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Sector and functional models of consultant care: in-patient satisfaction with psychiatrists

  • Richard Laugharne (a1) (a2) and Milind Pant (a1)
Abstract
Aims and method

To investigate in-patient satisfaction with psychiatrists, comparing National Health Service (NHS) trusts with sector consultants against NHS trusts with separate in-patient and community consultants (the functional model). The Care Quality Commission's in-patient survey was used, comparing mean scores on four questions concerning patient satisfaction with consultants.

Results

Patients scored higher for being treated with respect in trusts with sector consultants. In questions concerning trust, being listened to and getting adequate time, patient satisfaction scores were again higher for sector consultants, but did not reach 5% significance.

Clinical implications

Moving to a split between in-patient and community consultants may reduce in-patient satisfaction with care. The continuity of care with sector-based consultants may be a factor in greater in-patient satisfaction.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Richard Laugharne (richard.laugharne@pms.ac.uk)
Footnotes
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Declaration of interest

R.L. has argued strongly to maintain the sector model at the NHS trust in which he works.

Footnotes
References
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1 Dratcu, L, Grandison, A, Adkin, A. Acute hospital care in inner London: splitting from mental health services in the community. Psychiatr Bull 2003; 27: 83–6.
2 Khandaker, G, Cherukuru, S, Dibben, C, Ray, MK. From a sector-based service model to a functional one: qualitative study of staff perceptions. Psychiatr Bull 2009; 33: 329–32.
3 Burns, T. The dog that failed to bark. Psychiatrist 2010; 34: 361–3.
4 Singhal, A, Garg, D, Rana, AK, Naheed, M. Two consultants for one patient: service users' and service providers' views on ‘New Ways’. Psychiatrist 2010; 34: 181–6.
5 Care Quality Commission. Mental health services 2009 survey reports. Care Quality Commission, 2010 (http://archive.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplehouseservices/patientsurveys/mentalhealthservices.cfm).
6 Noyes, R, Kukoyi, OA, Longley, SL, Longbehn, DR, Stuart, SP. Effects of continuity of care and patient dispositional factors on the physician–patient relationship. Ann Clin Psychiatry 2011; 23: 180–5.
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  • EISSN: 1758-3217
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Sector and functional models of consultant care: in-patient satisfaction with psychiatrists

  • Richard Laugharne (a1) (a2) and Milind Pant (a1)
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eLetters

Re:Sector and functional models of consultant care: in- patient satisfaction with psychiatrists

Isaac Sundeep, Consultant Psychiatrist
23 July 2012

I commend the authors for raising this issue.

In 2004 I was working in a hospital in Kent when the sectorized approach was abandoned and the in-patient/out-patient way of working was launched. This also coincided with the launching of a plethora of teams inthe community.Each of these new teams were very clear of their exclusion criteria but a lot less clear about everything else.

Whenever I tried to question the evidence of this approach I ran the risk of being accused of impeding progress. It gradually came to me that this approach was not just the symptom of the malady of change for change's sake but of something far more sinister. It was borne out of a dislike of consultants. A manager actually blurted it out: "Your little empires are being demolished!"

I did the only thing I could do at the time. I fled as far away as I could from the influence of such half baked ideas. I am happy to report that up here in the Highlands of Scotland things are still very traditional and they work much much better.

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Conflict of interest: None declared

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Time-lag is important in patient satisfaction research

Dieneke Hubbeling, consultant psychiatrist
16 July 2012

Laugharne and Pant reviewed patient satisfaction scores from the in-patient survey of mental health trusts in England by the Care Quality Commission (CQC) in 2009 [1]. They compared patient satisfaction scores of trusts with a separate inpatient consultant model and trusts with a sector model. In the latter patients are treated by the same consultant in both the community and the ward. Patients were, on average, more satisfied with their consultant in trusts using a sector model, although this was only statistically significant (P<0.05) for one of the four CQC questions. On the basis of this finding, Laugharne and Pant argued for caution with introducing the separate inpatient consultant model.

