Navigation

Summary of guidance relevant to general practice published in May 2011

Greater support for GPs to help diagnose patients with common mental health disorders

NICE recommends that primary and secondary care clinicians, managers and commissioners collaborate to develop care pathways that promote access to services for people with common mental health disorders by:

- supporting the integrated delivery of services across primary and secondary care

- having clear and explicit criteria for entry to the service

- focusing on entry and not exclusion criteria

- having multiple means (including self-referral) to access the service

- providing multiple points of access that facilitate links with the wider healthcare system and community in which the service is located.

The guidance also gives advice on when to consider common mental health disorders. GPs should be alert to possible depression, particularly in people with a past history of depression, possible somatic symptoms of depression or a chronic physical health problem with associated functional impairment, and should consider asking people who may have depression two questions, specifically:

- During the last month, have you often been bothered by feeling down, depressed or hopeless?

- During the last month, have you often been bothered by having little interest or pleasure in doing things?

If a person answers ‘yes' to either of the above questions then consider depression and follow the recommendations for assessment.

A patient may present with possible anxiety disorders, particularly if they have a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or have experienced a recent traumatic event.

Consider asking the patient about their feelings of anxiety and their ability to stop or control worry, using the 2-item Generalized Anxiety Disorder scale (GAD-2).

A score of three or more on the GAD-2 scale indicates that they may have an anxiety disorder and should be assessed. If a patient scores less than three, but you are still concerned that they may have an anxiety disorder, then ask the following: Do you find yourself avoiding places or activities and does this cause you problems? If the patient answers yes to this question consider an anxiety disorder and follow the recommendations for assessment.

Support tools to help put this guidance into practice

To help put this guideline into practice, NICE has produced a series of support tools including an educational slide set, a baseline assessment tool to help look at variations in practice, a costing report and a costing support tool.

GPs and practice nurses should help develop cost-effective physical activity, healthy eating and weight management interventions for communities at high risk of developing type 2 diabetes.

This latest guidance recommends that primary care teams should work in partnership with local public health services to develop interventions for people of South Asian, African-Caribbean, black African and Chinese descent, and those from a lower socioeconomic background, where the incidence of type 2 diabetes is higher than among the general population.

Interventions should take into account the religious beliefs, cultural practices, age and gender, language and literacy of these groups.

Healthier lifestyle messages should be clear and consistent and integrated within other local health promotion campaigns or interventions.

Primary care teams should also encourage patients to achieve the national recommended levels of physical activity by including activities such as walking, cycling or climbing stairs as part of their everyday life.

Support tools to help put this guidance into practice

NICE has produced a costing statement which discusses the potential costs and savings that need to be estimated at a local level. There is also a self-assessment tool to determine how close current practice is to that recommended in the guidance and offers help with prioritising implementation activity, and a slide set that can be used for training.

New treatment options for peripheral arterial disease

Naftidrofuryl oxalate is recommended as an option for the treatment of intermittent claudication in people with peripheral arterial disease for whom vasodilator therapy is considered appropriate after taking into account other treatment options, according to final guidance from NICE.

Treatment with naftidrofuryl oxalate should be started with the least costly licensed preparation.

But cilostazol, pentoxifylline and inositol nicotinate are not recommended for the treatment of intermittent claudication in people with peripheral arterial disease.

People currently receiving cilostazol, pentoxifylline or inositol nicotinate should have the option to continue treatment until they and their clinicians consider it appropriate to stop.

25 May 2011

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.