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Primary care networks and mental health


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?

This blog was written in conjunction with Andy Bell, Deputy Chief Executive of the Centre for Mental Health.

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.