Primary Care Mental Health Service Development
Primary Care Mental HealthService DevelopmentScoping of the current state of services across thethirty two London boroughsSeptember 2017Supported by and delivering for London’s NHS, Public Health England and the Mayor of London
PCMH Version 1September 2017ContentsForeword . 4Introduction . 5Section 1 . 6Summary of Findings . 6Primary Care Mental Health Model Types . 6Service Scope . 7New Care Roles . 7Training . 7Funding . 7Outcome Measures . 7Psychopharmacology . 7Communication: Shared IT systems. 8Key Themes in PCMH Model Development . 8Section 2 . 11NORTH WEST LONDON SERVICES . 11BRENT . 12CENTRAL LONDON (WESTMINSTER) . 13EALING . 15HAMMERSMITH & FULHAM . 17HARROW . 18HILLINGDON. 20HOUNSLOW . 21WEST LONDON (covering KENSINGTON & CHELSEA QUEENS PARK AND PADDINGTON INNORTH WESTMINSTER) . 24NORTH CENTRAL LONDON SERVICES . 27BARNET . 27CAMDEN . 30ENFIELD . 32HARINGEY . 34ISLINGTON . 35NORTH EAST LONDON . 39BARKING & DAGENHAM, HAVERING, REDBRIDGE . 39CITY & HACKNEY . 40NEWHAM . 42TOWER HAMLETS . 44WALTHAM FOREST . 47Healthy London Partnership2
PCMH version 1September 2017SOUTH WEST LONDON . 50CROYDON . 50KINGSTON . 51MERTON . 52RICHMOND . 52SUTTON . 54WANDSWORTH . 59SOUTH EAST LONDON . 61BEXLEY. 61BROMLEY . 62GREENWICH . 65LAMBETH. 67LEWISHAM . 68SOUTHWARK . 69APPENDIX . 71Map of current status of services across London . 71Table of current status of services across London (grouped within STP footprint) . 72North West London STP . 72North Central London STP . 73East London STP . 74South West London STP. 75South East London STP . 76Working in PartnershipThis guide has been produced by the London Clinical Networks andHealthy London Partnership, working together to improve services forLondoners.Healthy London Partnership is a collaboration of London’s health and care system to support thedelivery of better health in London. We aim to work with a growing community of people andorganisations across London to make it the healthiest global city in the world by 2020.The London Clinical Networks provide clinical expertise and leadership to drive decision-making,reduce variation and improve services. The vision is to create clinical leadership which linkshealth and social care for consistent, evidence-based, high quality, efficient health and wellbeingfor the capital.Healthy London Partnership3
PCMH version 1September 2017ForewordWe hope our suite of documents on primary care mental health (PCMH) will be a real support tothe mental health system in London as we push ahead to develop innovative ways to supportand care for those with mental wellbeing or health needs. So, I am delighted to introduce thispan-London scoping of current and planned PCMH services across the thirty-two Londonboroughs.It has taken a great deal of dedicated work to pull this review together and we are grateful tothose in Healthy London Partnership and the Clinical Network for Mental Health (LondonRegion) who have worked very hard to deliver this product. It is designed to complement therecently published literature review (evidence base) for new primary care mental health servicedevelopment.In this document, we bring together the wide range of current and planned service offers acrossLondon, focusing on service development to better meet the needs of those presenting toprimary care services with mental health difficulties. In line with the Five Year Forward View andBetter Care for London, new PCMH models are being formed which provide care closer to homeand include family, friends and carers, and care closer to sources of community support in theless stigmatised setting of the GP surgery.There is an associated emphasis on supporting those working within the primary care setting toprovide timely and effective mental health care to those with increasingly complex presentations,with quick and easy access to specialist advice and clear lines of referral to sources ofcommunity-based support.This document aims to promote knowledge-sharing at all levels across London between keystakeholders, from general practice level up to the level of STPs. A guidance document is alsocurrently being written to support PCMH development in London, promoting more integrated andco-produced mental health services, with individuals with lived experience at the heart of newservice development.Dr Phil MooreGeneral PractitionerDeputy Chair, Kingston CCGCo-Chair, Mental Health Clinical Leadership Group (London Region)Report authored by Dr Dorothy Newton, Darzi Fellow, Healthy London PartnershipHealthy London Partnership4
