Panel
- Dr James Gossow, GP partner and Deputy Medical Director (Systems Improvement and Professional Standards) – NHS England, North East and Yorkshire
- Dr Steve Wright, Consultant in Community Psychiatry & Early Intervention, Clinical Lead for Mental Health, Learning Disability & Autism Humber & North Yorkshire Health & Care Partnership. He is also co-chair for York Mental Health Partnership.
- Dr Nick Timlin, GP, McKenzie Group Practice, Hartlepool
- Dr Libby Collins, GP Principal, University Health Service, Sheffield and Clinical Lead for ADHD, NHS England – North East and Yorkshire.
Transcript
James Gossow
My name’s James Gossow, a GP partner in the North East. I’m also Deputy Medical Director for NHS England, North East and Yorkshire, Systems Improvement and Professional Standards. So today we’re going to be talking about mental health and the role of primary care, particularly around mental health, neurodiversity and mental well-being. I’m the host today and the title of this podcast is ‘Mental Health and general practice.’
Firstly, we know that mental health conditions are common. We probably see about one in five of our population in England with a mental health condition – that translates to about 9.4 million patients. Secondly, we also know that sadly, unfortunately, mental health can have serious implications for our health and that patients with mental health conditions or neurodiversity or learning disabilities can have shortened life expectancy. Thirdly, we also know that demand is increasing. We’re seeing increased demand for help and support, particularly amongst our younger patients. And then finally, we know that primary care is often the first port of call for support and help from patients, particularly regarding mental health. I remember many years ago when I was a young medical student in the early 90s being told that something like 90% of work is carried out in primary care and without that, 90% can have a psychological component. Now those numbers might be slightly apocryphal, but certainly they are powerful and they give us some indication that a lot of work does take place in primary care and that everything we do as human beings often has a psychological component.
So, we know with mental health we’re dealing with common conditions, we know they can have serious implications for our patients. We know the demand’s rising and we also know the importance of primary care. So, what we’re going to be talking about today has real importance and real meaning for us. So, what we’ll probably do is talk about some of the great work that we’re doing in the region. We can then also talk about the 10-year plan and some of the shifts that we’re seeing through to that.
and then how primary care can help and support our patients.
So, I’m going to now go over to our panel and ask our panel members to introduce themselves.
Nick Timlin
I’m Nick Timlin. I’m a GP partner in Hartlepool. We have a large 30,000 practice, which is about 1/3 of the town, a town with quite severe deprivation – I think it’s in the top 10%. Sadly, our mental health has been down in years gone by. And we’ve responded to that by going ahead with transformation programmes, which have been led by Tees, Esk and Wear Valley Mental Health Trust and those changes are making a difference and we’re predicted to reduce our mental health problems and all the associated social effects going forward. So the future, is bright, although the history is not great. We also had one of the worst number of admissions for alcohol problems. And certainly, that’s sort of on the public health radar in terms of reducing that and in our practice, and practices across Hartlepool, we’ve been doing preventative work with that in mind.
James Gossow
Nick, shows how important primary care is, doesn’t it? Libby, over to you?
Libby Collins
I’m Dr Libby Collins and I’m a GP at the University Health Service in Sheffield, which is a student practice. The majority of our patients being between 18 and 25, though we do have plenty of patients outside of that range as well. And more recently, I’ve taken on the role of clinical lead for ADHD for the North East and Yorkshire region.
James Gossow
Thank you Libby, and over to yourself Steve.
Steve Wright
Hi, I’m Steve Wright. I’m a consultant psychiatrist with Tees, Esk and Wear Valley’s NHS Foundation Trust and have a role as the clinical lead for Mental Health, Learning Disability and Autism with Humber and North Yorkshire Health and Care Partnership. I’ve worked as a deputy medical director and medical director as well and as such in York, we got involved with a big transformation programme that arised out of the sudden closure of the hospital in York. That involved linking up with Trieste in Italy and a programme of co-production to develop a new way forward, really, in terms of community mental health that has ultimately allowed us to be part of the national programme for 24-7 neighbourhood mental health centres, which is one of the centres that we’re supporting locally.
