Clinical Decision Making Skills for the Integrated Worker Essay

This assignment will define and try the sine qua non for a elect process betterment in spite of startance the tract of cordial salubriousness, as well as evaluating the suggested return. Demonstrating how this function cig atomic number 18t protest and benefit integrated employ, discussing the ways in which the agencys statutory obligations and responsibilities impact on devil single and group decision fashioning. The chosen service rise for this assignment is the inception of a moral wellness nurse into uncomplicated solicitude lock, for example, a GP Surgery. Focusing on service affairrs with affable wellness issues in the biotic community and on that pointfore in the assistance of the local native C ar Trust (PCT). on that point is an self-explanatory need for movement towards better wellness and hearty wangle for individuals with psychogenic wellness infirmityes in primeval fright.No wellness without psychogenic health A Guide for everyday physical exercise (De fibrement of health, DoH, 2012, online), sets out what General Practitioners (GPs) gage do to improve kind health and enhance cargon and suffer offered to those with psychogenic health conditions in the community. This document alike states that one in four GP consultations tarradiddle for psychogenic health problems (DoH, 2012, pg8, online). Treatments for those with intellectual health issues exist the NHS in the United Kingdom approximately 105 zillion per year (DoH, 2012, pg8, online). Primary alimonyfulness plays a pivotal position in caring for those with cordial health illnesses in the community and in or so cases this f whollys into the obligation of the local GP surgeries.Therefore GPs are i hatfully berthd to identify signs of distraint and those with adventure factors for poor noetic health (NHS Confederation, 2011, online). Primary charge bearrs, to a greater extent grumpyisedally GPs are usually the un dately point of call for an individual experiencing some found of psychological discommode (DoH, 2012, pg13, online). It is essential on that point is early recognition and referral to any specialiser genial health run mandatory, saving time, money and individual distress in the keen-sighted-run.An area which remains problematic is the considerment of somatogenetic health fretting require for those with mental health illnesses. Research continues tohighlight that the sensible health of those with mental illnesses is frequently poor and sight with long-term carnal conditions envision higher levels of mental health issues (Nash, 2010, pg2). It is ironic that a great deal of the research carried out is with individuals that are currently in contact with any health or neighborly care exert (Nash, 2010, pg2). This issue could be tackled at heart primary winding coil care operate, as GPs especially can treat the whole person linking sooner than separating physical and menta l health (Knapp, 2011, pg3, online).Professionals inside the primary care sector could bang problems when trying to identify their fibre in relation to meeting the health needs of those with mental health issues, as well as offering interventions and jump to those identified as high risk of take aiming mental health problems, such as, individuals with long-tem physical conditions (Nash, 2012, pg 10). Yamey (1999) found that a number of patients had actually been removed from GP registers at some point prior to entrance moneying secondary mental health operate. This causes uncertainty that some mental health illnesses could be construed as a creator for being excluded from GP surgeries (Yamey, 1999). MIND (1996) carried out a survey which in like manner destineed that a extensive majority of individuals felt they had been treated unfairly by their GP due to their mental illness.This could be a consequence of everywherelook of understanding and minimal instruction in the area of mental health in the primary care sector. Although this research is dated, it is relevant as g overning white papers and initiatives currently being introduced are still recommending that more specialised training in mental health is mandatory for passe-partouts end-to-end the primary care sector. Each of the initiatives aim toward improved integrated operative and lower hospital admissions due to deteriorating mental health by providing early admission charge to services and early recognition of mental health issues in primary care. This highlights the importance of the chosen service improvement, non only for individuals with mental health issues but for those at risk of break awaying mental illness and the NHS as a whole.These recommendations are present in No health without psychological health A Guide for General Practice (DoH, 2012, online), The NHS Outcomes fabricing 2012/13 (DoH, 2011, online), and numerous another(prenominal)s. It remains clear that p rofessionals deep down the primary care sector are notreceiving qualified training in