Gardening, art, sport – "prescriptions" for mental health that don"t involve pills

Group therapeutic work had never appealed to Kerina, who was diagnosed with borderline personality disorder and obsessive compulsive disorder in her 30s after suffering from mental health issues all her life. “You sit there reading paperwork and it feels like you’re in a classroom,” she says.

Then two years ago the community mental health team in Mid Ross in the Scottish Highlands gave her a “social prescription” – referring her to Branching Out, a Forestry Commission Scotland programme designed to help people recover from long-term mental health problems. For 12 weeks she spent five hours a week in the woods doing conservation work, bushcraft and environmental art.

“I enjoyed it straightaway,” says Kerina, who now volunteers as a mentor with the Abriachan Forest Trust, where she completed the course. “It’s so different from your normal life. You go out there and all your worries leave you. We built shelters, tables, workbenches, a kitchen. We chopped wood, we cooked, we sat around the campfire.

“It just seemed to really work for me. I remember saying: ‘I feel like I’ve been here for ages.’ I’d only been there a day.” Though she still has good and bad days, she says she now finds her problems easier to deal with, and is working towards a formal award in volunteering.

The use of social prescribing – where GPs and other primary care professionals refer patients to non-medical activities, such as gardening, arts and sports, normally delivered by the voluntary sector – is growing, with many schemes tackling mild to moderate mental health problems. Studies have suggested a range of positive mental health and wellbeing outcomes.

But in January a report commissioned by Natural England warned that the lack of a standardised referral mechanism, or funding for the activities offered in the majority of services, posed “fundamental barriers” to the NHS’s ambition to increase the scale of social prescribing.

It identified Rotherham’s service for people with long-term health conditions, which started in 2012, as having many of the ingredients for good practice – including a simple and effective referral system, well-informed link workers to help patients choose an intervention, and, crucially, funding for those interventions.

The report also highlighted the service Rotherham has since started for people with mental health issues, which began as a one-year pilot in 2015 and has just been extended for a third year. In an evaluation of its first year, 93% of service users reported progress against at least one of eight wellbeing outcome measures, and 64% reported progress on four or more.

While the service initially focused on those who had been using services for five to 20 years and needed a support network and meaningful activities to help with a successful discharge, it is now expanding to work with people earlier on.

But Janet Wheatley, chief executive of Voluntary Action Rotherham, which coordinates the programme, backs up the warning in the Natural England report: “You can’t direct more and more people to use resources in the community without providing funding to support that.”

Gardening, art, sport – "prescriptions" for mental health that don"t involve pills

Are you affected by the NHS stopping gluten-free prescriptions? | Matthew Holmes

The NHS is to stop prescribing gluten free foods to patients suffering from digestive conditions such as coeliac disease as part of its latest budget cuts.

GPs in England will also be told not to prescribe medications such as those for upset stomachs, travel sickness and haemorrhoids in the drive to eliminate waste from the NHS’s £120bn annual budget.

If you have coeliac disease, we’d like to hear from you. Simon Stevens, chief executive of NHS England, said it no longer needs to prescribe some foods as they are on sale in supermarkets, but those who are already struggling for money and are helped with the cost of prescriptions could be hit hard. Are you affected?

Share your stories with us in the form below and we’ll use some of them as part of our coverage.

Are you affected by the NHS stopping gluten-free prescriptions? | Matthew Holmes

NHS draws up list of items to be banned from prescriptions

The NHS is to stop giving patients travel vaccinations, gluten-free foods and some drugs that can be bought over the counter in an effort to rescue its ailing finances.

Simon Stevens, the chief executive of NHS England, announced the changes in an interview with the Daily Mail in which he detailed new efforts to get better value for money so that money saved could instead be spent on promising therapies that have recently been developed.

GPs will be told to not prescribe medications such as those for upset stomachs, travel sickness and haemorrhoids in a new drive to eliminate waste from the NHS’s £120bn annual budget.

Stevens said: “We’ve got to tackle some of the waste which is still in the system. The NHS is a very efficient health service but like every country’s health service there is inefficiency and waste.

“There’s £114m being spent on medicine for upset tummies, haemorrhoids, travel sickness, indigestion, [and] and that’s before you get to the £22m-plus on gluten-free that you can also now get at Morrison’s, Lidl or Tescos.

“Part of what we are trying to do is make sure that we make enough headroom to spend money on innovative new drugs by not wasting it on these kind of items.”

