Mental health in primary and community care: report - December 2024

Introduction

The Mental Health and Wellbeing Strategy, published in June 2023, noted that mental health has been and always will be an essential part of general practice. Mental health issues are a common feature of consultations, and even more so in deprived communities and within a cost-of-living crisis. The Scottish Government recognise that despite substantial investment in primary care, pressures on general practice mean that some patients find it challenging to access the appointments, support, and treatment they need within practices.

The challenges experienced by practice staff in responding to the level of demand, range, and complexity of mental health presentations have been well documented. The Short-Life Working Group on Mental Health in Primary Care^[1] noted in their 2020 report that the lack of alternatives mean GPs are the primary clinical support for individuals with complex needs that they are not always trained to deal with. Having only general practice involvement in this range of complex needs is unsatisfactory for the person and can have a high impact on GP workload.

The report also noted that GPs are regularly supporting less complex mental health needs, often associated with other social stressors. This may require little clinical input, and it does not address the underlying issues for the individual.

It was for these reasons, the Scottish Government set out in the 2021 Programme for Government its intention that ‘By 2026, every GP Practice will have access to a mental health and wellbeing service, funding 1,000 additional dedicated staff who can help grow community mental health resilience and direct social prescribing.’

The delivery of increased mental health and wellbeing workforce capacity in general practice, working closely with GPs, would enable more support, assessment, and treatment to be provided directly within primary care. It would enable strong links to community services, including social services, substance use, and community groups, as well as services delivered by third sector organisations which are vital for people experiencing distress because of social factors. At the same time, the GP would remain key to continuity of care for the patient.

While financial challenges have caused this programme to remain paused since 2022, the Scottish Government remains committed to delivering increased mental health and wellbeing workforce capacity when it is feasible to do so.

The Mental Health and Wellbeing Delivery Plan, published in November 2023, set out the initial actions the Scottish Government and COSLA would progress with partners to deliver the ambitions in the Strategy. Action 3.1 of the plan highlighted the need to drive a shift in the balance of care across mental health to ensure a focus on prevention and early intervention in the community. To achieve this we would work collaboratively to improve access to support, assessment and treatment in primary care mental health and wellbeing services.

An internal Scottish Government Mental Health in Primary Care and Communities Governance Group was established to develop options to deliver this action. This was followed by a programme of engagement with key mental health, primary care, community, and equality stakeholders, which has helped shape this report.

It has been necessary to focus on smaller scale improvements which maximise existing resource and opportunities in the immediate future. Despite this, we remain committed to delivering additional mental health and wellbeing workforce capacity in general practice when sustainable funding becomes available. We understand that further investment is needed to truly shift the balance of care, allowing general practice to provide continuity of care and the support, assessment and treatment needed, while continuing to provide strong connections with a wide range of services, including secondary care mental health services.

There has also been a significant increase in neurodiverse people seeking a diagnosis and requiring support. We recognise that this creates challenges for a range of services, we also know how important a diagnosis can be to someone’s wellbeing. That is why the Mental Health and Wellbeing Strategy Delivery plan also identified this as a priority and committed to ‘working with education, NHS boards, the third sector and other delivery partners to strengthen support, care and treatment pathways across the lifespan for neurodiverse children, young people and adults’.

We will progress the actions outlined in this report and work with partners to continue to consider what more is needed to improve support for people who need to access help in general practice, as well as the support needed for the general practice workforce.