Primary mental health care

1. Primary mental health care And PRIMARY CARE NETWORKS

2. DOI • RCGP Metal health and whole person care lead and older people’s mental health fellow. • SWB CCG Clinical lead for learning disabilities and mental health • Director Mindsafe • Salaried GP Laurie Pike Health Centre, Modality and Babylon healthcare • I have received funding from Janssen to attend a medical conference

3. What I’m going to cover • The importance of primary mental healthcare • Current challenges facing primary mental healthcare • Potential solutions which can be delivered through PCNs

4. Why is mental health so important for primary care?

5. Perinatal period • LTC • Older people • Veterans • Socioeconomic problems • BAME groups • LGBT people • Physical and intellectual disability

6. Medically unexplained symptoms

7. SMI SERIOUS AND ENDURING MENTAL ILLNESS • Primary care is central in care of people with SMI • SMI is one of the clinical domains in QOF • NICE recommended annual health checks • Variation in care “CCGs are to offer NICE recommended screening and access to physical care interventions to cover 30% of the population with SMI on the GP register in 2017/18, moving to 60% population from the following year. This is to be delivered across primary and secondary care.” The Mental Health 5year Forward View

8. What can primary care offer? • Accessible • Community based • Less stigmatizing • Holistic • Communication skills • Skills and experience in physical health and chronic disease management

9. But… • CAPACITY • RESOURCES • POLICY DEVELOPMENT • COMPLEXITY • COMPETING PRIORITIES • WORKFORCE SKILLS • SECONDARY CARE BARRIERS

10. What features of PCNs care important? • Bring different roles into primary care • Integrated care models- collaborative care • Investment in primary care in network priority areas: QOF QI • Focus on early intervention, prevention and personalisation

11. How do we fill these gaps? • Social prescribing • Integrated primary, secondary and community services • Quality improvement activities locally identified and owned

12. Social prescribing • Signposting • Supervised, structured self help and exercise • Specific resource targeting • Coaching

13. Other roles contributing to pmhc • First contact physio’s • Pharmacists

14. INTEGRATED CARE APPROACHES • IAPT for long term conditions in primary care • Collaborative care

15. Integrated care: People with Serious Mental Illness and primary care

16. Investment in primary care in network priority areas: QOF QI “NHS England and GPC England have agreed to an ongoing programme of indicator review in key priority areas, including heart failure, asthma and COPD care for changes in 2020/21, and mental health for changes in 2021/22” The Quality and Outcomes Framework (QOF), BMA 2019

17. QI MENTAL HEALTH anxiety and depression • Early identification of people particularly those in marginalised groups • Improving patient experience of mental health services delivered in primary care. • Provision of accessible, proactive and safe care for people with depression and / or generalised anxiety disorder

18. Reviewing practice prevalence rates and variation • Reflecting on previous quality improvement activities • Develop SMART goal • Self-assess clinicians’ knowledge • Involve all practice staff • Involve patient representatives in the project • Participate in 2+ GP PCN peer review meetings • Complete the QI monitoring template

19. TAKE HOME POINTS • Mental health is important for both patients and GPs • Currently challenges to delivering mental health care in primary care • PCNs offer solutions through new investment in primary care workforce, greater integration between primary and secondary care services and news ways of focusing on quality improvement