Next month, NHS England will start reviewing 10 items which it says are “ineffective, unnecessary [and] inappropriate for prescription on the NHS, or indeed unsafe”, which together cost the service £128m a year. The Department of Health is expected to then issue new guidance advising GPs that they are not prescribed.

They include omega 3 and fish oils; the painkiller fentanyl: lidocaine medicated plasters; a tablet used to treat high blood pressure called doxazosin MR; and a drug called tadalafil, which is used to treat erectile dysfunction, along with gluten-free foods and travel vaccines.

NHS Clinical Commissioners, which represents England’s 209 NHS clinical commissioning groups (CCGs) – the GP-led bodies which hold health budgets locally – has asked NHS England to look into whether the 10 itemsare a good use of scarce cash when the NHS is undergoing the tightest budgetary squeeze in its 69-year history.

Many other common medications could soon be added to the banned list. NHS Englandsaid: “In light of the financial challenges faced by the NHS, further work will consider other medicines which are of relatively low clinical value or priority or are readily available over the counter and in some instances, at far lower cost, such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream. Guidance will support clinical commissioning groups in making decisions locally about what is prescribed on the NHS.”

NHS bosses hope the moves could ultimately save as much as £400m a year. The service is facing serious financial problems. NHS trusts in England recorded a deficit of £2.45bn last year and are expected to end this financial year almost £1bn in the red again, despite repeated warnings to get their finances in order.

An NHS spokesman said: “New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.

“The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.”

Stevens’s money-saving initiative is a foretaste of a major initiative he will unveil on Friday. He will announce details of his long-awaited “delivery plan” to fulfil his pledge, first made in October 2014 in his Five Year Forward View modernisation blueprint, to radically transform how the health service works by 2020 so that it delivers better care and closes the £22bn gap which is expected to open up in its own finances by then in order to remain sustainable.

He will give the go-ahead to between six and 10 of the 44 sustainability and transformation plans (STP), one covering each part of England, which are intended to implement his ideas, which centre on moving a lot of care out of hospitals and treating patients closer to home and keeping them healthier so that they avoid expensive £400-a-night unnecessary stays in hospital.

The STP plans have proved very controversial because they could see dozens of hospitals lose key services, such as their A&E or maternity unit.

NHS draws up list of items to be banned from prescriptions

NHS to have one website for appointments, prescriptions and advice

A one-stop NHS website where patients book appointments, order prescriptions and access medical advice is being developed, health officials have announced.

For minor ailments patients will be able to check their symptoms online and read up on all manner of diseases.

The NHS.uk website will also enable patients in England to register with a GP and download their own medical records.

Patients will also be able to compare how well their local health service performs against others for areas including cancer, dementia, diabetes, mental health, learning disabilities and maternity care.

Information about individual trusts performances on dementia, diabetes and learning disability services will be published through the MyNHS website immediately, with more information added in the autumn. This data will be taken in to the NHS.uk site at a later date.

The NHS.uk system, which is hoped to be ready by the end of next year, will offer a new online triage system for the NHS’s 111 service. Patients will be able to enter symptoms online and get tailored advice or a call-back from a healthcare professional, a Department of Health spokeswoman said. The triage system is being developed with patients and clinicians and will be trialled before it is available for the general public to use.

The move, which is to be announced by the health secretary, Jeremy Hunt, at the NHS Expo event in Manchester, aims to give the smartphone generation easier access to NHS services. “We live in the age of the smartphone and we want the NHS to reflect that,” Hunt said.

“Our new plans will make it easier for patients to get the medical support and information they need, and should encourage more of us to use the growing range of online NHS services available. This is a way of supplementing patients seeing their doctor in a more conventional, face-to-face setting, and crucially it will give people more choice and the opportunity to access healthcare in a way that works for them.”

The announcement has been made at the same time as a review of IT in the NHS is published. Prof Robert Wachter was commissioned by the Department of Health to look at the English healthcare system’s approach to IT.

He made a series of recommendations to help the NHS, including highlighting “exemplar” NHS trusts that are leading the way. Prof Wachter said: “The NHS is a gem – delivering excellent outcomes at costs well below other international systems such as those in the US. However, for it to continue to provide a high quality and accessible service for staff and patients it simply must digitise. The one thing that the NHS cannot afford to do is to remain a largely non-digital system – it is time to get on with IT.”

Responding to the review, Hunt said he will make 12 trusts exemplars, so others can learn from their experience. He also outlined plans to introduce an academy dedicated to training NHS staff in digital skills.

In the past UK health leaders have been heavily criticised over a failed multi-billion-pound IT system. Ministers shelved an ambitious scheme, designed to create electronic patient records for use across the NHS in England, in 2011.