James Gossow
Thank you, Steve. So earlier on we were talking about some pretty big numbers, weren’t we? One in five of a population having a mental health condition, 9.4 million patients affected in England. What do we see are the biggest challenges in primary care?
Nick Timlin
I would say there’s a lot of sort of young people with depression. It seems to have come out of the COVID sort of period. I know before the COVID period, there was something like 20% of people would suffer with depression and anxiety and sort of during that period, it went up to about 30% of the patients. Certainly, I have lots of young people afraid to go out, don’t work – they’re requesting sick notes, or help from counselling or antidepressants, and there’s sort of a huge need for sort of support in sort of all mental health aspects. There seems to be sort of a backlog of kids who sort of like didn’t go to school through that period, which seems to be coming through as well. So, you know, that’s quite difficult. The other area I would say is people are getting older and there’s a lot of dementia and we’re having to deal with that. There’s also the rise in awareness about ADHD and neurodevelopmental problems. So, patients are coming in requesting referral to those sorts of things.
James Gossow
Thank you, Nick. It’s multifactorial, isn’t it? We’re seeing increase in demand, COVID legacy, as you said, the effects on mental health and lifestyle, but also on work, and then looking at ageing population and dementia effects too. Libby, you’re very close to neurodiversity. Do you want to talk a little bit about some of the challenges we’re seeing in neurodiversity?
Libby Collins
Yeah, it’s interesting that it does come up in a lot of different areas, the way it can cause different issues. I think Nick making reference to more awareness about neurodiversity as a condition is really relevant because I think the whole concept of what even is neurodiversity, is fairly new. It might not be a new concept, but it’s certainly presenting to doctors in a new way that it hasn’t done in the past, I think. And I think it does raise the question about, you know, what do we consider part of somebody’s identity versus what we find pathological, you know, where does it become a disorder? And from that point of view, it’s really difficult to then make services that fit with that as well, because we’re looking at a whole, it’s a whole range, isn’t it, of problems that people can present with and how we address that is a new problem that we’re seeing coming to us in different areas.
One of the problems that I have found is the big overlap between what could be considered neurodiversity or neurodivergence and also other common mental health problems. So we see a lot of patients who have got some overlap with anxiety or depression or OCD and trying to work out where they fit in, how to find out what’s the primary diagnosis and how to treat that, you know, as a priority and then what other services might be useful for them to be factored into as well. And when we’re thinking about the different services that are available, obviously the mental health services have got huge pressures on them anyway. And there doesn’t seem to be a very clearly defined pathway for people for simple neurodivergent queries.
And that currently isn’t entirely clear. I think we’re still waiting to see where the direction goes. Other problems that we have with identifying neurodivergence is obviously people able to mask their symptoms and how that causes difficulties for the population if they’re presenting in their normal roles and trying to fit in with a neurotypical world that people are learning different tactics and ways of covering up the issues that they’re having. But that’s not necessarily in the long term particularly helpful because we need to be able to see these issues and see what we’re dealing with.
From the point of view of the services as well, I think moving towards a needs-led service is what appears to be the direction of change. But what that actually means for different people is really difficult to pinpoint. So, looking at how we can support people with neurodiversity, and their specific challenges are still something that’s coming to light really. There’s lots of issues that need to be unpicked, but I’m not sure there’s a lot of answers at the present time.
James Gossow
Thank you, Libby. I think you’re right. I think, again, some really fascinating issues that you’ve raised there. There’s an increased awareness, isn’t there? When we see our patients with neurodiversity, there’s often a range of issues and needs and unmet needs that we’re trying to support with. And it’s that concomitant mental health that we’re trying to untangle and support for our patients. There’s also that broader picture that we know and the challenges that we’re seeing of really long waiting times for our patients, a confusing array of varied providers with the right to choose and pathways is something both you and Nick have also raised.
Steve, is there anything that you’d want to add from a secondary care perspective looking in on primary care?
Steve Wright
Well, I think that really, you know, I think it’s really interesting how much there is and how we have to do things differently. And a lot of it is about how we all work together across systems. And you, as you highlighted, James, you know, the multifactorial nature of the worsening problem with mental problems with mental health in the community. So, I think from the secondary care perspective, it’s important that secondary care has its flaws, as we know, and one of those is the difficulties around access.
