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Integrating mental and physical health in primary care

Dr Emma Tiffin is Clinical Mental Health Lead, Cambridgeshire and Peterborough Sustainability and Transformation Plan (STP), and an advocate for Improving Access to Psychological Therapies (IAPT) services within primary care.

Forty-six per cent of patients referred to our Psychological Wellbeing Service for a mental health problem also have a physical health long-term condition. These patients are used to being seen in their local GP practice, which is a familiar environment, providing both physical and mental health care, and most would choose to have their care provided here.

If the patient has a long-term condition such as diabetes or cardiovascular disease, at my GP surgery we will offer them an annual health check. This includes asking about any co-existing mental health problems. If mental health issues are identified patients are referred for talking therapy and I think are more likely to engage with treatment if this is offered at the practice location which they are used to attending.

Co-location usually means the patient doesn’t have to travel far for their psychological treatment which encourages attendance and for some patients receiving treatment in their GP surgery reduces their perception of stigma associated with having a mental health problem.

Feedback from IAPT therapists direct to GPs and the wider primary care team is another benefit of closer integration of psychological therapies into primary care and it facilitates better communication and coordination of patient care, as well as GP education and upskilling of primary care staff. For example, where patient consent is given, information on the cognitive behavioural techniques (CBT) used for the effective treatment of anxiety for individual patients can be shared more easily, as well as the management plan for that individual patient going forward.

The feedback process and the regular sharing of information between mental and physical health professionals, works well in multi-disciplinary team meetings, helping to ensure they are patient-centred. Effective communication and coordination of care in the primary care environment should also lead to an overall reduction in the number of patient referrals to secondary care, which releases capacity for patients that do need secondary care treatment.

As a GP I consider that 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 as part of the GP offer.

Dr Emma Tiffin

Dr Emma Tiffin has worked in mental health clinical leadership roles for over 15 years. Most recently she has focused on developing a sustainable integrated community-based service model for planned and unplanned mental health care. The model includes a First Response Crisis Mental Health Service with local sanctuaries and a Primary Service for Mental Health (PRISM) which brings together specialist mental health (including IAPT), primary care and community services. She is a national adviser for the NICE programme of work developing a national community mental health pathway.

Dr Tiffin is a practising GP in Peterborough and has a weekly radio show, Health Matters, on BBC Radio Cambridgeshire. In 2016 she was awarded Health Education England’s East of England Leadership Award for Service Improvement and Innovation. The First Response Service won the Positive Practice Mental Health Award for acute/crisis care last October and in November Dr Tiffin was a runner-up for GP of the Year at the General Practice Awards. She was awarded Healthcare Leader of the Year at the 2017 national GP awards.

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