NHS England in Astonishing U-turn

NHSE suddenly announced on 12^th April that it had decided to cut the funding for secondary care practitioners accessing NHS Practitioner Health with immediate effect. This decision shocked the medical and dental profession, particularly those who have used the service or have recommended the service to colleagues. 

Questions have been raised about how NHSE reached this decision without any evidence of a risk assessment of the impact of the loss of service.

NHS Practitioner Health was launched in 2008.  It provides a confidential, self-referral, free service that is open to registered doctors and dentists in England who are struggling with mental health and dependence issues, making it particularly beneficial for senior practitioners. It is entirely independent of Trusts and NHSE.

Over the years Practitioner Health has treated 32000 doctors and dentists. The service costs £11m pa which is a drop in the ocean for NHSE. It is a successful service. 75% of practitioners accessing the service who are not able to work when they first contact Practitioner Health, return to work after treatment.

Following the announcement, a social media campaign was started by Dr Rachel Clarke, the author of the TV series ‘Breathtaking’ to force a review of the decision. Using X (formerly known as Twitter), Dr Clarke organised a letter with over 14,000 signatures to be sent to NHS England’s Chief Executive Amanda Pritchard and Victoria Atkins the Secretary of State for Health calling for decision to be reversed. Surprisingly, on Monday 15^th April, NHSE announced a reversal of the decision, re-instating the service, pending a review.

‘Breathtaking’ was based on Rachel Clarke’s book describing the experience of being a hospital doctor during the pandemic. Jed Mercurio made it into a TV drama series shown on ITV earlier this year, with the theme of the mental health of the doctors being a key plot line.

The consequence of the 12^th April announcement was that secondary care practitioners would no longer be able to access Practitioner Health as new patients, instead they would have to be treated by their Trust’s Occupational Health service and their health and wellbeing service as well as their GP practice. Given the well-publicised challenges that have faced secondary care practitioners in all disciplines in recent years, during and after the pandemic this seemed like a curious and shortsighted decision. The savings would be minuscule. In the grand tradition of bad decisions, the Chief Strategy Officer of NHSE Chris Hopson, was sent out on social media to double down on the decision over the weekend. Instead of reassuring people, this approach only inflamed the situation. Doctors took to ‘X’ to share their thoughts. Examples were offered of how poor the replacement services are for those in urgent need of help. One doctor described seeking help following the suicide of her husband, only to spend the consultation being asked about how her ankle was….it had been injured several years earlier. Others described an acute request for an appointment being dealt with by being offered an appointment six weeks later.

It is not widely known that Occupational Health teams have a dual duty of care, one, to the patient in front of them and the second to the employing Trust. This means that Occupational Health teams within Trusts cannot be truly independent for the patient, and the patient cannot be confident that the details of their consultation will remain confidential. The Occupational Health team has a duty to advise the Trust of patient safety concerns which means that a visit to Occupational Health in a Trust may result in the patient being referred to the Trust’s capability procedures, and potentially onwards to the GDC/GMC.

It not surprising that the independence of Practitioner Health is treasured by its patients and its ambassadors and supporters.  Practitioner Health’s mental health team is skilled in managing healthcare practitioners with mental health and dependence problems. The insights they have result in focussed and practical care from one healthcare practitioner to another.

Although most of the defence organisations have independent counselling services for members that are struggling with stress and anxiety, none can offer the type of mental health care that Practitioner Health provides, so a feature of the social media campaign over the weekend from a dental perspective was the input from the three traditional defence organisations as well as the BDA.

This episode has brought the work of NHS Practitioner Health to the front of mind and gives an opportunity to remind dentists in England that they can self-refer for advice and support if they are struggling with mental health issues. It is particularly useful to know about this service when it has become so difficult to gain access to local GP services. Practitioner Health has a network of team members around England so that they can offer both face-to-face and remote consultations. Its important to remember that the service is not an acute psychiatric service nor is it an occupational health service. The team is used to supporting practitioners that are subject to regulatory or disciplinary proceedings.

Dear @DHSCgovuk & @NHSEngland,

Please find attached a letter for @VictoriaAtkins & @amandapritchard signed by over 15,000 NHS members of staff.

We protest in the strongest terms your abrupt decision to cut the mental health support that @NHSPracHealth provides to staff. 1/3 pic.twitter.com/ERNVRJsi9b

— Dr Rachel Clarke (@doctor_oxford) April 15, 2024

Resources for dentists:-

• Here is a link so that colleagues can access the NHS Practitioner Health:- Accessing The Service (practitionerhealth.nhs.uk)
• Remember that the dental profession has its own telephone helpline:- Confidental | Emotional First Aid for Dentists (confidental-helpline.org)  
• Mental health support can be accessed here too Dentists' Health Support Trust | DHSTDentists' Health Support Trust (dentistshealthsupporttrust.org)