Short Life Working Group for Mental Health in Primary Care: report

Proposals, Recommendations and Principles

Proposed Model

41. Within an area served by a group of GP practices (this could be a locality, part of a locality or a cluster area) there should be a multi-agency team providing assessment, advice, support and some levels of treatment for people who have mental health, distress or wellbeing problems. The multi-agency team may include Occupational Therapists, Mental Health Nurses, Psychologists, Enhanced Practitioners, Link Workers as well as others such as those providing financial advice, exercise coaches, family support and peer networks.

42. That team would provide assessment and support to the individual to access appropriate levels of advice, community engagement treatment or care – some of which would be delivered within the Primary Care setting, depending on the skills and capacity of the team.

43. The team would work closely with and / or be part of the wider community team in that area, engaging with the wider assets of the community, health and social work staff and with other agencies as appropriate.

44. Although the team would be aligned to a group of GP practices, there should be named members of that team that work closely with each individual practice to provide continuity and allow the development of effective clinical or multidisciplinary team relationships.

45. Practice systems should allow patients to be directed to an appointment with the appropriate members of the MDT based on self-directed care, including self-referral. This option should be publicised and communicated to the practice population.

46. The team would provide timely support and treatment for people in that setting with the GP providing clinical leadership and expert general medical advice where needed. Where more specialist input is required the resources of Community Mental Health Team or other appropriate secondary care Mental Health service would be accessed and work in partnership with the Primary Care team where appropriate (e.g. shared care around medication).

47. The team should have members that are trained in mental health and may be drawn from mental health nursing, clinical psychology or Allied Health Professional (AHP) disciplines. The team should also have members or close links with other staff with relevant expertise and experience e.g. Community Link Workers, Addiction Services, Health Visitors, Health Improvement staff and financial inclusion teams.

48. The SLWG recognises that the use of terminology can be a source of confusion about what we are trying to achieve. The terms Primary Care multidisciplinary team or locality multidisciplinary team have different connotations for different professional and geographic groups. Rather than seek to ‘name this model’, the SLWG has sought to describe the function which local areas can name as appropriate.

49. A critical part of this approach will be a local communications strategy to inform local populations about how they can access services. Tools may range from social media channels, website updates and local newsletters, posters, flyers.

Proposed benefits

50. The Group suggest that this approach would realise a number of improvements that would benefit both individuals and practitioners. An enhanced range of service provision, embedded within a range of wider community assets would mean individuals can be better, and more quickly, connected to the support that meets their needs in the right settings. This will also support more efficient and targeted use of resources across a local area. Better communication across service providers will improve early intervention, continuity of care and better support self-management. The Group also considers that such a model would potentially reduce referrals to specialist services while also improving support for those who do and ensuring it is delivered promptly.

Proposed next steps

51. To further develop this approach, initial work should be undertaken to establish the baseline by identifying the level of support currently available in teams across Scotland, however, they are currently named and described. Posts in the Primary Care setting funded through Action 15 or the Primary Care Improvement Fund should be considered, and any opportunities to further expand capacity through those funds should be supported and encouraged.

52. A needs analysis should be conducted to scope the need for expansion of such a team/service. The expansions should be funded through a proposed Primary Care Mental Health (PCMH) development fund that will be jointly managed through the mental health and Primary Care planning processes within Health and Social Care Partnerships (HSCPs).

53. The development of an asset-based community development should be a collaborative one, led by HSCPs as part of Integration Joint Boards (IJBs) strategic commissioning plans. Local communities and ‘experts by experience’ should be fully engaged in this. As a minimum, local GP sub-committees, HSCPs, locality management, mental health service leads, psychology leads, interfaces with schools and third sector interface structures should be part of this collaborative approach.

Recommendations

54. To support the implementation of ‘the model’ described in this paper, the SLWG recommends the following:

• Recognise the central role of Primary Care within the Mental Health system and of MH & WB within Primary Care. This should be a priority for development within the MH Services Renewal Plan and also the revision of the GP Contract MoU (through further definition of MH as an “additional role” for expansion and development). In developing PCMH capacity to deliver a 24/7 service, the principles that we have set out above should be followed.
• Review existing additional role developments in PCMH, such as those funded under Action 15 of the Scottish Government’s Mental Health Strategy or through Primary Care Improvement Plans (PCIP). This work should be led by a newly established Development Group. There should be a partnership between the MoU/PCIP process and the MH planning process at local level with objective of maximising PCMH capacity along the lines of the model described in this paper.
• The same Development Group also undertake a “gap analysis” to scope workforce and resource requirements associated with providing a 24/7 service with a view to implementing a funded PCMH development programme in 22/23 and thereafter. This should include a plan for monitoring impact of this approach going forward.
• The Development Group would also promote implementation of robust systems to deliver peer-to-peer decision supportbetween community and specialist services and within Primary Care mental health services to ensure patients are receiving the best care, from the most appropriate staff, irrespective of where they present in the service.