Summary of guidance relevant to general practice in November 2011
Longer term management of self-harm
NICE recommends that GPs should refer patients who have a history of self-harm, such as cutting or poisoning themselves, and at risk of repetition, to community mental health services for assessment.
This latest guideline covers the long term management of self harm and follows on from a previous NICE guidance that focused on the treatment of self-harm within the first 48 hours of an incident.
GPs should make referral a priority when levels of distress are rising, high or sustained; the risk of self-harm is increasing or unresponsive to attempts to help; or if the patient requests further help from specialist services.
Patients under the age of 18 should be referred to child and adolescent mental health services, and referral should be a priority if the levels of distress in the parents or carers of children and young people are rising, high or sustained despite attempts to help.
If a person who self-harms is receiving treatment or care in primary care as well as secondary care, then primary and secondary health and social care professionals should ensure they work cooperatively, routinely sharing up-to-date care and risk management plans.
In these circumstances, primary health and social care professionals should attend Care Programme Approach (CPA) meetings.
Support tools to help you put this guidance into practice
Caesarean Section (Update of CG13)
NICE has updated the 2004 caesarean section guideline following the emergence of new evidence. The updated guidelines contain new recommendations on who should be offered a caesarean section and on the use of prophylatic antibiotics.
GPs should take into account the new recommendations when giving advice to pregnant women.
NICE recommends that certain groups of women, such as those who are HIV positive and those who have had a previous birth by caesarean section, should now be offered a vaginal birth instead of a caesarean section.
Women who are HIV positive should be told that, in certain circumstances, the risk of transmission of HIV is the same for a caesarean as it is for a vaginal birth. As a consequence, such women should not be offered a caesarean section on the grounds of HIV status to prevent transmission of the disease to their baby.
The updated guideline dispels the myth that “once a caesarean, always a caesarean” as the risk of fever, bladder injuries and surgical injuries in women who have had up to and including four caesarean sections is the same for a vaginal birth as it is for a caesarean section.
If a woman does decide to request a caesarean section due to anxiety about childbirth, NICE recommends that the woman is referred to a healthcare professional with expertise in providing perinatal mental health support. This is in order to address her anxiety in a supportive manner.
A planned caesarean section should only be offered if, after discussion and offer of support, a vaginal birth is still not an acceptable option.
23 November 2011