NHS to have one website for appointments, prescriptions and advice

"Soft-touch" physicians create 10m needless prescriptions a 12 months, says Wonderful

About a single in 4 prescriptions issued for antibiotics in England each and every 12 months – about 10m in all – are probably to be pointless as individuals deliberately search for “soft-touch” doctors who give in to their demands for the medicines, a foremost well being official has stated.

Mark Baker, director of clinical practice at the National Institute for Health and Care Excellence (Great), has warned that the increasing crisis of antimicrobial resistance, in which profligate use of medicines has permitted bacteria to develop resistance, threatened healthcare and the “whole basis of medicine”. He also explained infections would have to be handled by surgical treatment if drugs no longer worked.

Baker is director of clinical practice at the National Institute for Wellness and Care Excellence (Great), whichNice on Tuesday published advice on the concern for medical professionals, dentists, podiatrists, pharmacists and other experts.

Expectations of getting antibiotics have been now “entrenched”, stated Baker. “There are men and women who are addicted to the concept of possessing antibiotics. If they know there is a soft-touch doctor then they go to them.” If they did not realize success with one medical professional, they would attempt yet another or even search the internet to supply the medicines, he said.

Except if the most recent advice was translated into action, he explained there would have to be a rethink in practice “because we have invested 60 years assuming that most infections will be cured by antibiotic drugs”.

If these no longer worked, explained Baker, “then we will have to rediscover and relearn how to treat infections surgically and I do not feel anyone desires to be in that position”.

Associated: Considering of asking your medical professional for antibiotics? Consider once again | Sarah Boseley

The advice calls for prescribers to examine with individuals the very likely nature of their condition, the positive aspects and harms of quick prescribing, and choices this kind of as “watchful waiting” or delayed prescribing, when prescriptions are issued only soon after microbial samples taken from individuals have been examined.

It demands much more rigorous neighborhood policing of prescribing practice, with expert teams monitoring and evaluating information from distinct hospitals, GP practices and other prescribers.

Cases of very high, escalating or reduced volumes of prescribing ought to be examined.

Baker stated an open and transparent culture must permit well being specialists to query colleagues’ prescribing practices when they had been not in line with local or nationwide tips and no causes have been given for those choices.

There was a lot of really great practice, stated Baker, but examples of undesirable practice may, as a final alternative, be referred to skilled regulators this kind of as the Basic Healthcare Council (GMC).

Tim Ballard, vice-chair of the Royal University of GPs, mentioned the guidance “to give the appropriate antibiotic at the proper dose at the appropriate time” was wise.

“But we can come underneath enormous pressure from individuals to prescribe antibiotics, even when we know they are not the correct course of action. People need to realise that this is hazardous for every single and everyone of us, not just ‘other people’.”

He explained it may be counterproductive and unhelpful to involve disciplinary procedures when GPs already faced “very tough and demanding conversations” with individuals.

The college would be searching to regulators to support GPs who refused to prescribe unnecessary antibiotics and then faced complaints from patients.

Separate advice for patients, probably backed up by NHS public education campaigns, is anticipated following yr.

The Division of Health mentioned: “Tackling the overuse of antibiotics is a global issue that has an effect on everybody – government, patients, physicians, dentists and vets treating animals – not just GPs.

“In buy to make certain we have effective antibiotics for generations to come, we are raising worldwide awareness of the dangers of resistance to antibiotics and offering resources for GPs to support prescribing choices.”

Niall Dickson, chief executive of the GMC, said doctors should only prescribe if they had been pleased that this would serve the patient’s requirements.

“Where they take into account that the treatment method would not benefit the patient, they do not have to offer it.”

However, the GMC saw the Wonderful recommendations as “being a lot more about modifying the norms of practice typically than pursuing person doctors”.

Connected: Resistance is not futile – how to tackle drug-resistant superbugs

The dangers of antibiotic resistance initial grew to become a significant situation in the Uk in the late 1990s when they were raised by Sir Liam Donaldson, the then chief health care officer. His successor, Dame Sally Davies, took up the cudgels in 2013, with David Cameron calling for international action the following yr.

Professionals worry the crisis is deepening, with no new class of antibiotics or other major scientific growth in 30 many years.

A total of 41.6m prescriptions have been issued in England in 2013-14, costing the NHS £192m.

Prior Good guidance on the use of antibiotics to deal with respiratory tract infections, issued in 2007, was aimed at cutting prescribing by 22%. After an first dip, it started to increase once more.

