Medically Unexplained Symptoms /Somatic Symptom Disorder: National Summit 2017

This important and timely conference will support delegates to better understand and meet the needs of people with medically unexplained symptoms/somatic symptom disorder. 

The summit follows on from a similar popular event held in London at the end of 2016, and will provide a networking and learning forum for leaders and practitioners in the field of somatic symptomdisorder. Through national updates, extended sessions and practical case studies the Summit will bring together leading practitioners in this area, and focus on developing a holistic integrated service, improving the management of people in primary care, evaluating the Stepped Care Model and Learning from the National Pathfinders, developing nurse led services, commissioning services and looking ahead to the future of care for people with medically unexplained symptoms.

The Tavistock and Portman NHS Foundation Trust has substantial experience in developing and implementing integrated, GP based primary care services focusing on MUS .Their Hackney PCPCS (Primary Care Psychotherapy and Consultation Service) has won numerous national awards, and a Health economics evaluation in 2015 showed that it produced excellent “value for money”. Their TAP project (Team around the Practice) in Camden builds on this tradition and incorporates Social prescribing , in partnership with the VSO “Mind in Camden”. These services are amongst a number of pioneering approaches from throughout the UK, to be showcased at the MUS summit, all bringing new models, health economics data, outcome monitoring and patient involvement.

“A large number of people experience physical symptoms for which no clear biological cause can be identified. These symptoms are often chronic in nature (for example, persistent pain, tiredness or gastric symptoms); they can cause people significant distress, and often have an important psychological component. The terminology used to describe these symptoms is a subject of debate. For these difficult-to define problems, applying a clear diagnostic label (mental or physical) can be inappropriate, and a biopsychosocial approach towards management is particularly important.

The concept of medically unexplained symptoms can also include people who have a physical condition but experience symptoms at a level that is disproportionate to the severity of that condition. Medically unexplained symptoms are more common than is often recognised, and people experiencing them are typically referred for multiple investigations and assessments, at considerable expense to the system and with little or no benefit for the patient. The NHS in England is estimated to spend at least £3 billion each year attempting to diagnose and treat medically unexplained symptoms"

Bermingham et al 2010.

Much of this expenditure currently delivers limited value to patients; at worst, it can be counterproductive or even harmful.. Poor management of medically unexplained symptoms can have a profound effect on quality of life. People with such symptoms often experience high levels of psychological distress as well as co-morbid mental health problems, which can further exacerbate their medical symptoms (Henningsen et

al 2003; Kroenke et al 1994). More than 40 per cent of outpatients with medically unexplained symptoms also have an anxiety or depressive disorder (Nimnuan et al 2001). Chronic pain can worsen depressive symptoms and is a risk factor for suicide in people who are depressed.

Patients with medically unexplained symptoms account for an estimated 15 to 30 per cent of all primary care consultations (Kirmayer et al 2004) and GPs report that these can be among the most challenging consultations they provide. Medically unexplained symptoms also account for a significant proportion of outpatient appointments – in one study, accounting for more than 20 percent of all outpatient activity among frequent

attenders (Reid et al 2001). In primary care, some of the 'The case for change: 10 areas where integration is needed most' biggest challenges are related to patients with a mixture of medically unexplained symptoms and poor adjustment to a long-term physical health condition, leading to disproportionate symptoms and medication use for the long-term condition. The annual health care costs of medically unexplained symptoms in England were estimated to be £3 billion in 2008/9, with total societal costs of around £18 billion (Bermingham et al 2010). 

“People with medically unexplained symptoms, …and those with complex mental health problems frequently get ‘bounced’ around the NHS, passed from one service to another, none able (or willing) to offer them the flexible, personalised and sometimes time consuming support they require.”

Managing Patients with Complex Needs, The Centre for Mental Health