June 14, 2013
Post #264 Shortlink: http://wp.me/pKrrB-3dG
NHS England: Pilot of Enhanced GP Management of Patients with Medically Unexplained Symptoms
NHS Barnet Clinical Commissioning Group
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Note the use of the term “Bodily Distress Syndrome (BDS)” despite the lack of a body of evidence to support the validity, reliability, safety and clinical utility of the application of the BSD construct* in primary care.
Note also, the list of illnesses under the definition of “MUS”: Chronic Pain, Fibromyalgia, Somatic Anxiety/Depression, Irritable Bowel Syndrome (IBS), Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis (ME), Post-viral Fatigue Syndrome.
*For information on the Fink et al concept of “Bodily Distress Syndrome” see Part Two of Dx Revision Watch Post: ICD-11 Beta draft and BDD, Per Fink and Bodily Distress Syndrome
22 May 2013
PILOT OF ENHANCED GP MANAGEMENT OF PATIENTS WITH MEDICALLY UNEXPLAINED SYMPTOMS
NHS Barnet Clinical Commissioning Group
Medically Unexplained Symptoms
The term ‘medically unexplained symptoms (MUS)’ are physical symptoms that cannot be explained by organic pathology, which distress or impair the functioning of the patient. Patients often present with physical symptoms that cannot be explained even after thorough investigation. Other terms used to describe this patient group include: Functional Somatic Syndrome (FSS), Illness Distress Symptoms (IDS), Idiopathic Physical Symptoms (IPS), Bodily Distress Syndrome (BDS) and Medically Unexplained Physical Symptoms (MUPS).
Symptoms and Diagnosis
Shortness of Breath, palpitations
Fatigue, weakness, dizziness
Pain in the back, muscles, joints, extremity pain, chest pain, numbness
Stomach problems, loose bowels, gas/bloating, constipation, abdominal pain
Sleep disturbance, difficulty concentrating, restlessness, slow thoughts
Loss of appetite, nausea, lump in throat
Irritable Bowel Syndrome
Chronic Fatigue Syndrome
Post-viral Fatigue Syndrome
PROJECT AIMS AND OBJECTIVES
• To pilot a commissioner initiated, enhanced GP management service for patients with MUS in primary care. Refer to Figure 1 for details.
• The pilot will be carried out at selected Barnet GP practices (approximately 15) managing a minimum of 10 patients with MUS over 12 months.
• To identify patients with MUS using an electronic risk stratification tool the ‘Nottingham Tool’ with a review of the generated list at a multidisciplinary (MDT) GP practice meeting for the final patient selection.
• To enhance post-graduate GP training by providing education and training workshops and focused work group meetings on the management of MUS.
• The project will also test the assertion that identification and management of MUS would result in savings to commissioning budgets.
PROJECT OUTCOMES AND BENEFITS
There are several benefits that could be realised from implementing this project. These are as follows:-
• Improved outcomes for patients with MUS, better patient experience
• Improved quality of life
• Improved GP-Patient relationship
• Reduced GP secondary and tertiary referrals
• Reduced unnecessary GP and hospital investigations and prescribing of medicines
• Reduced GP appointments and out of hours appointments to A&E or GP
There is a high prevalence of patients with medically unexplained symptoms presenting to primary and secondary care services. Patients with MUS are high healthcare service users having a major impact to our local health economy and health outcomes. GPs are well placed to manage MUS patients as this patient group are 50% more likely to attend primary care. We believe that our proposed enhanced management of care by the GP will result in both market and non-market benefits. This proposal has gained approval from the NHS Barnet CCG Primary Care Strategy and Implementation Board, QIPP Board and the NCL Programme Board for the 2013/14 financial year…
In partnership with:
Plymouth Hospitals NHS Trust, Sentinel Healthcare Southwest CIC, Southwest Development Centre, September 2009
July 2009 – December 2010