A survey final year suggested more than a quarter of physicians prescribed antibiotics even when they have been not certain they were medically required, and nine in 10 felt underneath strain from individuals to prescribe them. Other figures suggest practically all individuals who inquire for antibiotics get them.

"Soft-touch" physicians create 10m needless prescriptions a 12 months, says Wonderful

Prescriptions for Ritalin and other ADHD medication double in a decade

Nearly a million prescriptions for Ritalin and relevant drugs for consideration deficit hyperactivity disorder (ADHD) have been dispensed last yr – more than double the quantity of a decade ago.

The figures have prompted a damning indictment of the method from authorities who declare that the operating down of mental well being companies has led to kids getting misdiagnosed and inappropriately prescribed drugs.

There have been 922,200 prescriptions last yr for methylphenidate hydrochloride, the chemical name for Ritalin, and equivalent merchandise. In 2010, 661,000 were dispensed compared with 359,a hundred in 2004. Tips from the National Institute for Wellness and Care Excellence suggest that the use of these medicines should only be a last resort. There have been repeated warnings from experts that clinicians were as well readily prescribing psychostimulants to youngsters when the evidence recommended there have been no long-term advantages. Animal research have also raised issues over the likely for harm.

Tony Lloyd, chief executive officer of the ADHD Foundation, which provides assistance for kids with the condition, mentioned children had been getting let down by a money-starved technique. NHS paying on children’s mental well being solutions in England has fallen by more than 6% in real terms because 2010.

“The tips are clear that medication need to be dispensed as a final resort. But that is clearly not what is happening,” stated Lloyd. “They are prescribing since kid mental wellness providers are overwhelmed. There are quite handful of services like ours.

“There has been a 41% improve in the number of kids beneath the age of sixteen in just the final 5 years, and so the little spending budget for psychological well being solutions is currently being targeted on that.”

ADHD, which is suffered by effectively-identified figures this kind of as the world champion racing driver Lewis Hamilton and the actor Emma Watson, has signs this kind of as inattentiveness, hyperactivity and impulsiveness more than a sustained period.

The psychostimulants prescribed by medical professionals are believed to stimulate a part of the brain that adjustments mental and behavioural reactions.

Kate Fallon, chief executive of the Association of Educational Psychologists, explained medicines were currently being prescribed by “harassed paediatricians”.

She additional: “These figures present an exponential development.

“We hear stories of teachers who had no notion that a single of their pupils had ADHD till Mum appears with Ritalin. Conversely, we hear of teachers telling dad and mom, ‘We cannot deal with this little one, so you must go to the doctor’.”

ADHD is generally diagnosed between the ages of three and seven. It is believed to impact close to 5% of schoolchildren in the Uk. The surge in prescriptions to treat the issue mirrors the scenario in the US, in which there was an 83% improve in revenue of the drug in between 2006 and 2010.

The use of Ritalin for a yr would be likely decrease a child’s development by three-quarters of an inch. There is also proof that it can precipitate self-harming behaviour.

Prescriptions for Ritalin and other ADHD medication double in a decade

NHS medicines watchdog lowers bar for statins prescriptions

Statin tablets. Photograph: Alamy

About 40% of the grownup population could be supplied cholesterol-busting statins medication by their medical doctors, below official advice from the NHS medicines watchdog.

The National Institute for Health and Clinical Excellence (Good) confirmed the draft recommendation it produced in February, which sparked a row among doctors in excess of alleged above-prescribing. Some critics accused Nice’s guideline group of shut ties with the pharmaceutical business.

Prof Mark Baker, director of the centre for clinical practice at Good, strongly defended both the choice to provide the medicines to people with a lower danger of heart condition than previously suggested and the independence of people doing work on the guideline. They had carried out their operate “in the face of some entirely unjustified attacks on their integrity,” he explained.

“I have to remind you that no one will get into our tips group if they have any considerable vested interest, particularly a financial interest,” he explained at the launch of the guideline on tackling the threat of heart attacks and strokes. All the interests of the group members were declared, not like people of some of the critics, he explained. Appointees to the group are essential to have had no economic involvement with pharmaceutical businesses for at least the prior year.

Great says GPs should first talk about life-style measures – a better diet program and much more exercise – with men and women who have a ten% risk of a heart attack or stroke in the subsequent ten years. They can then supply a statin if they believe it appropriate. Previously, GPs have been suggested to intervene when their patient had a twenty% risk.

