1. Dr Peter Graves Chief Executive Bedfordshire & Hertfordshire LMC Ltd Pastoral Care for sustainable General Practice

2. Case 1 48-year old female GP Progressively taken on more and more responsibility and therefore stress Self-prescribing Beta-blockers under a patient’s name Referred to psychiatrist by LMC Suspended, referred to GMC dealt with as ‘Illness’

3. Roles of the LMC Statutory obligations* : – To consider a complaint from one GP about another and report the outcome – To make arrangements for a medical examination of a GP (*Paragraph 27 (1) Part 6 of the NHS (GMS Contracts) Regulations 2004)

4. Beds & Herts LMC Ltd 1400 GPs 235 practices Range of services Pastoral Care

5. Case 2 37-year old female GP, single mother with young dependent family Self-prescribing increasing doses of anti- depressants and up to 30 Zopiclone daily under a patient’s name Referred for detox and specialist drug addiction advice at ‘CRI’ Suspended, referred to GMC dealt with as ‘Illness’

6. Pastoral Care Team of 14 GPs Regular training and support sessions Specifically trained to identify mental health and addiction problems Patient Safety

7. Pastoral Care policies & procedures Contacting the office Maintaining confidentiality Full information about the policies and when confidentiality between carer and GP will be broken

8. Case 3 29-year old male GP with wife and newly born baby to support Working as locum, with minimal support Self-injecting opiates acquired from terminal patients Discovered almost comatose by practice nurse when he failed to start afternoon surgery Suspended by HA and GMC dealt with under ‘Fitness to practice’ Back at work now and practising with ‘conditions’

9. Interactions GP GP’s own GP Occupational Health GP’s practice NHS England Pastoral Care Specialist Care?

10. The Future – Our aspirations LEVEL 1 GPs – some with special training LEVEL 2 Specialist Service LEVEL 3 Secondary Care Occupational health LMC Pastoral care

11. Specialist Services? Confidential Accepts self-referral Multi-disciplinary assessment Appropriate treatment Full support back to work