Chamber and committees

Each of the professions listed will have varying degrees of contact with those who suffer from anorexia nervosa and therefore varying needs in the area of specialist training.General Practitioners (GPs)GPs are encouraged to look at their own personal learning needs (based on the principles of adult learning) and the needs of their patients. Each GP receives an annual Postgraduate Education Allowance to support an agreed amount of training in areas approved by the Deaneries. In the future, the appraisal process will assist GPs to identify their learning needs with the help of trained appraisers.Community NursesThere is no discrete specialist training in this area for community nursing. The specialist practitioner programmes for community nursing (community psychiatric nursing, public health nursing and district nursing) touch on the subject and students sometimes use the subject for a project and thereby study it in more depth, but this is at their own discretion. Nurses working in this highly specialised area would attend ad hoc specialist short courses, study days, modules etc, at their own or their trust's discretion.TeachersIt is the responsibility of local authorities to ensure that a wide range of continuing professional development opportunities is available for qualified teachers. Training aimed at equipping teachers to deal with issues relating to anorexia nervosa could be recognised as one such appropriate opportunity.Social WorkersThere are no set requirements for the inclusion of specific training in relation to anorexia nervosa as part of the Diploma in Social Work. Most courses, however, will have specific input on mental illness, and in many cases eating disorders will be covered to some degree. Practising social workers, especially those in adult community care teams and those working in psychiatric hospitals or community mental health teams, will be involved in working with persons with anorexia nervosa as part of a multi-disciplinary team. Specialist information and training will be available to those working in such settings.Social workers who have been practising for two years and have relevant experience are eligible for additional specialist training as Mental Health Officers to carry out specific functions under the Mental Health Act. This entails additional training of at least 60 days and will have a taught component of between three and four weeks. As part of the latter there will invariably be input in respect of anorexia nervosa and other eating disorders, especially as they may present complex ethical and legal issues in respect of treatment. PsychiatristsAs part of the theoretical training involved in the three years' experience required of junior psychiatrists before they sit the Membership of the Royal College of Psychiatrists examination, there will be extensive didactic teaching in eating disorders. In addition, especially in the area of general psychiatry, junior psychiatrists will have the opportunity to see, assess, and treat patients with eating disorders, under consultant supervision. This clinical experience will be expanded in the three years that general psychiatrists spend as Specialist Registrars (SpRs).Alongside this, SpRs will have the opportunity to develop a special interest in eating disorders - there is protected time in the SpR contract to allow such a special interest - and SpRs also have the opportunity to acquire skills in particular psychological interventions such as cognitive behaviour therapy. About 50% of SpRs are involved in some form of psychological intervention training.The training in the specific area of anorexia nervosa can be accessed through postgraduate deaneries as part of NHS Education for Scotland, The Royal Colleges of Psychiatry and General Practitioners and other providers such as voluntary agencies. A template for eating disorders was widely distributed to all board areas in October 2001. It offered a service profile/specification for the organisation of co-ordinated services and support for those with, surviving or developing an eating disorder (NHS HDL (2001) 75).

Information from a sample of general practices, selected as representative of Scotland as a whole, provides national estimates of patients seen by GPs. Using information from this national sample, the following table shows the estimated number of patients seen by a GP and recorded with an eating disorder diagnosis during the year specified, for Scotland. A health board breakdown is not available. Note that, in some cases, the same patient may be recorded in more than one year. Also note that, because the information is derived from a sample, caution is advised in interpreting trends across years.Estimated Number of Patients, with an Eating Disorder Diagnosis, seen by GPs in Scotland, 1999-2001¹, by Age Group and by Gender

	1999 2	2000 3	2001 4
Total	3,400	3,850	3,750
by Age Group
0-14 years	775	725	525
15-24 years	1,025	1,200	1,150
25-44 years	1,300	1,575	1,450
45-64 years	175	175	275
65 and over	125	175	350
by Gender
Males	650	450	450
Females	2,750	3,400	3,300

Source: Continuous Morbidity Recording (CMR), ISD Scotland.Notes:1. Patients seen more than once in the same year will only be counted once for that year. Patients could be counted once in each different year.2. Based on 51 practices, population 288,433, January 1999 to December 1999.3. Based on 55 practices, population 348,257, January 2000 to December 2000.4. Based on 60 practices, population 370,605, January 2001 to December 2001.