Although we agree with Laugharne and Pant that the separate inpatientconsultant model has not been extensively empirically investigated, it is unclear whether the data provided by Laugharne and Pant really suggest that patients are less satisfied with this model of care, as an alternative explanation is possible, namely the effect of a time-lag.

Empirical evidence has shown that patients give higher satisfaction scores immediately after they have seen the health professionals and lowerscores after a few weeks[2] or a year[3]. Furthermore, in the data reported by Stevens et al. patients not only gave on average lower satisfaction ratings but also the standard deviation increased[3]. A similar phenomenon was noted by Laugharne and Pant[1].

The higher average scores on patient satisfaction with sector consultants could well be explained by the fact that patient were still under the care of the sector consultant when answering questions about their inpatient stay, while most respondents from trusts with an inpatient/community consultant split would have been no longer under the care of their inpatient consultant at the time they answered the questionnaire.

References

[1]R. Laugharne and M. Pant, "Sector and functional models of consultant care: in-patient satisfaction with psychiatrists," The Psychiatrist, vol. 36, pp. 254-256, 2012.

[2]H. I. Jensen, J. Ammentorp, and P.-E. Kofoed, "User satisfaction is influenced by the interval between a health care service and the assessment of the service," Social Science & Medicine, vol. 70, no. 12, pp. 1882-1887, 2010.

[3]M. Stevens, I. H. F. Reininga, N. A. D. Boss, and J. R. Van Horn,"Patient satisfaction at and after discharge. Effect of a time lag," Patient Education and Counseling, vol. 60, pp. 241-245, 2006.

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Conflict of interest: None declared

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Sector and functional models of consultant care: in- patient satisfaction with psychiatrists

Andrew Molodynski, consultant psychiatrist
16 July 2012

We welcome this article which seeks to examine the effects upon psychiatric inpatients of widespread service changes in England in the last few years. As this report highlights, the changes have not been evidence-based and it is difficult to identify the origin of them (1). Themain purported benefits of the so-called 'functional' system are a reduction in length of hospital stay for acute inpatients and improved leadership and organisation of inpatient units. The proposed advantages ofthe 'sectorised' model are clarity of responsibility and continuity of care. There is good evidence that the latter is valued by patients and carers (2) and associated with improved outcome in those with severe and enduring mental illnesses (3).General Practitioners and commissioners anecdotally favour simplicity and continuity of care and a personal relationship with their psychiatrist. These are all maximised in the so-called 'sectorised' model. In a recent survey of twenty GPs in South Oxfordshire, nineteen (95%) reported that they preferred continuity of care to increased specialisation in their local psychiatric services.More widely, there is evidence that countries that have embraced communitypsychiatry organised along principles of continuity have lower bed use overall (4) with the UK and Italy frequently cited as examples. This contradicts one of the most frequently given reasons for changing to functional/split services.

There is no substantial evidence in favour of change and accumulated knowledge that continuity is favoured by patients and carers, improves outcomes, and probably leads to lower bed use. We would suggest that clinicians therefore have a responsibility to continue to advocate the sectorised model, or the 'continuity of care' model as it perhaps would bebetter described. We applaud Laugharne and Pant for raising this fundamental issue once again and hope that a more searching examination ofthe merits of this change is conducted and further evidence continues to be gathered.

1.Burns T. The dog that failed to bark. Psychiatrist 2010; 34: 361-32.Saultz J and Albedaiwi W. Interpersonal continuity of care and patient satisfaction: A critical review. Annals of family medicine 2004; 2: 445-4513.Catty J, White S, Clement S et al. Continuity of care for people with psychotic illness: its relationship to clinical and social functioning. International Journal of Social Psychiatry 2011. DOI: 10.1177/00207640114214404.Priebe S, Badesconyi A, Fioritti A et al. Reinstitutionalisation in Mental health care: comparison of data on service provision from six European countries. BMJ 2005; 330:123-126.

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Conflict of interest: None declared

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