Rhiannon England/David Maher April 2014

1. Developing a Primary Care Mental Wellbeing Network Rhiannon England/David Maher April 2014

2. Whole System Review – A case for change 1) System re-design is required with a shift towards primary care based provision 2) A prevention strategy will reap short and long term benefits • Social resilience and primary prevention improve individual and population mental well being • Secondary prevention interventions, including employment, housing and social networking, improve the quality of life and recovery prospects for people with mental health problems 3) Pathways and access routes must be clear – a real single point of entry • With information about the range of services readily available to users, carers and professionals 4) Quality improvement is vital 5) Outcome measurements need development Successful implementation will: • improve and simplify access to specialist services • increase access to universal services • Increase independence, choice and control • support individuals to live ordinary, independent lives in their local communities • focus on both the social, health and employment requirements of patients at all steps of their care experience • promote resilience and staying well

3. Effective & Innovative Commissioning • Least Intensive First Time • Mental health services to work with community services, local organisations and primary care to enable people to access the right • services as early as possible • Care Closer to Home • Continue the emphasis on preventing hospital admission & extending the options for out of hospital care through the use of Serious • Mental Illness Local Enhanced Services • Building resilience • Commitment to the recovery model, promote the ability to live ‘ordinary’ independent lives & support people to use Recovery Plans • to map their success and keep positive • Customer Service • Safe services of excellent and effective quality, choice and control and outcomes focused • GPs as patient advocates in commissioning planning • Building collaborative care networks • Working with Local Authorities and other partners in building truly integrated support pathways for people

4. Why Primary Care? • GPs are trusted • nine out of ten patients were satisfied with the care they received at their surgery and over half of patients were ‘very satisfied’ (54 per cent). Only four per cent of patients were dissatisfied with the care they received. This suggests that the current doctor-patient relationship is highly valued and that the public place a significant degree of trust in doctors as professionals. • GPs know their communities, know their patients, and are best placed to apply a local and patient centred evidence base to designing future MH services • Primary Care have developed skills in managing Long Term Conditions • GPs understand the bio-psycho-social aspects of mental illhealth and are able to take a more holistic view of ‘what works’

5. Local Context – A Primary Care model of Mental Health

6. City and Hackney MH Enhanced Primary Care Model Primary Care (44 Practices working in 6 Consortia) Primary Care Liaison • (Clusters 3,11) • 1 x WTE Primary Care Liaison • (Clusters 3,11) • 1 x WTE Funded through SMI shifted activity Primary Care Liaison (Clusters 3,11) 1x WTE Primary Care Liaison • (Clusters 3,11) 1 x WTE Primary Care Liaison • (Clusters 3,11) • 1 x WTE Primary Care Clinical Support Primary Care Liaison • (Clusters 3,11) • 1 x WTE • Primary Care Liaison • (Functional Older Adults, Cluster 18) • 1XWTE • Primary Care Liaison • (Functional Older Adults, Cluster 18) • 1XWTE • Primary Care Liaison • (Functional Older Adults, Cluster 18) • 1XWTE Primary Care Liaison • (Functional Older Adults, Cluster 18) • 1XWTE • Primary Care Liaison • (Functional Older Adults, Cluster 18) • 1XWTE Funding required (from shifted FOA and dementia cluster 18) • Primary Care Liaison • (Functional Older Adults, Cluster 18) • 1XWTE Secondary Care Primary Care Dementia Advisors • 1x WTE Primary Care Dementia Advisors • 1x WTE Primary Care Dementia Advisors • 1x WTE Primary Care Dementia Advisors • 1x WTE Primary Care Dementia Advisors • 1x WTE Funded through dementia bed centralisation Primary Care Ancillary Support/Guides Primary Care Dementia Advisors • 1x WTE Primary Care Mental Health Guides Primary Care Mental Health Guides Primary Care Mental Health Guides Primary Care Mental Health Guides Primary Care Mental Health Guides Funded non-recurrently Primary Care Mental Health Guides

7. Acceptance Criteria

8. Secondary Care SMI Local Enhanced Service SMI QOF Enhanced Primary Care Liaison Function Key Roles • Determine the appropriateness of referrals according to selection criteria guidelines. • Prepare and write the transfer summary, then co-ordinate the transfer process. • Collate risk assessments and medication management plan. • Co-ordinates transfer of patient to GP care including Information Governance authorisation from patient. • Enables development of rapport between the patient, any carer, secondary care and the GP. • The transfer process offers the opportunity to clarify and model the monitoring process with the GP. • Monitoring includes ensuring case notes are updated across management systems • Transferred patients are reviewed clinically initially six monthly to ensure appropriate care and appropriate stepping up or down. • Intervene to provide interventions for brief periods to re-establish clinical relationships that show signs of breaking down. • Supports the clinical assurance process for moving SMI patients onto a Local Enhanced Service provision. • Provide pre-assessment support for those patients who may need stepping up into secondary care. • A patient registration and tracking system maintained by liaison function supports the GP in maintaining continuity of care and provides information about satisfaction and other quality assurance metrics. • Coordinates quarterly Consultant-Led clinics for case discussion and professional development. • Supports the delivery of a Development Curriculum to upskill • primary care in managing mental health conditions. Primary Care

9. Stepped Care Cost & Monitoring Framework LES costs due to the shift of patients *£100 per patient discharged into primary care NHS ELC Wide £137,600

10. Transforming health services – Case Examples • Primary Care based mental health provision through Serious Mental Illness Local Enhanced Service- (EPC- Enhanced Primary Care) • Primary care based psychological therapies support for: • medically unexplained symptoms where significant psychological features are present • Personality disorders, experiencing crisis or difficulty engaging in services and where secondary or tertiary care is not appropriate • People with mental health problems who have been discharged from services and do not meet referral thresholds for current primary or secondary services • “Frequent attenders” for GP consultations in primary care • Difficult or poor engagement in services • A&E based psychotherapy support for frequent attendees, MUS and difficult to manage patients • Rapid Assessment Interface & Discharge service: • Psychiatric liaison service reducing admissions, reducing length of stay and rapidly coordinating care • Providing holistic support for acute in and outpatients • Streamlining care pathways for those with co-morbidities