mental health care. They do not shake sufficient knowledge of mental health and some(prenominal) do not possess the general skills required day to day when snuff itings with mental health service users (DoH, 2012, pg5, online). This is co-occurrence by Good Medical Practice (2006),(General Medical Council, GMC) which sets out the belief guidance for GPs offers no mention of individuals with mental health issues, suggesting that this document is ground solely on the general population and does not taking into account the differing needs of those with mental health issues.A programme that was introduced in Wales in 2011 provides intellectual health First Aid Training to a immense group of service providers including primary care. It t individuallyes them to provide initial help to somebody experiencing mental health problems, deal with a crisis situation or the commencement ceremony sig ns of someone growing mental ill health and guide people towards appropriate help (MIND 2011, online). This shows some progress towards increasing knowledge and cognizance of mental health illnesses in a wider range of health care providers.There is express to show that in GP practices without mental health professionals, truncated training for primary care providers have substantial benefits for patients who are mentally ill (Ross et al, 2001). This weathers the need for specialist training and the chosen service improvement, as a mental health nurse in a GP process would be specially happy to work with individuals with mental health illnesses and would have an ken of the difficulties service users whitethorn face when regaining services.There are some another(prenominal) aspects that could present a hindrance to mental health service users when accessing services. Communication difficulties can cause problems for individuals with mental health issues as they whitethor n not witness able to make themselves understood by health care professionals. They may suffer anxiety or panic disorders qualification it more difficult to communicate effectively. One of the most problematic areas in mental health and for those suffering mental health illnesses is stigma (Nash, 2010, pg10). Discrimination is not just confined to the general population as research has shown that healthcare professionals can hold stereotypical views towards their clients (Nash, 2010, pg10). This could pr charget individuals from seeking help and support for both physical and mental health problems.Some service userswith mental health issues may have previously experienced some form of discrimination and had a negative experience when accessing primary care services. For example, experiences involving reply module with bad attitudes or individuals being made to believe the physical symptoms they are experiencing are part of their mental illness (Nash, 2012, pg12). This shows tha t individuals with mental health issues suffer from ine case and discrimination regarding their healthcare reinforcing the need for improved access to primary care services. Previous negative experiences can cause individuals to consternation re plaiting causing them to fend off seeking help for a physical condition. Furthermore, if a person believes the may be mentally ill, they may avoid accessing any kind of support as they fear being label and discriminated against due to the stigma attached to having a mental health illness. Employing a mental health nurse in a GP cognitive operation can bring services closer to eliminating barriers among primary care services and mental health, improving the healthcare of those in the general community suffering from some sort of mental illness.The proposed service improvement supports the need for reducing health inequalities and barriers to those with mental health issues wishing to access services. Barriers to healthcare specifically P rimary care services can include communicating difficulties, lack of understanding from both service user and professional aspect and there may be inadequate support visible(prenominal) to mental health service users when accessing their local GP surgeries. GPs may lack the interpersonal skills required to manage some symptoms of mental illnesses. Such as unbefitting sexualised behaviour that can be expressed during psychotic episode (Norman & Ryrie, 2009, pg711).The professional may feel uncomfortable and embarrassed when examining an individual and unaware of how vanquish to deal with this situation.Symptoms of mental illnesses can themselves often prevent individuals with a barrier to accessing services. An individual suffering stamp will most likely lack motivation and volition (Norman & Ryrie, 2009, pg429) making it extremely difficult for them to self-refer or even care more or less their mental and/or physical health. Further back up the need for the chosen service im provement as families, carers and friends of such individuals could support them in attending their local GP surgical process enabling them to access specialist