Primary care networks and mental health

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The creation of primary care networks (PCN) is one of the most significant elements of the NHS long-term plan. Around 1,300 PCNs will become the hub (or ‘dock’ to quote Simon Stevens) around which community and mental health services will organise themselves – but are services ready for this? And are PCNs ready to take on the challenge of improving mental as well as physical health in the communities they serve?

PCNs will take specific responsibility for three important areas: improving general practice services in their local areas; supporting people with more complex needs who need support from a wider range of professionals in the community; and, more gradually, looking at ways of improving the health of people in their communities.

In order to support this work, and in recognition of the workforce crisis among GPs, PCNs will have funding to support the employment of additional staff, including physiotherapists, pharmacists and social prescribing link workers to help people with long-term physical conditions and ongoing health needs. These roles were targeted specifically because modelling suggested there would be adequate additional supply of these professionals. This means, however, that there no funding has been identified for specific mental health nurses or roles in psychology, for example. While there is a welcome commitment to expand teams part of the Improving Access to Psychological Therapy (IAPT) programme, there will still likely be a shortage of mental health professionals working in primary care.

Primary care mental health is a multi-faceted issue that does not lend itself to a one-size-fits-all approach.

Primary care provides the vast majority of NHS mental health support and the case for improving primary care mental health services has been clearly made. It is also clear that people with severe mental health problems often don’t have their physical health needs met. Despite the absence of funding for specific roles, some local areas are already forging ahead and developing new approaches to providing mental health support in primary care. These vary in scale, purpose and the types of need they seek to meet. They range in size from single mental health practitioners working in individual GP surgeries to entire new services. Some seek to help people with poor wellbeing who do not have a diagnosable condition, and some work with people with complex conditions requiring longer term psychological therapy than is available through IAPT, while others support people who are discharged from community mental health services (see the report from the Centre for Mental Health, Filling the chasm, for examples). And there are marked differences in the staff they employ: including psychologists and psychotherapists, nurses, peer support workers, ‘navigators’ and more.

This wide range of approaches will give PCNs an assortment of ideas for how they might meet mental health needs in their localities. The benefit of such diversity is that networks can tailor services to their community’s needs. But there is also a significant risk that it will leave major gaps and that opportunities to share and learn from experience (and indeed from history) will be missed. Primary care mental health is a multi-faceted issue that does not lend itself to a one-size-fits-all approach, but equally it is important that we avoid creating 1,300 different solutions to this major national challenge.

There is clear and compelling evidence that social and emotional wellbeing from the start of life underpin our mental and physical health.

An important new opportunity for PCNs will come in the shape of the commitment made in the long-term plan to improve ‘core’ community mental health services. This will inevitably overlap with primary care and hopefully bring investment into services that have been neglected in national policy for too long. It presents PCNs with the opportunity to work with mental health trusts to develop an integrated offer across primary and secondary care, including groups of people who have traditionally been excluded from both.

Finally, the challenge of population health is one that cannot be addressed without careful and ongoing attention to mental health. There is clear and compelling evidence that social and emotional wellbeing from the start of life underpin our mental and physical health. Only by working arm in arm with public health teams in local councils and with the communities they seek to serve will PCNs be able to grasp the opportunity of promoting good health and preventing illness long term.

At a recent conference on mental health in primary and community care at The King’s Fund, there was a clear view from delegates that PCNs could represent an opportunity to improve mental health support. Such a positive and hopeful view about a forthcoming NHS structural reform is both unusual and heartening. But to fulfil their potential, PCNs will need from day one to take positive and concerted action to support better mental health. If it is left to chance or it is tacked on after other business, it will not work. We hope that all PCNs will make mental health a priority from the start, and we are keen to hear about how this is happening as the theory and policy get translated into practice.

Comments

Dr Malcolm Rigler

Position
RetiredGP and Project Volunteer @ The Patients Association,
Organisation
The Patients Association
Comment date
29 July 2019

The pressures on GPs are currently severe and almost overwhelming. Not least because whatever is prescribed or suggested by way of diagnosis or treatment patients and carers will "Google" what has been said and then quite frequently be faced with a torrent of information some good some not so good. Patients often then seek further GP consultations for information about which websites to trust. In response to this search for reliable information Macmillan Cancer Care has created the post of "Digital Nurse" to guide people to reliable websites.
Macmillan Cancer Support | Clinical Nurse Specialists‎
Adwww.macmillan.org.uk/‎0333 257 4905
And one Town Council at Nailsea near Bristol has found £300,000 to establish a "Digital Health Hub" to help patients and carers to learn digital skills and to find reliable Health and Social Care Information .
Find out more about Nailsea Place and 65 High Street | nailseatown.com
https://www.nailseatown.com/find-out-more-about-nailsea-place-and-65-hi…
11 Feb 2019 - The video below, commissioned by Nailsea Town Council, promotes 65 High Street and the wider Nailsea Place project. Watch it here: …
This project inspirational project is already being replicated in other locations. GPs and Networks of GPs should therefore seriously reconsider
the value of their "silo mentality" and find the imagination and the energy to look beyond the NHS and networks within the NHS and
find out about developments going on outwith the NHS that in many ways are being designed and developed to support patients and carers by Town and Parish Councils with the understanding and help of The Society of Local Council Clerks and its 5,000 "Health Professionals" i.e. Town and Parish Clerks.
It has been said that "without a vision the people perish" . In this case it seems to me that if GPs and CCGs lack the vision to see what is going on alongside the NHS - "under their noses" so to speak then their difficulties and pressures will only become more and more severe and maybe before long become insurmountable.

Lynn Freeman

Position
Occupational Therapy Manager,
Organisation
NHS Fife
Comment date
12 August 2019

I note that the article does not mention Mental Health Occupational Therapy Practitioners specifically, which is not surprising. I'm about to start a pilot working in a GP Practice and would be interested to hear comments from any other AHP clinicians working in Primary Care Mental Health

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