An estimated four.five million much more individuals will be eligible for statins, in addition to the 13 million presently eligible. Great says half these patients will possibly not be presented them or will refuse. Somewhere amongst 5 and 10 million are believed to be taking the drugs at present.

The medication are now off-patent and for that reason cheap. Great says if 80% of the 4.five million newly eligible take them, the cost to the NHS will be £52m, which is tiny in the context of the cost savings from heart assault and stroke treatment method.

If two million – significantly less than half – of the decrease-threat group accept statins, Nice estimates that an additional four,000 deaths from heart attacks will be saved, and eight,000 strokes and 14,000 non-fatal heart attacks prevented.

Critics of statins have contested their rewards in individuals at reduced risk and raised considerations about side-results. Baker rejected these arguments. The evidence from randomised, managed trials of the medication “demonstrate the very same frequency and severity of signs in the statins and the placebo group,” he explained.

“Most of the side-results attributed to the medication but not always brought on by them are very typical. The occurrence of issues like muscle ache has minor or nothing to do with whether folks consider statins.”

A single extreme sort of muscle pain had been reported, but it was very unusual, he explained. He believed that some sufferers and GPs had wrongly assumed the significant response was as common as the mild one particular.

Opposition to statins for the decrease-threat group surfaced in the British Health-related Journal last year. The journal has retracted statements in two papers it published. Independent professionals have been asked by the BMJ’s editor, Dr Fiona Godlee, to advise on whether the papers ought to be retracted, in response to a contact from Professor Rory Collins, joint head of the clinical trials support unit at Oxford University.

Nice’s guidance was welcomed by numerous senior scientists, but some pointed out the importance of attempting to modify people’s life style in preference to handing out medicines. “We must not basically use pharmaceuticals to treat the benefits of unhealthy conditions,” mentioned Sir Michael Marmot, director of the Institute of Health Equity at UCL. “Choosing healthier lifestyles is a lot more challenging simply because our society promotes low cost unhealthy meals, lower alcohol costs, and vehicle use rather of walking or cycling.”

NHS medicines watchdog lowers bar for statins prescriptions

Rise in antidepressant prescriptions rates in England: get the data

The amount of antidepressants dispensed annually in England rose by 25m between 1998 and 2012– from 15m items in 1998, to 40m in 2012 – according to a new study which claims that England’s increasing use of antidepressants has accelerated since the financial crash in 2008.

Published as part of the Nuffield Trust and Health Foundation’s QualityWatch programme, the research shows that almost half of the increase between 1998 and 2012 occurred in the four years between the 2008 financial crisis and 2012 (the last year for which data is available). Meaning the annual rise in prescriptions has risen to 8.5% per year since the banking crash, compared to 6.7% before.

The release notes:

This striking increase is despite the incidence of depression having risen much more slowly over the same time period, meaning that either antidepressants were heavily under-prescribed in 1998, or they are heavily overprescribed now.

Some GP practices also prescribed far more antidepressant medicine than others even where their patients were similar – suggesting over-use or under-use in many parts of England.

Researchers also found that even when regional characteristics are taken into account, large geographical variations in the rate of prescribing exist – echoing research carried out in 2011 by the Guardian which revealed a north-south divide in the prescription of antidepressants.

This latest report – examining the number of tablets dispensed on NHS prescriptions across the country – shows that between October and December 2012/13, rates varied from 71 items per 1,000 people in NHS Brent, to 331 items per 1,000 people in NHS Blackpool.

They also found that generally, there were higher rates of prescribing in the north-east and lower levels in London. The map below shows antidepressant prescription rates per 1,000 people by primary care trusts (PCTs) in England.

Other key findings from the report are:

• Areas with more white people, more women, and more people over the age of 65, had the heaviest use of antidepressants


• Areas with more men and more people from ethnic minorities, had significantly lighter use
  
  


• GPs who prescribe more antibiotics also tend to prescribe more antidepressants, suggesting doctors vary across the board in how likely they are to use drugs to deal with their patients’ conditions.


• An analysis of changes over time found that increases in unemployment were associated with significant increases in the number of anti-depressant tablets dispensed. A 1% rise in unemployment typically meant one and a half more tablets were given out per person on a GP list, per year

The table below shows figures obtained from the Health and Social Care Information Centre (HSCIC) by the Nuffield Trust and the Health Foundation. They show the number of antidepressant drugs prescribed by PCTs in England. The downloadable spreadsheet also has data on the trend in prescribing of antidepressants in England.

Download the data

• DATA: download the full spreadsheet

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Rise in antidepressant prescriptions rates in England: get the data