Why isn’t Advice and Guidance CQUIN mandated for Mental Health?

Published: 23rd May 2018

In this article, Jenny Welling-Palmer, who has held strategic and operational roles in a number of large teaching hospitals, shares her thoughts.

The 2017–19 National CQUIN program is in full swing across the NHS. There are 13 nationally defined CQUINs which aim to “improve quality and outcomes for patients including reducing health inequalities, encourage collaboration across different providers and improve the working lives of NHS staff.”

The 6th indicator is to offer Advice and Guidance, with the goal of improving GP access to consultant advice prior to referring patients to secondary care. This indicator is mandated for Acute Trusts but not for Mental Health Trusts (MHTs).

Here are three reasons why we think it should be:

1) It improves patient care

Advice and Guidance gives GPs rapid access to specialist Mental Health clinicians at their local MHT. An immediate clinician to clinician conversation means that a GPs’ patient will receive the correct course of treatment, care and support. In many cases this allows a GP to keep managing their patient in primary care.

Patients will avoid unnecessary time on a waiting list when a referral isn’t necessary as well as giving them the reassurance that their GP can access a specialist opinion for their care if needed.

When the outcome of an Advice and Guidance call is to make a referral, the GP and their patient can feel confident that this is the right course of action.

2) It saves CCGs money

In Oxfordshire we helped avoid 39% of referrals through our Mental Health Advice and Guidance service for adults and older adults. This is based on all calls made by GPs for their patients that they were planning on referring to the local Mental Health Trust, Oxford Health.

We therefore saved the cost of the time for the referral to be written, a clinical team at Oxford Health triaging the referral, an assessment appointment being scheduled, and an assessment appointment taking place. Our CCG clients typically see at least 3 X return on investment from the cost of our service within one year, therefore saving them significant money.

3) It helps manage demand for Mental Health Trusts

We are aware of the pressures that MHTs are under with increasing demand, long waiting times and staff shortages.  Our service works as a proven and effective referral management tool, by ensuring that only those people who are clinically necessary are seen for assessment and treatment. We also help to keep patients in primary care who would have previously been referred and added to a waiting list for a medication review. With our service, a GP can have a brief clinical conversation about medication, saving the need for a full secondary care appointment.

We don’t want this CQUIN to be a missed opportunity for Mental Health Trusts.  As we can mobilise fast – in a matter of days – we can still work with CCGs and MHTs to put this CQUIN in place for 2018/19 as a locally devised indicator or set it up for delivery in 2019/20. We have facilitated over 85,000 calls across the NHS and want to keep supporting GPs, clinicians and people with mental health problems.

If you are interested in understanding better how our service can help Mental healthcare provision in your area. Please contact us on 01865 261467 or email Jenny.welling-palmer@consultantconnect.org.uk

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.



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