help at an initial stage of their illness. It may be necessary for a mental health nurse in a GP mental process to be advertised as individuals cannot access services if they are unaware they exist. Booklets and leaflets could be made available to raise awareness of mental health issues and the support available to individuals, their friends and families informing the community that specialist help is available first hand in spite of appearance their local GP surgery.Another barrier that is present in the provision of care by primary services and GP surgeries is the use of the medical checkup model. The health professionals indoors a GP surgery adopt a medical admission when treating their patients. This aims to treat the medical illness and reduce the total number or patients attending the surgery. Although this is nec essary inwardly a GP surgery background signal there remains a need to consider social factors when adopting the medical approach (Barbour, 1995, pg2). There are limitations when using the medical model, however as it can prevent healthcare professionals from treating patients individually in a person centred manner, treating only the obvious medical condition (Barbour, 1995, pg10). This could have a full noxious effect on an individuals health and well-being, resulting in increased appointments with their GP causing more distress and prolonging their suffering.This in turn increases the likelihood of an individual requiring crisis intervention and eventually costs the NHS more in the long-run (Norman & Ryrie, 2009, pg172). The Royal College of General Practitioners (RCPG) Roadmap (2007) document supports the need for adopting a model in which health and social care needs are considered in general practice (RCPG, 2007, pg1). There has been confusion around which professionals r ole it is to provide physical health care to the mental health population for many geezerhood (Phelan et al, 2001). Government policy recognises the importance in considering physical health care needs of those with mental health illnesses in both primary and secondary care settings (Newell & Gournay, 2009, pg 322).General practice has transformed significantly over the past decade and current regimen policy is aiming to improve access to and the choice of services available to patients, expanding the role of a GP and improve choice of care overall (Gregory, 2009, Pg3, online). Government policy is implemented in the structure of clinical governance and is important inhighlighting improvements that are required in a wide range of services within the NHS including mental health and primary care (NHS subscribe, 2011, pg12, online). Clinical governance is exposit as a system in which NHS organisations are accountable for unceasingly improving the quality of their services (Scally & Donaldson, 1998, online). It is a framework that trains professionals endlessly develop and improve the quality of the services they provide. Clinical governance involves the research and development, risk management, furtherance of openness, education and training for staff, clinical effectiveness and clinical auditing of services within the NHS.It is extremely important that high quality care is provided in healthcare and clinical governance ensures professionals are individually accountable for the quality of care they provide (South Tees NHS Trust, 2013, online). Buetow and Roland (1999, pg184, online) suggest there is a barrier among managerial, organisational and clinical approaches to quality of care denoting that the aim of clinical governance is to bridge deck the apparent gap by allowing all professionals within an organisation contact and freedom from the control of managerialism (Buetow & Roland, 1999, pg189, online). Although this suggests the aim is to promote equality throughout organisations when it comes to quality of care. There remains a need for one individual or a small group of people to drive the role and responsibility and change by reversal the clinical governance lead or team (Buetow & Roland, 1999, pg189, online).In a primary care setting such as a GP surgery this would entail being responsible for a braggart(a) number of professionals who may have had little reason to communicate with severally other previously. This could cause conflict within an organisations cultivation if the quality of care professionals provide is questioned. The surgical incision of health (2008) stated the current system of NHS primary care does not ensure a consistent level of pencil eraser and represents insufficient quality across the country.Resulting in GPs becoming required to hold a licence which is reviewed and renewed every five years and to register with the financial aid Quality Commission (CQC) from 2011 (GMC, 2009, online). This ensures up to date practice, competence and assures the provision of quality care. Clinical governance enables services to show how targets have been met within their organisation and how they meet the needs of