Shared learning database

Sheffield Health & Social Care NHS Foundation Trust
Published date:
October 2008

Reorganising an existing care pathway for clients with OCD & BDD to reflect NICE guidance stepped care model. This has included developing a multi-disciplinary tertiary care specialist team to coordinate the new care pathway, deliver training and clincial supervision, and provide a treatment service for clients with the most complex needs.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

To become a centre of excellence in the delivery of evidence based psychological, pharmacological and social interventions for clients with OCD or BDD. 1. Develop and implement a revised care pathway for clients with OCD or BDD, including providing a tertiary clinic for treatment for service users who are suffering from the most severe and complex presentations of OCD & BDD, in the context of enhanced CPA. 2. Provide increased numbers of joint assessments/ psychological formulations, training in evidence based interventions, and increased supervision activity to members of the Community Mental Health Teams 3. Catalogue lessons learned during the establishment of the team to contribute to the development of further specialist teams.

Reasons for implementing your project

To date there has been a small primary care mental health team in Sheffield offering a very limited service to clients with OCD or BDD. Referrals of clients with OCD or BDD are currently accepted from all levels of services including GPs, other secondary services such as Crisis Assessment and Home Treatment, or tertiary services such as the CBT team. The CMHTs currently offer this client group care-coordination, risk assessment and management, pharmacological and limited psychological interventions. Where the client presents with no risk to themselves or others, or with no social needs, they will be generally be referred to a CBT specialist, either within the team where available or to the CBT team within the Psychotherapy Service. Referrals of clients with OCD or BDD to any of the psychotherapy teams can currently be made by any health professional in Sheffield. In the vast majority of cases these clients will be allocated to the CBT team and only this intervention will be delivered during the care episode. Clients with OCD or BDD may receive inpatient care but this is rare. When this client group enter inpatient services it is usually because they have become a severe risk to themselves or others. The primary interventions used are pharmacology and risk management. There is an ongoing difficulty for clients presenting with OCD or BDD in receiving pharmacological, psychological and social interventions concurrently. Levels of expertise in the assessment, formulation and treatment of OCD and BDD within each setting are unclear and vary across team members. 1.6 Aims of comprehensive care pathway To develop, implement and review a care pathway that ensures that clients presenting with OCD or BDD receive the most effective treatment at the right time and from the right professional or team for their level of need.

How did you implement the project

Unknown as yet

Key findings

The proposed project is a before and after service evaluation based around contemporary themes of access, service delivery, service model, outcome, and user and carer experience. These reflect explicit standards detailed in the National Service Framework for Mental Health and areas for further action identified in the 5 year review of progress towards NSF standards (Dept of Health 2004). As such this evaluation will investigate the following questions, Access 1. What are the characteristics of the population accessing the service and how do these compare with similar services nationally? (e.g. ethnic diversity, age groups, diagnosis) 2. Specifically how is the service used by age groups relating to previous service provision? (i.e. older adult vs working age) Service delivery 1. What are the characteristics of the service delivery (e.g. referral rates, sources of referral, patient diagnoses, presenting problems, duration of contact, service utilisation, staff skill mix)? And how do these compare to the previous service delivery? 2. What is the impact on related services (e.g. Crisis teams, CMHTs, Inpatient bed use)? 3. How much supervision and training is delivered by the team? Service model 1. What is the care pathway that leads to and follows Specialist Team use? And how does this compare to the previous service model? 2. What are the professional users? views of the service? (e.g. CMHTs, IAPT, Crisis teams, GPs) 3. What are the team staff views of the service? 4. What are team staff experiences of the new service? By professional group? Outcome 1. What are the clinical outcomes for clients? 2. What is the cost of the new service provision per care episode? 3. What are re-referral rates to the service? User and carer experience 1. What are service users views of the service? 2. What predicts user satisfaction with the service? 3. What are carer views of the service?

Key learning points

1. There is a great willingness amongst all staff groups to change the care pathway for the benefit of clients. 2. Resistance to change came from lack of resources rather than institutional factors. 3. Support is needed early from key individuals within the organisation. in this case professional leads provided staff sessions which helped push the change towards implementation, i.e. it wasn't seen as a development by one group that others were being pushed towards. 4. Trust support services such as IT, information, contracting etc, needed more lead in time to the change to support the implementation 5. Using a clear project management tool (in this case Prince2) helped steer the project on time and in budget.

Contact details

Simon Houghton
Consultant cognitive behavioural psychotherapist
Sheffield Health & Social Care NHS Foundation Trust

Secondary care
Is the example industry-sponsored in any way?