Commissioning us - Primary Care
Mental Health Facilitation
The need to manage severe mental illness in primary care
GPs often don’t feel confident providing adequate support to patients with severe mental illness. This patient group tend to present frequently to their GPs but really need support from a skilled mental health professional. The economic case for primary care mental health is strong with evidence that it can reduce the cost of welfare dependency and improve the management of chronic diseases.
How can we help
We worked with GPs in Leicestershire to design an innovative service to manage people with severe mental illness in primary care. GPs on the Leicestershire IAPT Consortium Board recognised that, as well as patients with anxiety and depression, there are other patients with mental illness whose care either did or should take place in primary care. As part of the Good Thinking service, we work with Assura Leicestershire LLP practice based commissioning group and Leicestershire Partnership Trust to develop and deliver specialist support in primary care.
Who the service is for
Together with our partners we address the needs of patients with non-psychotic and chaotic and challenging disorders (care cluster 8). These patients are often unreachable by secondary care but present frequently to their GPs i.e. adults aged 16 and over who may be developing a severe mental illness. We also support adults on the Severe and Enduring Mental Illness register (care cluster 11). These people have non organic conditions with a diagnosis of psychosis, schizophrenia or bi-polar disorder, and / or are taking anti-psychotic medication or prescribed lithium.
What we do
We offer regular clinics in GP surgeries and home visits. We provide a review of a patient’s mental state, any psychiatric medication and give appropriate evidence based interventions as well as carrying out annual physical health checks. We also provide advice and assistance for non urgent assessments and for those who do not meet the service criteria, we signpost to other services and refer to carers’ services.
We work with the primary care teams to determine, on a practice by practice basis, how the overall aims of the service can best be met. Our staff carry out individual work with identified patients, work with practice nurses to help SEMI registered patients receive generalist care, work on mental health reviews, supporting GPs with chaotic patients unsuitable for secondary care or supporting patients awaiting a CMHT (Community Mental Health Team) assessment.
How the service works
The service works by offering everyone on the Mental Health Register an appointment for an annual mental health review carried out by our staff attached to the GP surgery. The review will identify any social, occupational, psychological and health promotion needs. If under a CMHT, we will liaise with the appropriate worker or the Consultant. The aim is to help people access primary care services through encouraging attendance for a physical health check at least once a year. The person is assisted in working towards their own recovery by promoting social inclusion and encouraging the use of community resources.
Benefits for GPs
- High quality, regular mental health reviews for patients with severe and enduring mental illness (including those under secondary care).
- Reviews take place in primary care and in consultation with other members of the primary care team so that a patient’s physical needs (e.g. diabetes, hypertension, metabolic syndrome) and mental health needs (antipsychotic medication) are not dealt with as separate issues.
- Outreach monitoring of stable patients with psychosis (care cluster 11) who might otherwise not wish to engage with the surgery.
- Our member of staff is part of the primary care team who can offer advice and information to GPs on the management of chaotic patients and frequent attenders (care cluster 8).
A comparison of Quality and Outcomes Framework (QOF) achievement in the year before and after the implementation of the MHF service shows an increase in four out of five of the mental health indicators in Leicestershire County and Rutland.
In the year after the implementation of the MHF service (09/10) Leicestershire County and Rutland was the highest performing PCT across the region for indicator MH09: “The percentage of patients with schizophrenia and bipolar affective disorder and other psychoses with a review recorded in the previous 15 months. In the review there is evidence that the patient has participated in routine health promotion and prevention advice appropriate to their age and health status”.
This service is value for money with the cost in year one at £541,450 for twelve staff, rising to £821,247 in year two for an additional seven staff.
Training: Make your Practice mental health friendly
This training has been designed to acknowledge the little time and resource we have available. By providing the short bursts of information it will also help us to consider mental health as well as physical health problems when caring for patients – bringing us closer to that crucial parity of esteem between the two.
Clare Gerada, RCGP Chair
The need for supporting professionals in primary care
Mental health problems affect us all – whether we experience them ourselves, or through patients, colleagues or friends and family. Primary care is the point at which most people with mental health problems access services and support.
‘Make Your Practice Mental Health Friendly’ is bite sized training in mental health for busy primary care staff. It includes a ten minute training appointment delivered in the practice, by a trainer with direct experience of receiving mental health care from their local general practice. Evaluation of the training showed that there was an overall statistically significant improvement in attitudes following the face-to-face training, with a 35% increase in confidence about working to promote mental health.
- 1 in 4 people will experience a mental health problem.
- 9 in 10 people with a mental health problem are just seen in primary care.
- 7 in 10 GPs say more people are coming to see them with mental health problems.
To watch a video about our GP Training, or to register an interest visit www.ttcprimarycare.org.uk
Need practical advice & info? We can help.
Contact our Advice team about mental health & related issues
0300 5000 927 Monday - Friday 9.30am - 4pm, not including bank holidays