GP-based care breaks down barriers between physical and mental health
Case study summary
Specialist mental health practitioners are providing enhanced support for patients in all GP practices across Cambridgeshire and Peterborough. The Primary Care Mental Health Service ensures patients can talk to mental health professionals in the familiar environment of their own GP practice.
Covering all GP surgeries in Cambridgeshire and Peterborough, the Primary Care Mental Health Service ensures patients can access prompt advice and support for both their mental and physical health needs in a familiar community setting. The integrated nature of the service sees GPs, specialist mental health practitioners, recovery coaches, peer support, social care and third sector staff working in partnership to provide overall care for the patient. The service was launched fully in December 2017 and focuses on people aged 17 to 65 with mental ill-health. Promoting early assessment, treatment and onward referral in the community, the core specialist mental health service is provided by Cambridgeshire and Peterborough NHS Foundation Trust (CPFT).
A patient requiring routine, planned care or assessment will initially see their GP who will seek advice from the Primary Care Mental Health Service, or use an electronic referral system to arrange for the service to contact the patient. The service will arrange a face-to-face assessment or give the patient advice by phone. If they are in mental health crisis they will be supported by the trust’s First Response Service. The patient meets Primary Care Mental Health Service staff in his or her local GP surgery, meaning they are in a familiar environment and travel is reduced. Each GP practice in Cambridgeshire and Peterborough has clinical space for practitioners to run clinics on designated days during the week. Senior clinicians are also available to see people with complex presentations.
The location was good in terms of a short travel time and the familiar setting helped reduce my anxiety. The practitioner listened to my problems and explained how she could help and what the plan would be. She was approachable, easy to get on with and I felt comfortable telling her things I wouldn’t tell many other people.
Steve, Primary Care Mental Health Service user
Prevention and early intervention
Patients are supported to focus on achievable goals and where appropriate access local community resources. The service aims to move away from purely medical to evidence-based treatment, care and support where prevention and early intervention are key.
Ree Wood, manages the Primary Care Mental Health Service. “The service promotes a patient-centred joint approach to physical and mental health, and supports patients to step down from specialist mental health services. Patients’ social care needs are also considered as part of this integrated approach,” Ree said. “Our new service has rolled out in phases across the county over 18 months. Our mental health teams, GP practice staff, social care staff, Cambridgeshire and Peterborough Clinical Commissioning Group, and third-sector colleagues have worked tirelessly to get the service embedded in primary care.”
As part of the service consultant psychiatrists offer ‘virtual clinics’ to GP practices, offering guidance to primary care staff on mental health presentations. A CPFT consultant psychiatrist said: “I have been visiting the surgeries in my patch every eight to 12 weeks to meet with the GPs and discuss patients they are concerned about, but also to do some short talks on relevant topics such as prescribing in personality disorders and strategies for drug treatment of depression. Referral numbers from these surgeries have decreased and GPs report they are keen for us to continue visiting as they find it educational and supportive.”
Steve – not his real name – was offered an appointment with the Primary Care Mental Health Service when he consulted his GP over self-harming behaviour and suicidal thoughts which he linked to factors including childhood trauma. He was seen promptly by his GP which prevented his mental health from deteriorating further into crisis.
“I was offered an appointment with the Primary Care Mental Health Service team at my local surgery,” he explained. “The location was good in terms of a short travel time and the familiar setting helped reduce my anxiety. The practitioner listened to my problems and explained how she could help and what the plan would be. She was approachable, easy to get on with and I felt comfortable telling her things I wouldn’t tell many other people. The practitioner gave me some sound advice and there was enough time in the consultation to cover everything.”
It was agreed Steve would self-refer to Mind to access group talking therapy. He said he understood the plan drawn up jointly with the mental health practitioner and was happy with the outcome. He rated the Primary Care Mental Health Service as “excellent”. “I feel in a strong position to move forward and feel more positive about returning to work,” he added.
A model for other NHS trusts
CPFT’s Director of Operations, Julie Frake-Harris, added: “Our Primary Care Mental Health Service is quite unique in the country and we have received a lot of attention from other NHS Trusts who are looking at our model.” She said key to setting up the service had been forging strong, trusting relationships with primary care colleagues, commissioners, third-sector organisations and community groups. Clarity around expectations of the service had been important in building relationships, integration and ensuring sustainability. Julie added: “There has been a need for a wholesale culture change across all sectors which we have addressed in a phased programme. Culture change is ongoing.”
An evaluation report (November 2018) by an independent consulting company into the impact on different groups said the Primary Care Mental Health Service “is a value-adding addition to the mental health support landscape in Cambridgeshire and Peterborough”. York Consulting highlighted a range of positive feedback following interviews with GPs, patients and mental health staff:
- the service is making a positive contribution to patient wellbeing and the management of mental health conditions
- the service is helping to break down barriers between primary and secondary care, and between physical and mental health provision
- patients not having to access secondary care and getting the support they need in primary care
- shorter waiting times for patients accessing the service and high levels of patient satisfaction.
The consultancy said the findings were “testament to the hard work that has gone into the design and day-to-day delivery of the Primary Care Mental Health Service.”
Cambridgeshire GP Emma Tiffin is the Clinical Mental Health Lead for the county’s Sustainability and Transformation Partnership. She said the Primary Care Mental Health Service is designed to ensure a seamless pathway for patients and a sustainable mental health system for the long-term. “Quality care and good patient outcomes are key to what the Cambridgeshire and Peterborough mental health system aims to deliver and this evaluation supports our aims,” she said.
Mental health is a priority for the NHS over the next 10 years, with the ambition to deliver high-quality mental health care for everyone, when and where it’s needed. Under the NHS Long Term Plan people with moderate to severe mental illness will access better quality care across primary and community teams, have greater choice and control over the care they receive, and be supported to lead fulfilling lives.
Further information: Cambridgeshire and Peterborough NHS Foundation Trust: Primary Care Mental Health Service.