Adult Protection and the Mental Capacity Act – A GP Perspective

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