families’ quality of life. As COVID-19 persists and winter pressures are experienced every year, these raise the question of what needs to be done to demonstrate the effects of poor oral health on patients with learning difficulties and mental illness.

With annual winter pressures in healthcare, many elective operations are postponed to allow capacity for increased demand. Dental general anaesthetics are amongst the first lists to be suspended, particularly since the arrival of COVID-19. During the first peak of the pandemic, limited access to personal protective equipment and concerns over viral transmission risked by aerosol generating procedures restricted the provision of community dental care to urgent cases, and dental general anaesthetics to life-threatening infections alone.These impacts were particularly acute for those with learning difficulties and mental illness, further exacerbated by social, geographical and financial inequalities. Waiting for patients to deteriorate to access dental care treatment seems in direct opposition to the mental health movement towards community and early management of mental illnesses.

Adapted harm reviews are a powerful tool for mental health and dental teams to demonstrate to hospital managers the multidimensional impact that poor oral health has and causing physical, behavioural and emotional deterioration on patients, families and supporting staff. Wider understanding of the dental needs of those with mental health conditions may foster research on the interplay between oral and psychological health, and remains vital to multidisciplinary, compassionate and holistic care.

Background: Demand for mental health support in primary care has increased during the COVID-19 pandemic. Furthermore, in an era of social distancing, the use of digital technology for communication has never been more important. It is therefore vital for mental health services to be easily accessible online, especially because 90% of people with mental health problems are cared for entirely within primary care, despite using <10% of mental health expenditure. Aims: 1. To evaluate the dissemination of resources and services to patients during initial mental health consultations. 2. To develop an easy to access and cost-effective resource containing details of both adult and child mental health services.

An anonymised survey was used to explore the dissemination of mental health resources at the Cotswold Medical Practice. The baseline data collection revealed a lack of easily accessible and shareable information, furthermore, a review of existing literature found that no resource existed containing details of both local and national services. Consequently, two virtual documents were created for adult and child mental health resources. These were added to an accuRx template to allow clinicians to easily send the resources to patients via text message. The resources were then re-evaluated 1–week and 5–weeks post–intervention.

Pre–intervention the average GP provided patients with 2.4 mental health resources and there was no standardisation of the information given. Post-intervention, over 25 resources were provided as both 6–page virtual documents contain a range of resources including: NHS services, local and national charity services, private services, self-help books and mobile apps.

The novel virtual resource produced is a cost-effective resource that helps improve the quality and quantity of information provided to patients about mental health services. The resource produced is compatible with virtual consultations and is sustainable for long term use.

The case for perinatal psychiatry as a subspecialty is strong. In the context of perinatal mental illness consideration has to be given to; differences in presentation, the need to account for mother and baby and the risks associated with inadequate treatment. Specialist services improve outcomes, reduce risks and save money. Despite the government's agenda of preventative healthcare, service provision has been inequitable across the UK. Here we detail the journey towards the development of new Community Perinatal Mental Health Services in Northern Ireland (NI).

In NI the first embers of a perinatal service were ignited by Dr Janine Lynch approximately 15 years ago when she established a small community perinatal team in Belfast Health and Social Care Trust (BHSCT). Her commitment and foresight regarding training inspired others, resulting in high levels of interest among trainees. From this grew a dedicated group of consultants committed to supporting service development across NI.

A multidisciplinary regional perinatal mental health forum was formed leading the development of a Northern Ireland Care Pathway in 2012. In partnership with women with lived experience, this forum led the bid for perinatal service development across the province.

Following years of campaigning the need for services was recognised in both the Bamford Review (2012) and RQIA Perinatal Review (2017). A commitment for funding for specialist teams, across all five health and social care trusts, was outlined in the Mental Health Action Plan in May 2020. Funding was finally approved in January 2021.

Significant work has gone into training to ensure there is a workforce ready to deliver services with focus on upskilling all professionals who deliver care to mums during the perinatal period. A competency framework has been developed to compliment this.

It is important to recognise the support and commitment of many members of the college Perinatal Faculty throughout this journey.

