Introduction

This document outlines the reasons why a patient may be discharged early from Psychiatry UK’s service. 

Its purpose is to clarify what is required of patients to ensure efficient and effective treatment and prioritise their safety and care.

Glossary of Terms

  • Discharge: Refers to the transfer of a patient’s care during or at the end of a treatment or service provided by Psychiatry UK. 
  • Disengagement: A lack of interaction from a patient on their online patient portal account. An interaction is classed as the completion of a form, attending an appointment or creating or responding to a note from a member of Psychiatry UK’s clinical or administrative teams. 
  • Regular engagement with Psychiatry UK’s service is essential to the delivery of safe and effective patient care. 
  • Episode of Care: A period of time during which a patient receives a specific type of service or treatment, e.g. the period up to and including the initial assessment; the period up to and including medication treatment; or other types of treatment interventions such as therapy sessions. 
  • Did Not Attend (DNA): If a patient does not attend an appointment, this is classed as a ‘Did Not Attend’ (DNA). (Please see more detailed guidance below.) 

Types of Discharge

Standard Discharge Procedure

  • Psychiatry UK will arrange to transfer a patient’s care back to their GP if no further treatment is considered appropriate by their clinician or prescriber at the end of an episode of care, e.g. at the end of their initial assessment or at the end of titration. 
  • A discharge will also be initiated if the patient requests to be discharged at any point during their treatment. If the patient is undergoing medication treatment, advice will be given on how to stop and dispose of any leftover medication safely. 

Early Discharge 

Patients may also be discharged from Psychiatry UK’s service at any point during their treatment journey for a number of different reasons (please see below). 

Declined Referrals 

A referral can be declined in accordance with our criteria at the point of triage by a member of Psychiatry UK’s administrative or clinical teams. In this case, Psychiatry UK will contact the patient via the patient portal or a letter, explaining the reason why their referral has not been accepted. They will also write to the patient’s GP. 

Reasons for Early Discharge 

Pre-Assessment 

Referral Process: Patients must not be registered with any other service while they are registered with Psychiatry UK. 

  • If a patient is referred to another provider or receives an assessment elsewhere, they will be discharged from Psychiatry UK’s service.  

Pre-Assessment Risk Screening: All patient referrals are screened and triaged to check that it is safe for the patient to be treated by an online company. 

  • A patient may be discharged if they are considered to be vulnerable or at risk of harm, or if it is felt they would be better suited to an in-person service. 

Change of location: Right to Choose is only available to those who are registered with a GP surgery in England.  

  • A patient will be discharged if they move to a different area and are no longer registered with a GP surgery in England, as they will no longer be eligible for Right to Choose.  

Information Requests (NHS/RTC Patients): Patients may be required to provide information such as risk assessments, identification verification, and pre-assessment forms before being able to schedule appointments. 

  • A patient may be discharged if they are not actively engaging with our service despite reminder notifications. 

Information Requests (Self-Pay Patients): Patients may be required to provide information as above. 

  • A patient who is registered with one of Psychiatry UK’s self-pay services may be discharged if they have not actively engaged for a period of 12 months or more. 

Pre-Assessment Checklist: All patients are required to complete a pre-assessment checklist, including updating their patient profile, uploading proof of identification and proof of address, and completion of pre-assessment forms to be eligible for booking an appointment. Reminder notifications are sent at 28, 56 and 105-day intervals. 

  • A patient may be discharged if they do not complete their pre-assessment checklist. 

Technology Requirements: Patients require access to the internet, and a device (e.g. computer, laptop or tablet). All appointments are undertaken online via the Microsoft Teams platform, where the patient’s camera and microphone must be switched on. 

  • A patient will be discharged if they do not agree to the use of Psychiatry UK’s online patient portal and/or online consultation assessments, including video and access to the internet, and use of email and a mobile phone. 

Zero Tolerance: Psychiatry UK believes that any act of aggression, violence or intimidation, either physical or non-physical, from any member of staff, patient, visitor or member of the public is unacceptable. Psychiatry UK is committed to the creation of a culture and environment where team members may undertake their duties without fear of abuse or violence. 

