1. Adult Protection and the Mental Capacity Act – A GP Perspective Dr Will Drever

2. The Mental Capacity Act Boring? Irrelevant? Unknown?

3. Aims and Objectives Introduction Reasons for my involvement Clinic Case Questions Discussion

4. Introduction GP Partner (Hawkesley, B’ham) Trainer / TPD South B’ham VTS Clinical Lead for Diabetes (BSC CCG) Practice lead for mental health Only formal psychiatry training :6 months SHO Not Section 12 Approved.

5. Reasons for my involvement Personal experience Specific case of Service User Serious Case Review : ‘Case A1’ Coroners Court Outcomes and recommendations Lack of GP knowledge Questions still unanswered

6. Clinical Case Service User : A.D. (deceased) 35y male Caucasian Schizophrenia + Learning difficulties Carer Mother Medical problem : gangrene of the feet Medical input : DNs x 6, GP x 4, Psych x 2, Home Treatment Team, TVN, Podiatry

7. Clinical Case : Key Issues Pt refusing hospital admission Mother with morbid fear of hospitals Potentially life threatening medical problems Psychiatric diagnosis clouding issues Deemed “no signs he lacked capacity” GP and DNs not aware of Mental Capacity Act Never seen without Mother Never formally assessed under MCA

8. Clinical Case : Chronology of events Treated for gangrene over 3 years (06-09) Reviewed by DNs > 100 times Review by GPs > 15 times Reviewed by Psych x 3 times Admitted eventually in septic shock “Life saving” surgery: never recovered Died before capacity was formally assessed Corners Court Case / Serious Case Review

9. Clinical Case : Outcomes Verdict : Death by natural causes Neglect of duty of care on all parties Recommendations raising awareness of MCA PCT wide training offered to all staff Formal training of GPs in our practice Raised profile of Vulnerable Adults Team Personal learning

10. Questions: re case Would the same thing happen again today? If deemed to have Capacity what next? If deemed not to have Capacity what next? What would least amount of force look like? Has MCA been used in other cases like this? What was the best good for A.D. ?

11. Discussion Any questions?

12. Thank you