Mental health has long been the Cinderella service of the NHS. Whilst it is true that there has been increased attention recently paid to mental health issues which are “now firmly on the national agenda” [i], there is still extreme strain on NHS resources. One in four adults experience at least one diagnosable mental health problem per year with the figure for children between the ages of five and sixteen years being one in ten [i]. It is therefore unsurprising that round 40% of GP appointments involve treating patients struggling with their mental health [ii].
The relationships GPs have with secondary care are vital to provide the best mental health support for their patients. Below are five ideas of how primary and secondary care can work together effectively:
- Have regular forums to share knowledge and perspectives: whether this be informal lunches/coffees or formal case reviews/seminars, often clinicians on either side of the system are dealing with the same patients and trying to fix the same problems. Getting everyone together to cross-fertilize knowledge can only lead to better patient care.
- Protect training time to focus on mental health: out of 21 mandatory clinical modules that trainee GPs are required to complete, only one is focused on mental health [iv]. Added to this, fewer than half of GPs who trained in 2017 completed a psychiatry rotation during initial training [v]. Time is always in incredibly short supply, but given the workload mental health brings GPs, ongoing and protected time on mental health is vital. Secondary care clinicians are a useful resource to training GPs.
- Develop systems which enable transitions of care where no one falls through the gaps (into and out of secondary care): stepping patients down back into primary care can be a challenging time for everyone involved. Robust systems and processes so that patients don’t endlessly bounce back and forth include clearly defined care pathways, agreed levels of care criteria, so everyone is in agreement on the clinical criteria for step-down, and easy re-access to a care coordinator should a patient need further specialist assessment or treatment.
- Create shared care prescribing: many mental health conditions often require complex polypharmacy prescribing. Creating shared care prescribing between primary and secondary care especially for CAMHS patients will generally reduce the time patients and their families are waiting for treatment.
- Work more with third sector organisations: increasing social prescribing within primary care to support non-medical issues which have a huge impact on people with mental health problems, such as housing, social isolation/loneliness, jobs and managing money. There are some great examples of services which CCGs have commissioned to support these issues locally within primary care.
How has Consultant Connect helped?
Rapid Mental Health Telephone Advice & Guidance from specialists at Oxleas NHS Foundation Trust has been available to primary care clinicians in Greenwich since September 2018. GPs and other healthcare professionals are able to get referral advice for working age adults and older adults. We went to Greenwich to find out what clinicians and commissioners think. Watch the video below to find out how the service is having a positive impact in this area.
Some areas who use the National Consultant Network also have access to mental health medication advice from a team of specialist pharmacists at a London Trust. Primary care clinicians in these areas are able to obtain advice on the best medication for patients of all ages and calls connect in 15 seconds on average. Timely advice in this way means that patients often avoid a trip to hospital.
- [i] The Kings Fund (2019), https://www.kingsfund.org.uk/projects/positions/mental-health
- [ii] Mind https://www.mind.org.uk/news-campaigns/news/40-per-cent-of-all-gp-appointments-about-mental-health/#.Wxj4ay2ZMnU
- [iv] The Independent (2018) https://www.independent.co.uk/life-style/gp-appointments-mental-health-half-patients-mind-research-depression-anxiety-a8387396.html
- [v] Mind (December 2017 – March 2018) https://www.mind.org.uk/media/30975560/gp-mh-2018-survey-summary.pdf