  • A patient will be discharged if they exhibit any such behaviours. 

Appointment Booking Process 

Booking Methods: Patients can book appointments through various methods, including online self-booking (self-pay patients), doctor or prescriber requests, or with assistance from administrative staff.  

Booking Link: Patients who are sent a ‘self-booking link’ will be required to book their own appointment from a list of doctors and their available appointments. 

Booking Reminders: A reminder notification is sent via SMS after 3 days if patients have not yet made an appointment. If an appointment is not made within 21 days of receiving the link, this may result in the patient being discharged. Follow-up appointment links expire after 42 days. 

  • A patient may be discharged if they do not use their booking link to book an appointment within 21 days (or within 42 days for a review or follow-up appointment). 

Follow-Up Appointments: A clinician may recommend that an additional follow-up appointment is required with the patient. 

  • A patient may be discharged if they decline or refuse a further appointment offered or requested by their clinician. 

Appointment Management 

Appointment Reminder Notifications: Patients receive automated email and SMS notifications regarding appointment booking links, appointment status and appointment reminders. 

  • Appointment reminders are sent 96 hours (via email) and 24 hours (email and SMS) before the appointment, with instructions and policy information. 

Appointment Rescheduling: An appointment may be rescheduled or cancelled via the MedQare patient portal. A new booking link will be sent out to book a new appointment.  

  • Patients can reschedule the same appointment twice within the same episode of care (e.g. Initial Assessment, or End of Titration Review) and will receive reminders of these rescheduling limits when attempting to cancel an appointment. 
  • If the appointment is due to take place in less than 48 hours, it will not be possible to cancel the appointment and it will be considered an Appointment Non-Attendance (DNA). 

Appointment Non-Attendance: Instances of patient non-attendance are recorded as a DNA (Did Not Attend) for the following reasons: 

  • A patient informs Psychiatry-UK that they will be unable to attend the appointment with less than 48 hours’ notice (e.g., due to sickness, emergency, or extenuating circumstances). 
  • A patient is unable to confirm their identity with photographic ID at the start of the appointment and has not provided it in advance. 
  • A patient attends in a location unsuitable for a confidential discussion (e.g., public space). 
  • A patient has technical difficulties that prevent the clinician from effectively carrying out the appointment. 
  • A patient will be discharged if they do not attend two appointments within an episode of care. 

Appointment Cancellation: Patients can cancel appointments through their MedQare account.  

  • A patient can only cancel the same type of appointment twice (e.g. Initial Assessment, End of Titration Review). The third appointment cannot be changed and if missed will be considered a non-attendance (DNA). 
  • A patient cancellation within 48 hours of the appointment will be considered a cancellation and a DNA. 
  • Appointments cannot be cancelled within 24 hours. Failure to attend will result in a DNA being recorded. 
  • A patient may be discharged if they: 
    • Cancel the same appointment more than twice during one episode of care. 
    • Cancel two Initial Assessment appointments within 48 hours, followed by non-attendance at the third appointment. 

Appointment Management (Self-Pay Patients) 

Rescheduling Appointments: Patients may reschedule an appointment by contacting Psychiatry UK’s customer support team via the Live Chat or telephone support line: 0330 124 1980 (Mon–Fri: 8am–6pm).  

Cancelling an Appointment: Patients may cancel an appointment by contacting Psychiatry UK’s customer support team via the Live Chat or telephone support line: 0330 124 1980 (Mon–Fri: 8am–6pm). If your cancellation is successful, you will receive an email confirmation. If you do not receive one, please contact us again. 

Appointment Non-Attendance (DNA): If a patient does not attend their appointment, this will be classed as a DNA. A new booking link will be sent automatically, and a new fee will be charged on booking a new appointment. 

Medication Treatment (ADHD Patients Only) 

 Preparation for Titration (medication treatment) 

Information Requests: Patients may be required to provide additional information about their GP, health or the results of any medical investigations requested by their doctor. 

  • A patient may be discharged if they: 
    • Are not actively engaging with our service despite reminder notifications.  
    • A medical investigation remains incomplete, or the results are outstanding, for more than 6 months.  
    • They do not attend an ECG appointment arranged with TeqDr. 

