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Practitioner Health Programme Success
Chief Medical Officer for England, (CMO) Sir Liam Donaldson, has hailed the just-published report on the first year of operation of the Department of Health-funded NHS Practitioner Health Programme (PHP) as a 'resounding success'

Chief Medical Officer for England, (CMO) Sir Liam Donaldson, has hailed the just-published report on the first year of operation of the Department of Health-funded NHS Practitioner Health Programme (PHP) as a 'resounding success'.

Sir Liam was speaking at a DoH press conference on January 29, along with PHP medical director, Dr Clare Gerada and Professor Alistair Scotland, who recently chaired a working-group looking at practitioner health.

The free, confidential PHP service was set up for dentists, doctors and other health professionals (HCPs) with health concerns - especially mental health problems and addiction - which could hinder their ability to function well at work and thus potentially harm patients.

The report - called Invisible Patients - emphasised that dentists work in unsupported, pressured environments for long hours, responsible for both staff and patients and financially accountable for their practices.

The number of dentists assessed during the PHP's first quarter was 17 per cent of the total, dropping to eight per cent by September 09. Greater awareness-raising was initiated as a result.

Scheme director Dr Clare Gerada said: "Dentists as a whole are at the far end of sickness treatment. So they can become very unwell when they present for treatment, with severe alcohol and depression problems. They work in a more isolated manner and have more pressure on them as they are the boss of the team. They are a more isolated and sicker group than doctors."

Sir Liam added: "Previously, doctors and dentists affected by physical or mental illness found it extremely difficult to access appropriate and confidential care. The PHP service offers specialised support to clinicians, allowing them to get the help they need so that we can ensure that they remain able to offer safe, high quality care to their patients.

"From the number of practitioner-patients accessing the PHP during its first year of operation, it is clear that there is a need for this highly specialised service.

"Never before have we had such a service that helps doctors and dentists in great need and protects patients."

The project, set up as a general practice with a referrals service, reported good outcomes with patient-practitioners demonstrating improvements in mental health and social functioning, as well as in the numbers returning to work and the reduction in potential risk to patients and the public. The report revealed that nearly 80 per cent of patient-practitioners were able to remain in or return to work after treatment.

Dr Gerada said it had been 'an enormous privilege to do this work'. She said: "Looking after sick health practitioners is an eye-opener as it is not easy to manage. We noticed how troubled and ill some were. We didnâ€™t realise the complexity of the problems.

"Dentists and doctors are one of the most unattended patient groups in health care. Their health needs can be as bad as those of homeless patients.

"Health practitioners 'don't get sick' - they erect self-inflicted barriers. The PHP project is a way to address their needs. Dentists and doctors also have to look after others which can do harm if they are untreated themselves. The scheme was set up to give practitioners the space to tell their story and get treatment."

Sir Liam said his 12 years as CMO heralded the success of a project he had long wished to see. He said: "One of the key proposals was the establishment of an environment for dentists, doctors and other HCPs with health problems to be seen. This has been very effective."

Prof Scotland added that suicidal thoughts were significantly higher in dentists, doctors, nurses and pharmacists who could find it hard to get help.
He said: "I'm keen that PHP-type services are made available to all health professionals across the country because, at over one million, NHS staff make up the biggest single group of patients for the NHS but they often struggle to access the same standard of services as others.

"We need three or four of these services across England, backed up by a panel of GPs and occupational physicians with extra training to treat health professionals."

Any medical or dental practitioner can use the service, where they have: a mental health or addiction concern at any level of severity and/or a physical health concern which may impact on the practitioner's performance. Practitioners might not access mainstream services because they do not want to admit ill-health, have concerns about confidentiality or choose to self-medicate.

In the PHP scheme, a GP heads up an integrated treatment-planning team. Problems presented during the programme - which has seen 184 patients in 12 months - included finance, housing, work and relationships. About two-thirds had health problems and one third addiction problems. More men tended to exhibit alcohol and substance abuse, while more women exhibited mental health problems on the whole. Mental health problems affected 114 patients - 62 per cent of the total - while addiction problems affected 67 patients - 36 per cent of the total. The remaining two per cent presented with physical health problems.

Dr Gerada said although dentists and doctors presented late with illness, they did very well when treated. Although other supportive services existed, like the Dentists Health Support Programme and British Doctors and Dentists Group, the PHP offered the most comprehensive assessment and treatment package.

She said: "Dentists and doctors tend to treat themselves and write prescriptions. Self-management can get them into trouble. They have a higher rate of depression and suicide and only tend to present for treatment when there is a crisis.

"Doctors and dentists like everyone else are only human and suffer from conditions and illnesses like the rest of us. We have found that the sooner they access the service when they are experiencing a health problem, the speedier their recovery will be."

Programmes are being developed to look at enhanced skills for GPs to treat other health professionals, with plans to extend the PHP to Avon and Newcastle.
For more information or to contact the PHP, ring 0203 049 4505.