In this article, our Mental Health Lead, Jenny Welling-Palmer, looks at some simple ways that clinicians can work together to deliver improved Mental Healthcare.
Mental health has long been the Cinderella service of the NHS. Only 11 per cent of the NHS budget is spent on mental health services, even though it accounts for 23 per cent of the burden of disease in the UK[i]. One in four people will experience a mental health problem each year, and although the prevalence of illness is not increasing, the ability of individuals to cope with mental health problems is[ii]. It is therefore unsurprising that GPs spend around one in three of their appointments on a component of mental health[iii], and nearly a fifth of their appointment time on social issues[iv].
The relationships GPs have with secondary care is vital to provide the best mental health support for their patients. Below are five ideas of how primary and secondary care can work effectively together:
- 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 General Practice Specialty Trainees are required to complete, only one is focused on mental health[v]. Added to this, between 2013 and 2015 less than half of all trainee GPs undertook any psychiatry rotation[vi]. 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.
Jenny Welling-Palmer is the Mental Health lead at Consultant Connect. She previously worked as Managing Director for Beacon UK, an innovative mental health system integrator that works in collaboration with the NHS. Prior to this Jenny held a number of strategic and operational roles in a number of large teaching hospitals.
If you are interested in understanding better how our service can help Mental healthcare provision in your area. Please contact us on 01865 261 467 or email firstname.lastname@example.org.
[i] The Kings Fund (2015).
[ii] McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds: NHS digital.
[iii] London Strategic Clinical Network for Mental Health. (2014). A commissioner’s guide to primary care mental health. Available from slcsn.nhs.uk
[iv] Citizens Advice (2015). A very general practice: How much time do GPs spend on issues other than health? Available from citizensadvice.org.uk
[v] RCGP (2015). The RCGP Curriculum: Professional & Clinical Modules (Version: 18 May 2015). Available from rcgp.org.uk
[vi] Mind (2016).