Location Request: Right to Choose is only available to those who are registered with a GP surgery in England.  

  • A patient will be discharged if they move to a different area and are no longer registered with a GP surgery in England and therefore no longer eligible to receive treatment under Right to Choose.  

Pre-Titration Checklist: Patients may be required to complete a pre-titration checklist, including updating their patient profile, uploading proof of identification and proof of address, and completion of pre-titration forms. Reminder notifications will be sent after 7, 14 and 21 days via email and SMS. 

  • A patient may be discharged if they do not complete their pre-titration checklist within 28 days. 

Prescriber Allocation: When a patient is allocated a prescriber, they will review the patient’s record to assess whether it is safe for the patient to start medication treatment.  

  • A patient may be discharged if their prescriber assesses that it would not be safe for them to start treatment due to a health risk or substance misuse. 

Consent to Start Treatment: Patients are required to read through their treatment plan and give their consent to start treatment. 

  • A patient may be discharged if they do not provide consent to start their treatment plan within 7 days of receiving their treatment plan. 

Titration Monitoring 

Throughout the titration period (12-14 weeks), the patient is required, for their own safety,  to complete regular monitoring forms with readings of their blood pressure, pulse and weight, record any side effects and score any improvements. 

  • A patient may be discharged if they: 
    • Do not submit a fortnightly monitoring form on 3 separate occasions. 
    • Do not actively engage with their prescriber for more than 14 days. 

Titration can be paused once during an episode of treatment, e.g. if a patient is going on holiday, working abroad, or has a medical procedure. This pause can be extended to up to 4 weeks. 

  • A patient may be discharged if they are unable to restart their treatment within 4 weeks (28 days). 

 End of Titration 

End of Titration Review: When the patient is stable on their medication, they will be requested to complete their End of Titration forms. 

  • A patient may be discharged if they do not complete their End of Titration Review Form within 7 days. 

 End of Titration Review Appointment: When these forms have been completed, the patient will receive a booking link to book an End of Titration Review (EOTR) appointment with their prescriber. 

  • A patient may be discharged if they: 
    • Do not use their booking link to book an EOTR appointment within 7 days. 
    • Do not attend 2 EOTR appointments. 

 Annual Review: Patients are required to attend an Annual Review while they are receiving ADHD medication. 

  • A patient will be discharged if they: 
    • Do not use their booking link to book an Annual Review appointment.
    • Do not attend 2 Annual Review appointments. 

If the decision is made to discharge a patient from the Titration Service, the patient will be fully informed about how to safely discontinue treatment and seek a re-referral, if this is something they would like to pursue.  

If the patient is re-referred to the service, they will be required to attend a review appointment with their doctor. If it is felt that treatment would still be appropriate, they will be re-allocated to the titration wait list.  

What does this mean for patients? 

Discharge From a Single Treatment Pathway 

A patient may be registered with more than one Psychiatry UK service. If discharged from one treatment pathway or episode of care, they can remain registered for other assessments or treatment in a different episode of care. 

This outcome allows the patient to continue receiving full access to their MedQare patient portal, so they will still be able to view invoices, assessment reports, clinic letters etc., and they will continue to be able to communicate with staff teams via the portal. 

 Full Discharge 

If a patient is fully discharged from all treatment pathways and Psychiatry UK has no further involvement in their care, the patient will be transferred back to the care of their GP or other primary care service. This means that if the patient is registered on different treatment pathways, they would be discharged from all services. 

This outcome allows the patient to have ‘Read Only’ access to their MedQare patient portal, so they will continue to be able to view invoices, assessment reports, clinic letters etc. However, they will not be able to communicate with Psychiatry UK staff via the portal. 

 Re-Referral 

Following discharge, if a patient wishes to return to Psychiatry UK for treatment, they can ask their GP to be re-referred. If their new referral is accepted, they will be entitled to continue their care. 

If you have any questions not covered in the above policy please check our FAQ section or use our ‘Live Chat‘ to speak to a member of our customer support team.