their patients, supporting the decisions made by professionals and teams within the organisation (Buetow &Roland, 1999, pg187, online).All organisations have what is known as an organisational or agency culture. Agency culture is made up of numerous aspects including, value and beliefs, language and communication, policies and procedures and rituals and routines within an organisation. Each organisation has a varied culture with a different set of beliefs and norms. It could be a result of these norms that staff members may not be willing to embrace multifariousness or take time to attend extra training for specialist service user groups such as the mental health population. It may appear that the service gains results and targets are met therefore may not want to change a nything. This places organisations at risk of neglecting areas for improvement. Changes within agency culture can sound a challenging process especially when there is disruption to tralatitious working routines (NHS Direct, 2011, online). Staff within a GP surgery may have been led by one individual or a small group of the same GPs for a long period of time and may feel the services they provide are sufficient.Newly measure up members of staff joining the workforce may feel their opinions and ideas are underappreciated or not even considered because the routines and procedures are already in place. An unwillingness to accept change could have detrimental effects on the mental health service user population. This is reflected in recommendations by government policy. No wellness without mental health (DoH, 2012, online), Making it pass (DoH, 2001, online) and Call to Action (DoH, 2011, online) each suggest recommendations for primary care services to develop the services provide d to those with mental health illnesses and stress the importance of mental health promotion within primary care. The culture within a GP surgery may appear to be more superior to other NHS services as most GP surgeries are independently contracted and are not direct employees of the NHS (Gregory, 2009, pg 8, online). This enables them to provide enhanced services such as blanket(a) opening hours and specific services for those with learning difficulties (Gregory, 2009, pg 8, online).The above are components of General Medical Services (GMS) whereas Personal Medical Services (PMS) enable GP surgeries to cater for the specific needs of the local population (Gregory, 2009, pg 5, online). This could include do drugs and alcohol services or mental health services if there were a large number of the localcommunity presenting to their GP surgery with these issues. The cultures within each of these types of GP surgeries could be different completely. In a PMS GPs could have received speci alist training in the areas large numbers of patients require support, resulting in patients feeling more valued and well-thought-of as well as staff members. GP surgeries can be seen as providing a gateway to specialist care (Gregory, 2009, pg8, online). This view could be difficult to change. but by offering a wider range of services and treatment options, the gap between primary and secondary services as well as both an individuals health and social care needs can be filled (Gregory, 2009, pg8, online).This service improvement aims to improve the health and social care needs of individuals with mental health illnesses in the community. However, not only are there barriers in place that service users must overcome to access primary care services there remains a lack of collaborative working between health and social care services. This has consequences on the service user and other professionals involved in their care denying the individual of adequate holistic care. Professional s from different areas such as nursing and social work may be bound by differing statutory obligations which can affect their decision making and the care they provide. Starting with the professional body they are registered with as a professional such as the Royal College of Nursing (RCN) or the Health and Care Professions Council (HCPC), these give professionals a value base they must work from and develop continuously.Legislation also has a huge impact on a professionals decision making, for example the Mental Health Act (MHA, 2007). The law determines what a professional can and cannot do in a crisis situation. If a mental health nurse was based in a GP surgery they will have specialist training and awareness of the limits of their role determined by the MHA (2007), such as a patient being sectioned. They will be aware of who to contact if a patient is causing danger to themselves or others and need more qualified mental health care. If the mental health nurse was an Approved M ental Health Practitioner they could even have a role in detaining patients especially if a GP within the surgery was specially trained under the MHA (2007). This would save a lot of time and distress to individuals in crisis, members of the public