Community perinatal mental health services are at an exciting juncture in NI. Each of the trusts have made a commitment to the development of services under the co-ordination of the Public Health Agency. Several have progressed to recruitment of key staff with the aspiration for services to go live before the end of the year. There will be an overarching, integrated approach, co-ordinated by the new Regional Perinatal Network.

As newly recruited consultants we look forward to working in partnership to address this long-standing health inequality and improve the outcome for women and their babies in NI.

To establish a multidisciplinary diagnostic autism assessment clinic in primary healthcare so as to reduce lengthening waiting lists for specialist hospital based services, to increase efficiencies and improve the patient journey and clinical outcome. Timely diagnosis and early access to community based early intervention services optimizes outcomes.

Waiting time for specialist hospital based services were increasing in number. Analysis of the data revealed that 42.9% of all referrals were autism related and 75.5% of these referrals were for autism assessments in under six-year-olds. Bottlenecks were found in the current system. In collaboration with primary healthcare colleagues, a new pathway was developed with paediatricians, social workers and primary healthcare physicians completing a comprehensive initial assessment including conducting a Childhood Autism Rating Scale (CARS). Each of the three hospital based child psychiatrists then ran a diagnostic autism clinic in the primary healthcare setting once a month (so three clinics in total) to review the initial assessment, meet the child and family/carers and then to confirm the diagnosis and write a medical report for community based services as appropriate. Follow-up care remained in primary healthcare unless there was diagnostic uncertainty, significant behavioural difficulties or comorbidities requiring medication. The project timeline started with one and gradually increased to four diagnostic assessments in each clinic, that is, twelve per month.

57 diagnostic assessments were completed in first eight month period. Waiting times for diagnostic assessments in under six-year-olds were reduced from two to four months to only one to two weeks. Medical reports were issued within five working days. Under six-year-olds and their parents no longer had to attend busy, less child friendly hospital settings but rather were able to attend a purpose build early intervention centre within the primary healthcare setting.

In conclusion, this is an example of a successful quality improvement project embracing the efficiencies of integrated models of care between primary, secondary and tertiary services. Critical success factors included strong leadership support, compelling rationale and purpose, clear clinical pathways and clear roles and responsibilities. It was presented as part of the hospital wide quality meetings in November 2021.

Acute Inpatient Psychiatric Wards present the challenge of a high turnover of patients who have multiple physical health comorbidities that both contribute to patients’ overall morbidity and may exacerbate any mental illness. Furthermore, there are a number of physical health parameters which must be checked and monitored in the initiation of psychiatric treatments. It is therefore important that patients receive physical examination, blood tests and Electrocardiograms (ECGs). The busy environment of inpatient units and the acute presentation of patients, who often decline interventions, lack capacity or cannot communicate their physical health problems, mean these assessments are often missed when offered in an ad hoc fashion. This Quality Improvement Project looked at implementing a Physical Health Clinic to look at whether this structured environment would provide better coverage of these physical health assessments.

The number of physical examinations, blood tests and ECGs both offered but declined and successfully obtained was measured on an Inpatient Ward with 20 patients and 2 junior doctors over 2 weeks with assessments being offered in an ad hoc fashion. Following this, a structured clinic run by a doctor and nurse with three 20 minute appointments three times a week was implemented and the same data collected over 2 weeks. A paired T-test was used to evaluate the results.

There was a statistically significant increase in the number of successfully obtained physical examinations, bloods tests and ECGs when the Physical Health Clinic was implemented (Mean difference = 7.33, Two tailed P value = 0.0480,95% confidence interval 0.16–14.50, t = 4.4, df = 2, standard error of difference = 1.667). However, there was no difference between the number of bloods, examinations and ECGs offered but declined (Mean difference = 4.83, Two tailed P value = 0.2495, 95% confidence interval −3.92–8.58, t = 1.6059, df = 2, standard error of difference = 1.453).

The clinic led to a statistically significant increase in the number of examinations, blood tests and ECGs successfully obtained. The reasons for this are hypothesized that having a structured clinic prepares the patient to have a physical assessment and ensures their availability, provides motivation for staff and increases the efficiency of assessments with appropriate teamwork between doctors and nurses. Issues with the Clinic are limited availability of junior doctor and nursing staff and emergencies disrupting the functioning of the clinic. Implementing the clinic on a wider scale is required to assess its effectiveness.