PCMH version 1September 2017IntroductionThere is increasing interest amongst healthcare providers and commissioners in the UnitedKingdom in new models of health care. Change imperatives increasing focus in this area includeThe Five Year Forward View1, The Five Year Forward View for Mental Health2 and The GeneralPractice Forward View3. These documents highlight the need for more integrated care provision,care provided closer to home, in the less stigmatised setting of the GP surgery, and closer tofriends, family and sources of community-based support. New models of Primary Care MentalHealth (PCMH) in London are focussing on joining-up mental health care, in particular mergingprimary and secondary care so patients experience true seamless care, effectively starting toerode traditional care ‘siloes’. Such development represents a significant opportunity forindividuals working within different areas of mental health care to share knowledge and benefitfrom best-practice expertise they can offer each other. Additionally, new models of PCMHrepresent a significant opportunity to consider in detail how mental health services can beredesigned using co-production: re-designing services in partnership with those who will beusing them to better ensure the most effective and appropriate mental health care provision.This document has been prepared by Healthy London Partnership, in collaboration with theClinical Network for Mental Health (London region). It draws together details of the currentprimary care mental health service offer across all thirty-two London boroughs/ClinicalCommissioning Groups. The aim of this work is to encourage knowledge-sharing acrossLondon, at all levels, from individual general practices to Trusts, boroughs and STPs, so thatareas can learn from each other the benefits and challenges of transforming their own serviceoffer.Data has been provided by each respective borough against a suggested framework ofinformation provision. The pan-London scoping document has been prepared alongside a reviewof the scientific literature which forms an evidence base for new models of care for PCMHservice development. Each London borough has identified a representative within their area whocan provide further information on their current or planned PCMH service.The document is presented in two sections. Section 1 provides an overview of the findings fromthe scoping exercise and section 2 provides a more detailed description of the service provisionfrom each of the 32 CCGs.1Five Year Forward View, NHS England (2014)Five Year Forward View for Mental Health, NHS England (2016)3General Practice Forward View, NHS England (2016)2Healthy London Partnership5
PCMH version 1September 2017Section 1Summary of FindingsPrimary Care Mental Health Model TypesThe primary care mental health London-wide scoping exercise demonstrated significantvariability in range and stage of development of new service models across the 32 boroughs,although more than 50% of boroughs now have an established primary care mental healthmodel. New care models which are planned or already in existence sit on a spectrum between asimple attached specialist working within the primary care setting and fully integrated multidisciplinary teams with members drawn from both primary and specialist services. See Fig. 2below for a breakdown between established, pilot and planning phase services.Examples of models developed around London at the present time include a range ofcollaborative care approaches, such as wrap-around models (e.g. in the Like MindedCollaborative in North West London), and in-reach models of care (such as in Croydon). Mostmodels provide care in a stepped format – whereby the provision of services (and the setting forthis), is based upon a careful assessment of individual mental health needs: individuals can then‘step-up’ or ‘step-down’ within the care pathway as their mental health presentation dictates.Some models focus efforts on increasing skill sets, confidence and capacity within generalpractices (such as in Southwark). Other boroughs (such as City & Hackney), have sought todraw the expertise of specialist services into co-located teams within primary care - workingtogether in the same physical environment and psychological team ‘milieu.’ Other boroughshave established a network of Link Workers acting as care facilitators and navigators at theprimary/secondary care interface (as in Barnet).Fig. 2 Number of boroughs with a planned versus established new model of careService PhaseEstablishedPilot PhasePlannedN/AEstablished PCMH service 56%, Pilot Phase 19%, Planning Phase 22%, N/A 3%Healthy London Partnership6
PCMH version 1September 2017Service ScopeThe majority of boroughs (23) have or are planning broad-based PCMH services (i.e. servicesoffered to those with common mental illness/mental health & wellbeing concerns [SMI ] inaddition to individuals with serious mental illness [SMI]).All services offer support to individuals aged 18 years and over (with the exception of oneborough offering a service from age 17.5 years and above). One borough has an upper age limitof 65 years for their service.The forms of support offered in general have one or more of the following service aims: Supporting individuals with psychotic illness who are stable and are transitioning back toprimary care from specialist servicesIndividuals with mental health difficulties who are currently managed by their GP whereadvice and support is required from specialists (including to help prevent the need forsecondary care referral)Individuals with mental health difficulties who are currently managed by their GP whowould benefit from referral to community-based sources of supportNew Care RolesA range of new care roles have been established across the London boroughs (or are planned)to help support individuals with more complex mental health difficulties within the primary caresetting. These roles are in most instances part of a multi-disciplinary