So, it’s very important that actually, a partnership approach is developed in each place where there’s an opportunity, and along the needs-led model alluded to. So, what we’ve tried to do is to involve communities, including those with minor problems, including those with neurodiversity, including those with continuing serious mental illness and high-level needs, and including citizens who want to know that there will be a responsive system. And I think where that’s been successful, it’s been around co-design, co-location and co-delivery and actually empowering very much at the heart of that, because I think that the stresses in primary care are considerable and that narrows the range of interventions that can be offered at that primary care level and what we want to be able to offer is to empower general GPs, but empower communities to offer a more holistic early model of care. So, what we want is really to be able to provide no barriers to support. So, a drop in, a no-referral system, a no-discharge system, which of course is something you’re familiar with in primary care but is something that has been eroded perhaps in that primary care, secondary care interface. But people can come in, developing trust within the community so that we start to make inroads into those less well heard communities, the inclusion groups and where we really need to make some progress because the greater levels of need tend to be in those people who are less liable to come forward. So, we, that’s where we are with the neighbourhood mental health centre pilot, we’re finding that a lot of people coming into them are now dropping in. We can’t quite untangle who’s been sent by the GP, who’s found out about it by word of mouth, who’s been referred by social care or a wide range of others. But that’s a less relevant point. I think it’s an academic one.
What we really are seeing is that people are able to come forward sooner with clinically significant needs and that we can largely meet those needs with non-clinical interventions. Social prescribing, peer support is a really popular element and It’s also a perfect workforce dynamic because people come in as receive peer support and then come back to be peer supporters. And there’s a rolling development process that’s already just happened organically without any promotion. But we also have the social prescribing, we have the prescribing and the psychological interventions that are there, but we know they’re limited. So, we’re better able to ensure that they are available to be offered to the people who need them because so many more people are less likely to need them if they get early help. It’s very promising if we can sustain it.
James Gossow
Actually, I mean, you’re hitting on some of the really big key shifts that we’re thinking about with the 10-year plan. We’ll talk about later about that whole community, that whole early intervention prevention agenda- you’re right. Okay, what are the initiatives in our region that we think are making a difference? I know we’ve got some good examples. Nick, you talked a little bit earlier about some of those interventions. Do you want to touch on them again?
Nick Timlin
One of the earliest interventions we did actually make was with the social prescribers. These are people who work in the practice, and we can refer to, to allow patients to access help. Often it’s with financial problems, housing, depression, you know, it can signpost them to interventions, counselling interventions and get them to even refer themselves, and often it’s just a lot of giving them information. We started the project with them on alcohol, as I mentioned before, this was sort of brought up as sort of being one of the areas to focus on in Hartlepool. Stockton has a similar sort of deprivation sort of level, yet their alcohol drinking levels weren’t as high as Hartlepool. And so, in the area we focused on that, and we looked at areas of practice where it would be normal to ask a sort of alcohol levels – levels of drinking – within the population such as diabetics. So that would all be well sort of documented. So, we focused on pre-diabetics where there wasn’t so much documentation and the social prescribers sent out questionnaires to fill in, finding out levels of drinking and those with the highest levels were then sent for intervention. So, they were offered some sort of help with the drinking, and they were also just given brief interventions.
Now, brief interventions on alcohol is just simple advice about how you can cut down your drinking levels, and so, and it’s shown to sort of, if you give these brief interventions to 10 patients, one will reduce the drinking and so it’s shown to be an effective intervention. And these were sent out to patients. We picked up about – I think about 600 patients were in this cohort that we looked at and out of them, 60 had reduced their alcohol after that time. So, it was a good preventative sort of method. Other things that we’ve done, because Hartlepool had produced these hubs in the town where patients could go and socialise and sort of get help with housing, etc. And it was, as Stephen had said, was a drop-in centre and people could just turn up with problems. They could access all sorts of things you know, there’s exercise bikes and there’s reading groups, there’s food banks, there’s all sorts of things to help them socially. These were already set up and then TEWV decided on the back of this – TEWVs the mental health trust – they would use these hubs and put people in to help with a drop-in centre. This started by getting the GPs to employ CPNs in the practice -they said they would stump up half the cost, and we in the practice stump up half the cost and so we’ve then CPNs come into practice and we can sort of refer into them. And so we get some help if we have a patient of TEWV that has stopped taking the medication, become unwell, we can refer straight into our CPNs to get help immediately or, you know, within a very short space of time in comparison to doing a mental health referral.
