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SummaryQuality improvement (QI) projects have been shown to positively influence patient care. They provide opportunities for trainees to present and publish their work locally and nationally, and to gain valuable leadership and management experience. We describe a pilot project to engage in QI trainees across a National Health Service trust and a school of psychiatry. After the first year of this programme over half of psychiatry trainees in the school (58% of core trainees and 47% of advanced trainees) are participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. Specialty doctors, consultants, foundation doctors, general practitioner trainees, medical students and the wider multidisciplinary team have all become engaged alongside trainees, working with patients and their families to identify problems to tackle and ideas to test.

Background Methadone maintenance treatment (MMT) in primary care settings is used increasingly as a standard method of delivering treatment for heroin users. It has been shown to reduce criminal activity and incarceration over periods of periods of 12 months or less; however, little is known about the effect of this treatment over longer durations. Aims To examine the association between treatment status and rates of convictions and cautions (judicial disposals) over a 5-year period in a cohort of heroin users treated in a general practitioner (GP)-led MMT service. Design Cohort study. Setting The primary care clinic for drug dependence, Sheffield, 1999–2005. Participants The cohort comprised 108 consecutive patients who were eligible and entered treatment. Ninety were followed-up for the full 5 years. Intervention The intervention consisted of MMT provided by GPs in a primary care clinic setting. Measurements Criminal conviction and caution rates and time spent in prison, derived from Police National Computer (PNC) criminal records. Findings The overall reduction in the number of convictions and cautions expected for patients entering MMT in similar primary care settings is 10% for each 6 months retained in treatment. Patients in continuous treatment had the greatest reduction in judicial disposal rates, similar to those who were discharged for positive reasons (e.g. drug free). Patients who had more than one treatment episode over the observation period did no better than those who dropped out of treatment. Conclusions MMT delivered in a primary care clinic setting is effective in reducing convictions and cautions and incarceration over an extended period. Continuous treatment is associated with the greatest reductions.

The article by Kennedy & Belgamwar1 nicely illustrates the importance of work experience in psychiatry for secondary school pupils. Unfortunately, this can be difficult to arrange in mental health trusts, despite recent guidance by the Royal College of Psychiatrists.2 Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) Medical Education Department recently joined forces with Bristol University to provide a week-long summer school event for local sixth-formers. This programme included 2 days of work experience with consultant psychiatrists and their teams as well as half a day with local general practitioners. This followed extensive work by AWP to change their work experience policy to allow 17-year-olds to participate. Our event consisted of taught sessions, similar to the programme detailed by Kennedy & Belgamwar, to help the sixth-formers explore what it might be like to be a medical student and doctor, as well as a session entitled ‘What is mental health?’. Our aim was to additionally support sixth-formers in their application to medical school and so we also provided sessions for personal statement advice and interview practice. We held an evening social event with an opportunity for parents and guardians to attend a question and answer session while the pupils watched and discussed a film related to psychiatry. A summer school competition was held encouraging pupils to write a reflective piece on their experiences of the week, for which they produced some excellent and thoughtful pieces of work. All pupils were allocated a mentor, either a medical student or trainee in psychiatry, to provide support before, during and following the event. Feedback from participants, parents and teachers has been very positive following our event, with pupils particularly valuing work experience, personal statement advice, interview practice sessions and being allocated a mentor. It was fantastic to hear them talking about their positive experiences of psychiatry during mock interview practice sessions. Encouragingly, 67% of our participants said that they would consider a career in psychiatry (‘strongly agree’ or ‘agree’) following the event. Kennedy & Belgamwar’s piece gives some excellent ideas for work experience programmes for secondary school pupils. I hope that more work experience and summer school programmes such as ours can be developed across the country, with the success and positive outcomes shown encouraging mental health trusts to lower their age limits for work experience to enable this.

Methadone maintenance treatment (MMT) in primary care settings is used increasingly as a standard method of delivering treatment for heroin users. It has been shown to reduce criminal activity and incarceration over periods of periods of 12 months or less; however, little is known about the effect of this treatment over longer durations.To examine the association between treatment status and rates of convictions and cautions (judicial disposals) over a 5-year period in a cohort of heroin users treated in a general practitioner (GP)-led MMT service.Cohort study.The primary care clinic for drug dependence, Sheffield, 1999-2005.The cohort comprised 108 consecutive patients who were eligible and entered treatment. Ninety were followed-up for the full 5 years.The intervention consisted of MMT provided by GPs in a primary care clinic setting.Criminal conviction and caution rates and time spent in prison, derived from Police National Computer (PNC) criminal records.The overall reduction in the number of convictions and cautions expected for patients entering MMT in similar primary care settings is 10% for each 6 months retained in treatment. Patients in continuous treatment had the greatest reduction in judicial disposal rates, similar to those who were discharged for positive reasons (e.g. drug free). Patients who had more than one treatment episode over the observation period did no better than those who dropped out of treatment.MMT delivered in a primary care clinic setting is effective in reducing convictions and cautions and incarceration over an extended period. Continuous treatment is associated with the greatest reductions.