Depression Template and Coding

Dr Helen DrewGP –Barton House Group Practice

Depression Lead – City and Hackney CCGhelendrew@nhs.net

Current Situation

• Across C+H we’re undercoding Depression by 1/3.

• An Audit shows that patients receiving antidepressants are not reliably being reviewed at least annually.

• Most at risk: other LTCs, multiple medications, or who are unable or unwilling to actively seek healthcare esp. for MH probs.

Why?• Multiple codes for Depression (over 200), unclear which ones

count (small proportion). No way to change codes in batches.

• Pop-up / target overload for physical conditions, MH conditions ?overlooked in some individuals.

• No system for knowing who has Depression and pro-actively managing them as a population like e.g. Hypertension / Diabetes / Asthma etc

• Patients less likely to actively seek review of MH conditions / don’t understand that ads could be stopped / unaware of other options.

Why change things? (coding)

• If not counted for QOF then official figures underestimate the scale of mental health problems in C+H > funding > services.

• What are the outcomes for this group?

• Limited code list makes it easier for you to audit the care of your own patients.

Why change things? (reviews)• There’s a group of patients who are slipping through the net:

– may be on antidepressants unnecessarily (depression resolved) but unaware/afraid to stop.

– Depression may still be severe and affecting their QOL but they are unaware of other options.

– This group may not be proactive and help-seeking, they may need prompting to come in.

– Effects on ability to manage LTCs, consultation frequency, MUS

– ?another diagnosis e.g. PD needing alternative treatment

Ideal World

• All patients receiving antidepressants to have QOF code considered.

• Review of condition and Ads at least annually for all.– Inc. severity and suicide risk, ?has it resolved – consider stopping / changing Ads, – ?have they had talking therapy– ?social prescribing if available / signpost services– ?diagnosis (??PD)

How?

Summary of Mental Health Services