So, it’s cutting out the crisis. It’s a long time since I’ve had to ring for a crisis team mental health assessment. And I would say this is on the back of these new transformations that have come. The mental health nurse has been going out to these hubs, and I know has started a drop-in service about – I think it only happens about once a week, but she can actually go out to the hub. And so, the patients who were not coming in can get seen. We have had on the back of that CPN another CPN start who could take on more sort of in-depth counselling, which I think has become psychotherapy-type sessions, which, you know, I haven’t heard of in years. And then on the back of that, we’ve had another child CPN start who can deal with ADHD, autism and gives us immense support. And so, if our patient presents to our receptionist and wants to come in and says, my child’s having behaviour problems, I need some help or I think might have ADHD or autism, they can just refer direct and miss out the GP. And I would say that has helped my job immensely because in the past I would have had to probably talk to that mam for a good half hour when you’ve got 15 minutes because the problems are so deep, to then do a referral and now that child goes straight to somebody who can immediately give them some help. And it certainly has transformed the way we look after this cohort of patients the child CPN who we have working for us, who does the child psychiatry, is excellent. She has a history of working for CAMHS, the Child Adolescent Mental Health Service, she also became a manager. She has liaised with all the schools in Hartlepool. She knows exactly what help they can get at each individual school. So when that child comes, she can say, oh, you know, just ask the teacher for this, just get them to do this, and I must admit, I absolutely love her (!) because she’s really made my job so much easier. And so, what I would see is quite a hard consultation. There’s now, oh, just send it to our child CPN and it’s all sorted. And the patients absolutely love it, you know, so it’s a real transformation.
James Gossow
Well done, Nick. I want to come and work at your practice. It sounds amazing with you. And I think you were mentioning about CPNs for those people who aren’t necessarily au fait with acronyms. That’s Community Psychiatric Nurse, isn’t it? Okay, Libby, over to you. I know you’re doing some fascinating work as well in neurodiversity.
Libby Collins
I always relish any opportunity to talk about the work that we’re doing in neurodiversity because it really is my little baby at the practice where I work. So, I mentioned that we’re a student practice and we have a huge number of patients who are looking at whether they may have ADHD as part of their profiles. And often this unmasks when people come to university as well because of the difference in the demands that are being put on the patients compared to the amount of support that they’re getting as students. And so obviously when they’re little or they’re at school or they’re living at home with their parents, they’re getting a lot more support but people come to university and the amount of support that they get sort of, you know, it tapers off a little bit, but the demands seem to really increase. And this unmasks people saying, oh, I suddenly can’t manage to do dot, dot, dot, whatever it is I’ve previously been able to do. And so frequently people will come to us saying, oh, I think I might have ADHD, we noticed that we had a really big increase from about 2022 onwards in people requesting these referrals. And unfortunately, our local services have been very much overwhelmed. And the vast majority of our patients, therefore, were being referred via the’ right to choose’ pathway, which is one of the NHS pathways as an alternative to the local provision. This has lots of benefits. You know, the waiting times tend to be a little bit shorter, and the patients are often very happy with their service. However, there is a huge cost to this service as well and when I approached our local ICB, they were very supportive of setting up an in-house service that we could offer for our students instead of having to refer everybody down this right to choose pathway.