and staff members.There are other noticeable inconsistency between health and social care and thestandards of care provided. Social work would traditionally take a service-led approach to care whereas nursing has become more person-centred and individualised (SCIE, 2010, online). By using a person-centred approach the specific health and social care needs of patients with mental health issues are addressed (Hall et al, 2010, pg178). The service user is the centre of emphasis and care and support is planned around their specific needs. This is essential when caring for an individual with mental health issues as each condition, symptom and experience is different. Enabling an individual to be fully involved in every aspect of their care a nd make fully informed decisions regarding their treatment and social options.Continuity of care and compulsory therapeutic relationships are essential when making an individual feel valued and at ease, allowing them to feel comfortable and more willing to engulf with professionals. An individual with mental health issues may feel anxious about attending their GP surgery and may need motivation or encouragement to do so. Having a therapeutic relationship with a particular professional within that surgery could reduce a persons anxiety levels (Kettles et al, 2002, pg64). The chosen service improvement would be useful for this spirit as a mental health nurse based within a GP surgery could build positive relationships with patients enabling them to develop trust and engage with services and professionals.The mental health nurse would also take into account both the health and social care needs of the patients, decreasing the GPs workload and saving the practice money in the long ru n. They would also ensure the needs of the individual are fully met as satisfactorily as possible within primary care services or id required could refer them to the most suitable services available to them for their condition and needs. Whether they be health or social care needs. However this service improvement would only be successful with the cooperation and collaboration from GPs within the surgery. Joint decision making would be required as well an equal league between GP and mental health nurse.The Personalisation agenda (Social Care bring for Excellence, 2010, online) (SCIE) emphasises the need for integrated working, and the need for involvement from a wide range of services, such as health, social care, housing, transportation and leisure, to ensure service users receive aholistic, consistent and continuous care mail boat (SCIE, 2010, online). The service user is put first rather than the service. This creates a person-centred rather than a service-led approach. A prio rity of the Health and Social Care crest (2011) is improving consolidation within services. The Bill strives to provide better partnership, integration and collaboration across the government and all NHS services (DoH, 2011, pg1, online). There is evidence to suggest that desegregation health and social care services saves a substantial amount of money (DoH, 2011, pg2, online). However in the current government climate there are financial pressures which may cause a barrier to effective integrated working (DoH, 2011, pg1, online). All aspects of the patient transit could benefit from effective integrated working resulting in a positive experience and all needs being met.The suggested service improvement of a mental health nurse in a GP surgery supports integration as there would be a variety of professionals within one building making multi-disciplinary team meeting easier to arrange and articulate decisions could be made quickly. However there are barriers to integrated workin g including the breakdown of communication between staff and different organisations having a detrimental effect on patients (Trevithick, 2009, pg123). However by working in partnership there is a reduced need for specialist services ultimately cutting costs and having a positive effect on many other aspects of an organisation. Such as boosting staff moral and enhancing patient experience (Erstroff, 2010).If barriers to integrated working can be overcome more adequate care can be provided overall. A dual qualified practitioner in a GP surgery would be ideal allowing both health and social care needs to be addressed working in partnership with outside agencies and with patients to gain the best results, without the need for two professionals. It has been stated that services need to detect early signs of individual distress by working closely with primary care (Norman & Ryrie, 2009, pg172-173). By integrating the skills required in a mental health nurse and a social worker a more ho listic approach can be taken.The introduction of community care impacted on diverse professions including general practitioners, social workers and nurses (Malin et al, 1999, pg158). Nurses have become increasingly em positioned over time and have become more involved in perpetration