Cost-effective prescribing is an increasingly important aspect of our practice. A service evaluation was carried out to assess the level of awareness and knowledge of different aspects of cost-effective prescribing among doctors working in the North East London Foundation Trust. A semi-structured questionnaire was used to benchmark knowledge against six standards.

The survey was completed by 71% of doctors working in adult or old age psychiatry. A total of 2% of doctors stated that they should always take into consideration the price of the drug when prescribing and only 5% of doctors claimed to know the price of medications they prescribe most frequently.

Strategies to improve the poor level of knowledge and awareness in this area of clinical practice would be of benefit in making the best use of limited financial resources without any detriment to patient care.

Relative to workforce numbers, the National Clinical Assessment Service (NCAS) has reported high rates of referrals for performance concerns in psychiatrists. Our aim was to see how these concerns would be distributed across good medical practice (GMP) domains. Such specification would help identify appropriate training and development interventions. Concerns were obtained from consecutive case reports (anonymised) of psychiatrists referred to NCAS between October 2004 and April 2006.

The proportion of psychiatrists with concerns in any domain was highest (just over 50%) in the domains of good clinical care and working with colleagues. Two-thirds had concerns across multiple domains.

Training and development needs of psychiatrists referred to NCAS are more complex and more prevalent in the GMP domain of good clinical care than previously reported.

The level of reading ability required to understand written information about key mental health issues designed for service users is examined. Information was taken from four reputable internet sources and analysed for readability. The relevant literature in relation to psychiatric patients and literacy is reviewed and potential solutions are proposed.

A considerable proportion of the available information has a reading age at or above 14 years. Some organisations appear better than others in providing information at a more appropriate level of reading ability.

Written information aimed at users of psychiatric services may not take into account that they are more likely to have impaired reading ability, even though they might not have an identified intellectual disability. Professionals who develop written materials can use tools in word processing software to assist with the appropriate development of these materials. Information technology could in the future provide information directed at users of psychiatric services that does not rely so heavily on written material.

A postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.

Forensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.

Forensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

To identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.

A total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.

Single men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

National clinical guidance states that patients on antipsychotics should have their metabolic profile regularly monitored. The aim of this study was to assess whether we are effectively monitoring metabolic profiles and to improve the detection, communication and intervention of metabolic abnormalities among patients on atypical antipsychotics. We describe a full audit cycle.

The audit resulted in a 24% increase in the number of patients on atypical antipsychotics being referred to the metabolic clinic. The number of abnormal results communicated to primary care showed a significant improvement of 25% (P <0.001), and ultimately the number of patients who received intervention improved by 17% (P = 0.001).

Audit feedback has been effective in changing clinical practice. The audit demonstrated the potential value of a metabolic clinic and shared care between primary and secondary practitioners for this group of high-risk patients.

The Annual Review of Competence Progression (ARCP) is a process of checking and evaluating evidence of competency attainment collected by a trainee over the preceding year. There has been no study evaluating trainees' perception of this new process. Two cross-sectional electronic surveys were conducted a year apart in the north of England. Out of 92 psychiatry trainees 58 (63%) completed the survey in 2008; 60 (63%) out of 96 trainees completed the second round in 2009.

Over the year there was a significant improvement in trainees' perception of the new process: 75% of respondents highlighted non-availability of a list of acceptable evidence for the portfolio in 2008, which reduced to 22% in 2009 (P <0.001). The percentage of trainees facing difficulty in accessing the electronic portal reduced from 73 to 28% (P <0.001). The trainees continued to express the need for explicit feedback at ARCP and improved training of the assessors in addition to other parameters.

The process of ARCP seems to have become robust over the year studied. There is scope for further refining of the process according to trainees' needs.