1. Dr Helen Drew (Barton House Group Practice) Helendrew@nhs.net
Depression Pathway
Dr Helen Drew (Barton House Group Practice)

2. Depression Pathway Aide-memoire of NICE Guideline CG90 (2009)
Reminder of new QOF targets
Summary of ICD 10 definitions of mild/moderate / severe Depression
Reminder of the range of local services available
Increase the prevalence reporting of depression locally

3. Read Codes and Prevalence
Currently our recorded prevalence of Depression in Hackney is 10% (compared to a London-wide prevalence of 7.5%)
We have double the London-wide average rate of Suicide.
(City and Hackney Joint Strategic Needs Assessment 2011/2012)

4. Screening?
Particularly consider elderly patients – strong links between depression and physical health problems , dementia, parkinsons.
The Nice guidelines emphasise the importance of screening; the screening element has been removed from QOF but it is still important to ask the question of our patients, particularly those who are elderly or who have physical health problems.

5. Intervention (mild to moderate depression)
The nice guidelines suggest low intensity interventions for those with mild depression. The initial interventions offered by the primary care psychology service in Hackney are often low intensity but can then be stepped up to higher intensity interventions.
The nice guidelines suggest that we shouldn’t be offering antidepressants as a first line in those with mild depression.

6. Primary Care Psychological Services!
Patients can self refer ( )
Appropriate for a wide range of patients, including as a first line treatment for mild depression, and with or without antidepressants in moderate depression.
Patients can be re-routed to other services without unnecessary delays if they need higher intensity input.
Primary care psychological services is a good first line treatment to offer for most of the patients who present with depression to general practice.

7. Intervention (Moderate / Severe Depression)
For patients who have physical health problems preventing engagement with face-to-face psychological intervention consider Telephone intervention, or antidepressants. (NICE)

8. Relapse Prevention

10. Breakout Groups Local Resources for people with Anxiety and Depression
Suggestions for the pathway – additions, changes?

11. Feedback....