care team, comprising arange of care roles, such as consultant psychiatrist, primary care nurse (or communitypsychiatric nurse), social workers, administrators, psychologists, occupational therapists andemployment advisers. New care roles are frequently in the form of care liaison workers orsupport workers who facilitate communication between primary and specialist staff and supportjoined-up integrated care provision. These individuals are also in many instances providing acare-navigation function, for example, helping individuals access appropriate sources of supportbased in their local communities (facilitation of social prescribing). The increasing presence ofpeer-support workers within PCMH teams is also evident.Individuals fulfilling new care roles within new primary care mental health services are drawnfrom a variety of backgrounds, including from existing primary care nursing staff, from therapyservices and as in-reach workers from specialist settings. The presence of GP-basedpharmacists is also evident in existing and planned PCMH services.TrainingThirteen boroughs (41%) have regular mental health training established.FundingApproximately 22% of boroughs (7 out of 18 boroughs who shared funding data) have recurrentfunding secured for their primary care mental health services.Outcome MeasuresSeventeen boroughs reported outcome measures having been defined for their primary caremental health services. A further seven boroughs are in the process of planning their outcomemeasures.PsychopharmacologyBoroughs were asked about their psychotropic medication prescribing practices, focussing onthe prescribing and monitoring of depot antipsychotic medication within the primary care setting.Healthy London Partnership7
PCMH version 1September 2017Whilst oral psychotropic medication (outside of clozapine) is prescribed by GP’s or PCMH staff,depot medication is less available to individuals via primary care, although more boroughs areplanning to include this offer via primary care services. Notably, some boroughs are planningprimary care-based clozapine and/or lithium clinics. The newly established role of primary carebased pharmacist is noted as being taken forward by one borough (which may increase thebreadth of psychotropic medication prescribing within primary care). Two boroughs specificallynote the availability of telephone advice on psychotropic medication prescribing for primary carestaff by specialists.Communication: Shared IT systemsNine boroughs have shared IT systems between their general practices and the Primary CareMental health team. This is either EMIS or SystmOne. One borough (Southwark) has developedan electronic shared care record which is accessible by both primary and secondary care staff.The need for shared I
The Five Year Forward View1, The Five Year Forward View for Mental Health2 and The General Practice Forward View3. These documents highlight the need for more integrated care provision, care provided closer to home, in the less stigmatised setting of the GP surgery, and closer to friends, family and sources of community-based support.
Mental health in primary care A briefing for Clinical Commissioning Groups 5 One in four of us will experience a mental health problem in any given year, but most of us don’t get professional help. Of those of us who do get treatment, the majority are treated within primary care.10 This is why good mental health support in primary care is so important. Local GPs and other primary care staff .
Principles of Primary Health Care Although the name of the program team reflects key service elements, it functions based on the principles of Primary Health Care. Primary health care is integrated and inter-sectoral. Primary health care emphasizes health promotion. Primary health care views the individual as a whole being.
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
Communityed-bas mental health services initiated within 30 calendar days of referral coordinating mental health services with a student's primary mental health care provider and other mental health providers involved in student care. Assisting a mental health services provider or a behavioral health provider as described in s. 1011.62, F.S.,
Community-based mental health services initiated within 30 calendar days of referral coordinating mental health services with a student's primary mental health care provider and other mental health providers involved in student care. Assisting a mental health services provider or a behavioral health provider as described in s. 1011.62, F.S.,
This guidance should also be read in conjunction with PHN mental health guidance on: Low intensity mental health services for early intervention; Primary mental health care services for people with severe mental illness; A regional approach to suicide prevention; Child and youth mental health services; and
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
Weaving Together Mental and Physical Health Care Outside the Safety Net www.chcf.org 3 Introduction Mental health issues commonly present in primary care. Twenty percent of primary care visits relate to mental health,1 and 79% of antidepressants are pre-scribed by primary care providers (PCPs).2 However, many PCPs do not have the time and .