In terms of national initiatives, we have published guidance on the best organisation of eating disorder services, including specifically services and support for those with anorexia nervosa and bulimia nervosa.Wider national initiatives on mental health will also have an impact on awareness and investment in services, including not least the current and promised £4 million to promote positive mental health and well-being.

Deaths in Scotland are coded using the Tenth Revision of the World Health Organisation's International Classification of Diseases (ICD10). In 2000, some 2,300 deaths were coded to the "Mental and Behavioural Disorders" chapter of ICD10. The largest category, almost 1,400 deaths, was "Unspecified dementia".

The information held centrally is not detailed enough to identify all the costs in the treatment of schizophrenia.

The revision of Circular 2/98 Guidance On Issues Concerning Exclusion From School has been through an initial consultation process. Following further consultation, the final version will be issued at the beginning of the new academic year 2002-03. A copy will be placed in the Parliament's Reference Centre.

All of the recommendations of the Discipline Task Group Report were accepted. A timetable for implementation was published in December 2001 in the Joint Action Plan agreed with the COSLA, the Association of Directors of Education and the Association of Directors of Social Work. Recommendations 1, 5, 35 and 36 have been implemented in full by the Scottish Executive. Implementation of the remaining recommendations is in hand.

The Executive will be contacting local authorities in June 2002 to request information on the progress of those recommendations to be implemented by local authorities and schools.

A report is due to be published at the end of 2002. The review is being conducted in a consultative and participative manner and emerging findings will be communicated by a national conference on 14 June, at Strathclyde University, and followed up in a number of regional seminars in September/October 2002. Interim briefing on the first phase of the review is available at:www.show.scot.nhs.uk/phis.

Alternatives to exclusion funding since 1999 is as follows:

Authority	1999-2000(£)	2000-01(£)	2001-02(£)
Aberdeen City	175,032	277,553	350,065
Aberdeenshire	251,052	401,924	502,104
Angus	113,126	183,006	226,250
Argyll and Bute	93,133	149,666	186,266
Clackmannanshire	48,331	77,638	96,663
Comhairle nan Eilean Siar	38,354	61,357	76,709
Dumfries and Galloway	156,778	252,193	313,557
Dundee City	137,800	218,133	275,600
East Ayrshire	126,487	200,437	252,974
East Dunbartonshire	128,262	206,015	256,523
East Lothian	84,089	137,321	168,179
East Renfrewshire	104,126	168,714	208,252
Edinburgh, City of	319,854	515,407	639,709
Falkirk	136,925	220,012	273,851
Fife	352,406	565,108	704,812
Glasgow City	487,950	777,872	975,901
Highland	235,564	378,371	471,128
Inverclyde	88,180	139,826	176,359
Midlothian	84,826	136,930	169,652
Moray	91,981	146,811	183,962
North Ayrshire	142,794	227,563	285,587
North Lanarkshire	347,659	552,573	695,317
Orkney Islands	26,971	42,996	53,943
Perth and Kinross	125,326	200,447	250,651
Renfrewshire	179,703	287,748	359,406
Scottish Borders	107,029	171,473	214,058
Shetland Islands	32,148	51,735	64,295
South Ayrshire	116,706	185,414	233,411
South Lanarkshire	314,836	501,845	629,672
Stirling	85,016	136,776	170,032
West Dunbartonshire	103,451	164,554	206,901
West Lothian	164,105	262,582	328,211
Totals	5,000,000	8,000,000	10,000,000

Notes:(a) Local authorities can utilise the allocated funding according to their own discretion, providing funds are used in accordance with the intended purpose of the award, in this case in relation to alternatives to exclusion. The Scottish Executive does not hold detailed information on specific projects.(b) Funding is provided on an annual basis.

The published Clinical Standards Board for Scotland audit tool includes provisions to cover the very important user dimension. Further, £196,000 has been invested in the Scottish Schizophrenia Outcomes Study by the Clinical Resource and Audit Group. That study, involving all NHS Primary Care Trusts, will run until 2004 and includes the collection of user centred data for people with schizophrenia.