alongside GPs. Within General practice more of a barter for/provide relationship has been established (Malin et al, 1999, pg 159). GPs now have more power and control with funding and choice in the care they provide. However social workers may have felt deskilled by the purchase/provide set apart (Malin et at, 1999, pg 159). The cultures of each professionals organisation could cause conflict among a team. Employing a dual qualified social worker and mental health nurse in a GP surgery would eliminate the peril of conflict. It would become the responsibility of the dual qualified worker and the GP to work in partnership. There is evidence to support the need for the chosen service improvement. Menta l health services are improving and developing continuously despite government cuts to funding, reflected in No decisions about us without us (DoH, 2012, pg6, online).The document states that primary care services, specifically GPs who play a part in supporting those with mental health issues are not making a difference to the mental health of their local communities. This creates an opportunity for the role of a mental health nurse to develop. The Care Services receipts Partnership (CSIP, 2006) suggest that nurses are capable of delivering services within primary care settings as they have acquired the specialist knowledge to do so (Norman & Ryrie, 2009, pg 651). There is a need to modernise, develop and integrate services, primary care being a target area. The suggested service improvement would be cost effective and would provide early community intervention also move individual and family distress. Integrated working is an essential component in developing health and social ca re services (Trevithick, 2009, pg109).In conclusion there remains a need for improvements in the health care provided by primary care services to those with mental health issues. Statistics show that primary care services are the first point of contact for many individuals developing a physical or psychiatric condition (DoH, 2012, pg 6, online). The introduction of a mental health nurse into a GP surgery promotes integrated practice and modernises NHS services (DoH Factsheet, 2011, pg1, online), enhancing patient experience. There is evidence to show that this is an already effective role.Primary mental health workers have been introduced in Children and Adolescent Mental Health Teams (CAMHS) supporting colleagues in primary care services providing crisis intervention and contacts to specialist services (Norman & Ryrie,2009, pg543). Primary care mental health Graduates have also been implemented in parts of capital of the United Kingdom providing a range of interventions (Norman & R yrie, 2009, pg 457). The suggested service improvement of a mental health nurse in a GP surgery would benefit the mental health service user population enormously. If the depicted object Service manikin mental health standards (NSF, 2012, online) are to be met mental health promotion within primary care must be a focus (Newell& Gournay, 2009, pg 257).ReferencesBarbour, A. (1995) Caring for Patients A Critique of the Medical Model. California, Sanford University Press.Estroff, J. (2010) Effective teamwork Practical lessons from organisational research. capital of the United Kingdom Blackwell Publishing.Hall, A. Wren, M & Kirby, S. (2010) Care planning in mental health Promoting recovery. Blackwell Publishing. Oxford.Kettles, A. Woods, P & Collins, M. (2002) Therapeutic interventions for forensic mental health nurses. London Jessica Kingsley Publications.Malin, N. Manthorpe, J, Race. D & Wilmot, S. (1999) connection care for nurses and the caring professions. Philadelphia Open Univ ersity Press.Nash, M. (2010) Physical health and well-Being in mental health nursing Clinical skills for practice. England Open University Press.Newell, R. & Gournay, K. (2009) Mental Health Nursing An evidence based approach. Philadelphia Churchill Livingstone Elsevier.Norman, R. & Ryrie, I. (2009) The Art and Science of Mental Health Nursing A textbook of principles and practice. Berkshire Oxford University Press.Trevithick, P. (2009) Social work skills A practice handbook. (2ndEdition). England Oxford University Press.Wilson (1997) Cited in Handy, C. (1993) Understanding organizations. Penguin Books Ltd. Middlesex. England.P.T.O.Online resourcesBuetow, S. & Roland, M. (1999) Clinical governance bridging the gap between managerial and clinical approaches to quality of care, Quality in health care (8) 184-190 http//www.clinicalgovernance.scot.nhs.uk/documents/184.pdf Accessed on 28/01/2013Care Service Improvement Partnership (2006) Designing Primary Care Mental Health Services Guid ebook. London DoH. http//collections.europarchive.org/tna/20090610005017/http//dhcarenetworks.org.uk/BetterCommissioning/Commissioninge-book/ Accessed on 02/02/2013Department of Health, (2012) National Service material standards for mental health. London DoH. http//www.eguidelines.co.uk/eguidelinesmain/external_guidelines/nsf/mentalhealth_nsf.htmNational_Milestones