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The establishment of primary care networks (PCNs) is one of the most important reforms to primary care in England in recent years.
This report, published jointly by The King’s Fund and the Centre for Mental Health, explores the opportunities the emergence of these new networks creates for improving the support and treatment provided to people with mental health needs in primary care, and describes why such improvement is badly needed.
Key messages
Primary care supports people with a wide range of mental health conditions, including people with high levels of need and complexity. There is a striking degree of consensus that the current arrangements for mental health in primary care do not serve the interests of patients or professionals.
The provision of mental health support in primary care does not meet the range of needs of that exist, with significant gaps in services. Children and adolescents and older people are among those who are often poorly served.
The Covid 19 pandemic means the case for change is stronger than ever, with intense workload pressures being experienced in both primary care and mental health services, and with potential increases in mental health needs in the population.
Psychological therapy services developed through the Improving Access to Psychological Therapies (IAPT) programme provide valuable support and treatment for many people but do not present a complete solution to the range of challenges that exist in primary care.
Significant numbers of people assessed as too complex for IAPT services have their referral to specialist mental health services rejected. This often leaves general practitioners (GPs) to pick up the pieces by supporting people with needs they may not have been trained to manage.
There has not been a clear national plan for improving mental health support in primary care for many years. NHS England’s new Community Mental Health Framework is a notable step forward but there remains a need for greater clarity about what primary mental health care should look like in future.
The primary care networks established across England since 2019 potentially create an important opportunity to develop more comprehensive approaches to primary mental health care, with new forms of provision shared across groups of neighbouring practices. Current plans are that from April 2021 this will include the option of using new funding to pay for mental health practitioners based in general practices.
Where primary care networks choose to use the new funding in this way, it is important that the creation of new mental health roles in primary care forms part of a comprehensive strategy to meet the full range of needs in the local population. This will involve rethinking how the system works as a whole, as well as putting extra resources into general practices.
As mental health trusts and commissioners across England develop plans to implement NHS England’s Community Mental Health Framework, they need to ensure that their plans reach into primary care and address the significant gaps and challenges that exist. Working closely with primary care network leaders offers a way to better understand what changes are needed from a primary care perspective.
Making progress on this issue will require joined-up policy-making at the national level. Close alignment is needed between primary care policy and mental health policy to ensure that each supports the other and that gaps are avoided.