Mental health and primary care networks: understanding the opportunities

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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. 

Comments

Mike

Position
Manager,
Organisation
Wessex Cancer Trust Isle of Wight Cancer Wellbeing Centre
Comment date
24 July 2020

What a fascinating and insightful article. Here on the Isle of Wight, late last year I approached the IAPT manager and offered the help of this charity locally to take psychological support referrals. Such referrals would include those affected by cancer and experiencing MH problems or those supporting someone with cancer and experiencing MH issues themselves. Wessex Cancer Trust on the Island employs one counsellor, has one volunteer counsellor and one volunteer psychologist.
I was also able to offer space in the centre I manage to one IAPT practitioner one day a week - where IAPT currently operate is in a pretty dilapidated building with limited space.
During the C-19 pandemic I cannot offer that space but have continued to take the occasional referral. I strongly believe that such sector cooperation is likely to become increasingly necessary and hopefully we're forming a working example of that locally.

Damien Brennan

Position
Mental Health Lead,
Organisation
Sussex Community Foundation NHS Trust
Comment date
24 July 2020

I very much welcome and agree with the points of this report. I wonder if there is a sense in which we risk polarising the middle ground between Primary care and Mental Health Trusts, Each have their , often overwhelming concerns and caseloads and populations to focus on. As the Mental Health Lead for a community Trust I am conducting an audit looking at the Mental Health needs of patients on the caseloads of community Nurses and Therapists , the initial findings identify at least 70% of patients with significant need which frequently impacts adversely upon the efficacy of physical health care provided by Nursing & Therapy colleagues daily. As is often the case access to Specialist MH Trust provision is limited by increasingly climbing thresholds. Where we have small pockets of access to locally provided psychological therapies, within our own teams the outcomes are better for patients and also staff resilience and ability to provide care is enhanced. Perhaps it is time to consider afresh that we should give up thinking that there is health without mental health...

Jo Lampert ( D…

Position
Retired GP . Member HealthWatch,
Organisation
private comment
Comment date
24 July 2020

As a GP for nearly 40 years I had a great interest in mental health and in improving services and joined up care with secondary services. My son ( mid 40's) has bipolar illness so I also have a carer's perspective. As his main emotional and financial support ( he does not claim benefits as he wanted to work in a self employed capacity) I feel deeply unhappy about the lack of care available once a patient has been discharged from secondary care . In the good days in our practice we had sessions from CPNs ( when CBT was "New") and clinical psychologists as well as in certain periods of time , visits from the local psychiatrist to discuss patients and advise. These have all ceased. IAPT offers mainly Group treatment in management of anxiety and depression.
People with chronic but not florid mental illnesses need help in medication management , accessing services and the minefield of benefits , help with employment taking account of limitations due to their illness , and help to avoid social isolation. Ageing carers like me fear for the future when we are not around . We have a problem in all disciplines in health care with the separation of Primary and Secondary care, and nowhere is this more important than in Mental health care.

Maggie Gilbert

Position
Coordinator,
Organisation
Better Living CIO
Comment date
24 July 2020

Everyone is making the right noises - that Care for the elderly and adults with learning disabilities desperately needs complete review, and the community should be involved - but no one is DOING anything about it! This is the concept of our new CIO - to link the needs of these vulnerable people and involve the community at large - thus greatly enhancing their Care and even reducing the cost to the government. Check out our website (betterlivingcio.org) and get with us! Help us to change things for the better!!!!

Nigel Rose

Position
Strategic Lead (Commissioning),
Organisation
Macc
Comment date
27 July 2020

As a former chair of Manchester MIND and a former manager of a community mental health team I very much agree with your comments. The big gap in local services is ongoing support. On the whole, this is better provided locally and by community and voluntary sector organisations in alliances with health and social care professionals. In Manchester, they cut many of these services a few years ago and since then the situation has got much worse, huge amount of unmet need and a focus on increasing bed numbers rather than supporting people so they don't need to go into hospital. In my experience it is extremely difficult to get health commissioners to focus on anything except therapy and medication. Unfortunately, this King's Fund report, to some extent, falls into the same traps.

Philip Griffiths

Position
Chief Officer,
Organisation
Tan y Maen Ltd
Comment date
03 August 2020

This report is long overdue as a statement of how and why mental health services should be redesigned to put the patients needs at the centre of support provided. We identified the gap between GP services and Secondary care over 5 years ago and have since set about redressing this by working closely with GP practices and embedding mental health assessment and support within local surgeries. The Meirionnydd Community Wellbeing projects operate in 6 GP surgeries, GPS refer to the support worker who attends the surgery weekly or monthly depending on demand. The service can also be contacted by GP s for referrals at anytime outside of actual 'clinic' sessions. The essence of this is that the initial contact with the patient is made without delay. Our target is within 48 hours of referral but usually contact takes place the same day or even within the hour of receipt. It is also of the utmost importance that assessment is followed up by commencement of service, equally quickly. We have a range of treatment and support options which include face to face support, using the Mental Health Recovery Star, App Based Support, online ccbt, psychoeducational groups for anxiety, depression and self esteem and Mindfulness sessions and courses. We also understand the need for peer support, which tjus report does not refer to but which groups play a pivotal role in ongoing support, ongoing assessment of need, and in providing social opportunities to tackle isolation. These also provide some physical support as they can involve walking groups, exercise groups and address the importance of outdoor activity through woodland groups etc. This model has been supported and now extended by one of the most maligned Health Boards in Wales and they should now be given credit for their innovative approaches. The new transformation agenda if this same board further extends this approach. Can we please recognise that this work has been ongoing, is nit new and is tried and tested.

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