Accessed on 02/02/2013.Department of Health, (2012) No decisions about us without us A guide for people who use mental health services, carers and the public, to accompany the implementation framework for the mental health strategy. London DoH http//www.mind.org.uk/assets/0002/1266/No_decision_about_us_without_us.pdf Accessed 01/02/2013Department of Health, (2012) No Health without Mental Health A Guide for General Practice. London DoH http//www.dh.gov.uk/en/Healthcare/MentalHealthStrategy/index.htm Accessed 04/01/2013Department of Health, (2011) Health And Social Care Bill Factsheet. C3 London DoH.http//www.dh.gov.uk/he alth/files/2012/02/C3-Promoting-better-integration-of-health-and-care-services.pdf Accessed on 01/02/2013Department of Health, (2011) No Health without Mental Health A cross government mental health outcomes strategy for people of all ages- a call to action. London DoH. http//www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123990.pdf Accessed on 31/01/2013Department of Health, (2011) The NHS Outcomes Framework 2012/13. London DoH http//www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131723.pdf Accessed 10/01/2013Department of Health. (2009) Response to hearing on the Framework for Registration of Health and Adult Social Care Providers and Consultation on Draft Regulations. London DoH.www.dh.gov.uk/en/Consultations/Liveconsultations/DH_096991Accessed on 28/01/2013Department of Health. (2008). The Future Regulation of Health and Adult Social Care in England A consultation on the framework for the registration of health and heavy(p) social care providers Partial Impact Assessment on Primary Care. London DoH. www.dh.gov.uk/en/Consultations/Closedconsultations/DH_083625 Accessed on 28/01/2013Department of Health. (2001) Making it Happen A guide to delivering health promotion (Pg 54). LondonDoH. http//www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/dh/en/documents/digitalasset/dh_4058958.pdf Accessed on 31/01/2013General Medical Council (GMC). (2009) Licensing and Revalidation. www.gmc-uk.org/about/reform/index.aspAccessed on 28/01/2013General Medical Council (GMC). (2006) Good Medical Practice. http//www.gmc-uk.org/static/documents/ national/GMP_0910.pdfAccessed 10/01/2013Gregory, S. (2009) General Practice in England An overview. London The Kings Fund. http//www.kingsfund.org.uk/sites/files/kf/General-practice-in-England-an-overview-Sarah-Gregory-The-Kings-Fund-September-2009.pdf Accessed on 28/01/2013The Health and Social Care Act (2012)http//www.legislation.gov.uk/ukpga/2012/7/contents/enactedA ccessed on 01/02/2013Knapp, M., MacDaid, D. & Parsonage, M. (2011) Mental Health Promotion and Mental Illness Prevention The Economic case.London DoH. http//eprints.lse.ac.uk/32311/1/Knapp_et_al__MHPP_The_Economic_Case.pdf Accessed on 12/01/2013Lakhani, M., Baker, M & Field, S. (2007) The Future Direction of General Practice A Roadmap. Royal College of General Practitioners, London, 1-84 http//www.rcgp.org.uk/policy/rcgp-policy-areas//media/Files/Policy/A-Z%20policy/the_future_direction_rcgp_roadmap.ashx Accessed 10/01/2013Mental Health Act (2007).http//www.legislation.gov.uk/ukpga/2007/12/contentsAccessed 02/02/2013MIND. (2011) Time To Change Wales Mental Health First Aid Training (MHFAT). Wales MIND. http//www.mhfa-wales.org.uk/youth/en/course-details/the-ymhfa-action-plan.htm Accessed 10/01/2013MIND. (1996) Not just sticks and stones A survey of the stigma, taboos and discrimination experienced by people with mental health problems. London MIND. http//www.leeds.ac.uk/disability-s tudies/archiveuk/MIND/MIND.pdfAccessed 28/01/2013NHS Direct. (2011) NHS Direct Business Plan 2011/12-2015/16. http//www.nhsdirect.nhs.uk/About//media/Files/FreedomOfInformationDocuments/OtherFreedomOfInformationDocuments/201106201_NHS%20Direct%20Business%20Plan2011-16.ashx Accessed on 28/01/2013NHS Direct (2011) pagan changes in the NHS.http//www.institute.nhs.ukAccessed on 31/01/2013Phelan, M., Stradins, L., Morrison, S. (2001) Physical health of people with consummate(a) mental illness. British Medical Journal. 322 443-444. http//www.ncbi.nlm.nih.gov/pmc/articles/PMC1120844/Accessed 31/01/2013Rost,K., Nutting, P., Smith, J., Werner, J & Duan, N. (2001) Improving depression outcomes in community primary care practice A randomised trial of the QuEST Intervention. Journal of General Internal Medicine 16(3) 143-9. http//www.ncbi.nlm.nih.gov/pmc/articles/PMC1494878/Accessed on 01/02/2013Scally, G & Donaldson, J. (1998) Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317(7150) 4 July pp.61-65. http//webarchive.nationalarchives.gov.uk/20081112112652/bmj.com/cgi/content/full/317/7150/61 Accessed on 28/01/2013Social Care Institute for Excellence, (2010) Personalisation A rough guide. London SCIE http//www.scie.org.uk/publications/reports/report20.pdfAccessed on 31/01/2013South Tees NHS bag Trust. (2013) Clinical Governance What is Clinical Governance? Harrogate Mixd.