Depression care

Helping patients with DEPRESSION to get the best from your doctor and the NHS

This web-site is about helping you to understand how you can get the best out of the practice and other resources. Terms highlighted in RED are key words that you should find in your own medical record. Staff are highlighted in BLUE. Equipment is highlighted in GREEN.

You may ask why?
The most recent patient survey has shown that patients want to be able to see the clinician sooner (ie less than 2 weeks) and on time (ie not have to wait an hour for a scheduled appointment) and feel that all their concerns have been met. It has been independently confirmed that the practice already offers more appointments than the average to its patients.

So how can we meet the demand?
Being prepared for the consultation greatly helps as does recognising the length of the appointment slot and helping the clinician to stay within the time limit.

You may ask how?
There are some simple steps that are essential for you to understand that will help you on your journey of discovery for your health and well-being:

1. What condition do you suffer with?
   Everybody can feel down or have a low mood sometimes. But clinical depression is defined by a range of symptoms that happen over a period of time, typically over 2 weeks. Often this may or may not be accompanied with anxiety. The context is also important as these symptoms may often occur in other circumstances too e.g. when someone has experienced a recent bereavement. Postnatal depression is a very specific condition. Please note: The advice here is not intended for patients who believe they have postnatal depression.
2. What does that condition mean?
   Here are some useful links for further information on depression and what it means to have depression:
   • NHS Choices:
   • Map of Medicine:
   • Patient.co.uk:
     
3. What help is available for you to use?
   This condition is primarily managed by the doctors. The doctors at the practice will ask you to answer a fairly simple set of questions known as Patient Health Questionnaire 9 or PHQ-9 every time you visit them so that they can assess your condition and how it is improving with treatment.
   
   We also have counsellors as well as Gateway workers in the practice who have special expertise with supporting you and helping you move forwards. They also have access to the “Beating the Blues campaign” as well as computerised Cognitive Behavioural Therapy (FearFighter) if deemed appropriate.
   
   In the community there are a number of organisations including MIND, Samaritans, Age Concern for elderly people and Off the Record! for teenagers between 13 and 25 that you may also wish to consider.
   
   If you have financial worries that are causing you to become depressed then you may wish to consider contacting your bank manager or the Citizens Advice Bureau or perhaps the Housing Association if there are problems relating to where you live.
   
   Getting back into employment is often a key step in normalising your life so contacting your local job centre is also important. But for some people this may not be appropriate – so always consult your doctor first if you are not sure.
   
4. What does the condition mean for you?
   You need to be able to understand how and why you have been diagnosed with depression. Also you need to understand how your doctor plans to manage your depression – through talking therapies such as FearFighter as well as drug therapy and perhaps time off work. The PHQ-9 scores will help to show how you are responding to treatment and whether alternative plans need to be considered too. Often improving your lifestyle by improving your diet and increasing the amount of exercise you are able to do can also help. Finally, it is recognised that if you suffer with a long term condtion such as diabetes or ischaemic heart disease, you are more likely to suffer with depression. So it is important to look out for this and as your understanding of your health condition improves, so will your chances of lifting out of depression. This information should be in your GP-held record for you to see.
5. What needs to happen now and in the future?
   The typical patient with depression needs the following:
   
   • The PHQ-9 score at diagnosis
   • A general review of your physical health including your height, weight, blood pressure, smoking status and alcohol intake.
   • A discussion of what exacerbating factors and what relieving factors there may be and what support is in place to help you through this difficult time. Contact numbers for carers is useful in case we need to contact them. This is all part of the risk assessment that the doctor does when they see you.
   • Medication Review every 6 months usually with the doctor.
   • If you ever get strong feelings of wishing to harm yourself, you must seek help IMMEDIATELY and not think it can wait until the next time.
6. What can you do to help?
   As this is a new way of working, it is worth discussing this with the nurse to see how this can be done the first time you decide to take control.
   • Get access to your GP-held record.
     Without knowing what is in your records and what you need to do, it will be very hard to know what to do when and with who. This is an essential first step for anybody with any condition or who wants the best from the practice.
   • Check your blood pressure, height and weight with the healthcare assistant prior to your medication review with the doctor.
     You can arrange this at the same time as seeing the doctor
   • Bring your blood pressure readings and weight with you to show to the nurse or doctor if you have been checking them at home.
     Ideally these will be registered in NHS HealthSpace (www.healthspace.nhs.uk).
   • Look at the web page – pre-consultation care – and go through it prior to your review with the clinician.
     This can help us to understand your needs better and what you want out of the consultation. We like to see patients for medication reviews of patients with depression rather than conducting them over the telephone. It gives us more information than simply what is said.
7. How are we doing?
   The Quality Outcomes Framework was set up so that practices can look at how successful they are in delivering services to their practice population and also give an opportunity to see how we compare with others around the country. This data is readily available from here (www.qof.ic.nhs.uk/search.asp). Overall we got 996 points out of a maximum of 1000 last year indicating that we are a very high performing practice across the board which is reassuring for you and us. We achieved a maximum score in the Depression domain gaining all 33 points that were allocated for this. Although we performed spectacularly, there is still some room for improvement. For instance, when you are diagnosed with depression, you should fillout a questionnaire. This happens most of the time but not always. Perhaps you could check and if you have not filled it out then you could ask for one and hand it in later. It’s in your interests to get the best treatment and that’s why we want you to check you are getting it!
   
   

How can you help us do even better and help other patients too?
This is very important. In your journey of discovery about your health, you may come across odd things that do not make sense about the way the practice runs and you may have a better suggestion. Or you may come across something new that we have not considered that helps you even more. Tell us about it next time you see a clinician or preferably write it down and hand it in or send it as a comment to the Patient Participation Group (PPG) so that they can bring it up with the practice the next time we meet up. Even better, why don’t you join the PPG and become an active member. We are always on the look out for new members and new ideas.

You will still need to come at least twice a year to see the doctor but next time you might wish to discuss alternative treatments to what you have been offered to date and perhaps bring your PHQ-9 score that gives a better indication of how well or otherwise you are doing.

Most importantly, by working together and understanding each other’s needs better, we can help you to get the best out of the practice and the wider NHS.