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Health chiefs have drawn up new guidance to encourage doctors to place mental health therapists in practice surgeries – bringing more mental and physical health services under one roof.
These new therapists will be integrated into primary care teams and focus on common mental health disorders such as anxiety and depression, particularly where this occurs in patients with a long term physical health condition such as diabetes, respiratory or heart problems.
Evidence suggests nine out of 10 adults with mental health problems are supported in primary care and broadening the range of services for patients, means local health services are better equipped to deal with patients’ physical and mental health needs.
Claire Murdoch, NHS England’s national director for mental health said: “Joining up talking therapy services in primary care settings is another big step forward for our patients and a key plank in putting mental health at the centre of the long-term plan for the NHS. We are on track to deliver 3,000 therapists in primary care, with over 800 in surgeries at the end of last year and this handy guidance should convince those practices that are yet to take the plunge of the benefits.”
Dr Nikita Kanani, NHS England’s acting director of primary care, said: “General practice is the front door of the NHS. We continue to support the expansion of the workforce so patients have access to a range of different health professionals so that we can better support both their physical and mental health needs.”
In house mental health therapists, largely provided through collaboration with local Improving Access to Psychological Therapies (IAPT) services are expected to be full members of the primary healthcare team – receiving self-referrals from patients as well as GPs, clinical pharmacists, practice nurses and healthcare assistants. In addition they should:
- Attend practice meetings
- Provide specialist advice to support to ensure mental health is taken on-board and considered as part of treatment and care in the surgery
- Link in with clinicians across other mental and physical health services on behalf of the patient and practice
This closer way of working usually means the patient doesn’t have to travel far for their psychological treatment encouraging attendance and for some patients, receiving treatment in their GP surgery reduces the perception of stigma associated with having a mental health problem.
Intervening at an earlier stage and addressing common mental health issues can also improve care, while closer team-working can help reduce the number of referrals to hospital or community care – releasing capacity.
Many parts of the country have already pressed ahead with plans to transform mental health and primary care services this way, including:
- In Sheffield, IAPT practitioners provide updates on the patient record on GP systems at each appointment. This provides the doctor with useful information on how the patient is getting on and enables them to have a fully informed conversation about their physical and mental health needs
- In Calderdale, the IAPT service uses the GPs’ diary system, which means practice staff can book appointments with the therapist directly. Practitioners get weekly case management supervision from supervisors in the service.
- In Cambridge and Peterborough, early results show that timely and effective mental health care for people with diabetes, cardiovascular or respiratory illnesses have resulted in a three-quarters reduction in inpatient hospital attendance and a two-thirds drop in A&E admissions, freeing up £200,000 of NHS funding.
Commenting on the work to improve the care on offer to patients in her patch, Dr Emma Tiffin, clinical mental health lead, Cambridgeshire and Peterborough sustainability and transformation Plan (STP) said: “As a GP, an important part of my work is to help make patients’ access to mental and physical health care as quick and easy as possible and that includes informing patients about the options available to access treatments and normalising mental health part of the GP offer.”
Dr John Hague, clinical mental health lead, Suffolk and North East Essex STP added: “If the IAPT service is seeing a patient then it is freeing up the GPs and nurses to do other work. So why not do it? There is no reason why not. Evidence-based low intensity treatments are effective in terms of patient recovery and for most issues offer the most rapid, sure-fire chance of recovery.”
Dr Charles Heatley is a senior partner at Birley Health Centre, in south-east Sheffield said: “We seized the opportunity straight away. The great thing about it is I can talk to any of the four or five mental health therapists who work at the practice. Those one-to-one discussions are useful and have led to the GPs at the practice working on different ways of referring patients to the IAPT service, as well as patients’ self-referrals.”
People with a physical health condition are more likely than the rest of the population to experience mental ill health. More than 16 million people in England are diagnosed with a long-term physical health condition, and one in three of this group will experience a mental health problem.
NHS England’s IAPT programme has been described as ‘the world’s most ambitious effort to treat depression’ and the latest monthly figures (May) showed 25,198 patients moved on to recovery – delivering the highest recovery rate (52.8%) ever.