So what we’ve developed is a system whereby all of the patients who want to look at whether they have a neurodivergent condition, all come in to one point of access and they’re seen by a care coordinator who is a young, really switched on, really bright, really clever woman who was previously working in our reception team who’s been trained up to do this role. And so, she’s got specific knowledge in the different pathways and different support that’s available for our students. So what she does when she sees these patients is she will initially get lots of information from the patients and look at where their needs are, what is it that they’re missing out, what they’re missing out and what they feel would be beneficial for them and the work that she does in that initial appointment is to find out if there is some support that can be offered that would meet their needs and therefore they wouldn’t necessarily need to go down a diagnostic pathway.
We still have many patients who want to go down the diagnostic pathway who may feel that, you know, medication might be an option for them, or they may have other reasons for wanting to confirm a diagnosis. And those patients then get passed to myself. I mean, it could be any GP, just happens to be that I’m working in this practice. So, they come to the GP, and I will have an opportunity to go through all of their records to look for any comorbid mental health conditions they may already have or any other issues that they might have had whilst they’ve been at university with us. And we also ask the patients to fill in quite a host of questionnaires that give us more information. And this includes what’s called a ‘functional impairment screening tool’ that we use. And so, we get lots of information about where the patient feels that their needs are greatest. And we also at that point collect information from an adult informant. So, this is usually a parent, but it can be a different adult, but it has to be somebody that’s known the patient for a prolonged period of time. And they get asked a series of questions. It’s quite a detailed questionnaire that they fill in about the childhood experiences, any developmental issues, and how they presented as a child in their, you know, primary and secondary school ages. So I get all of that information in, which then I can sift through and look for where there might be any sort of, you know, red flags that make me think, oh, this patient’s got other issues that we need to look at, or – it just helps with the whole diagnostic process. And we use that information to sort of screen the patients really to see whether they’re suitable for a primary care diagnostic assessment. And if they’re not suitable for a primary care diagnostic assessment, where else might their needs be met?
So sometimes this is through the mental health services, sometimes it’s through seeing a GP about an alternative diagnosis, but sometimes it’s that, you know, the educational side of things can be met by our university counterparts as well. So, we do work really closely with the department called, it’s called DDSS, which is Dyslexia, Disability, Student Services, I think. I might have to look that one up. But they are able to provide a huge amount of support for our university students, including learning support plans, access arrangements for exams and projects towards their degree. We also have study skills sessions, and also peer support as well that’s available through the university. Separate to the university, we also have social prescribers, as Nick had been describing in his practice, that the social prescribing is really a massive part of meeting the needs of the neurodivergent communities as well, because there’s lots of things that is already available that they might not be aware of. So, it’s bringing those things into the awareness and looking at a person-centred approach as well. So between the care coordinator and the screening process, we identify -we aim to identify – the majority of the needs and how they can be met. For the patients who do need to go on for a diagnostic assessment, a proportion of those will come through to see me in my diagnostic clinic, which I absolutely love doing and find a really interesting and rewarding part of my role is to be able to actually do that, you know, within a few weeks of them accessing our services rather than having to send them off for a many, many months wait for the same. I feel that that’s really important for our students just because they’re at university for a short amount of time in reality. They’re here for three years, sometimes five years, sometimes a bit longer if they’re doing PhDs as well. But we want to support those students so they can get the best out of their experience here. And I think putting them onto a waiting list for a long, drawn-out process isn’t in their interest. So, I’m really proud of the work that we’re doing because I feel that we’re making a really big difference to our students and we’re meeting a need that they specifically have. It may not be necessarily applicable to, you know, pick up this project and move it into other areas, but there’s certainly a lot of learning that could come from the project that we’re doing about how the students can access extra support and how they can have their needs met in a not necessarily medicated way.
James Gossow
Brilliant. Thank you, Libby. I’m always immensely proud of the work that takes place in primary care, both yourself, Nick and Libby of the innovation that we show as GPs and primary care clinicians. It’s amazing what we can do when we set our minds to it, isn’t it? Okay, so we know some of the national projects that are out there. We know about Talking Therapies. We know about peer support and advocacy, which we’ve already touched on lightly in some of the earlier discussion. We’ve got mental health teams in schools. We’ve got CAMHS, which is the Child and Adolescent Mental Health Service. We’ve got individual placement and support. We’ve got perinatal mental health services. We’ve got the crisis team as well, eating disorders and early intervention in psychosis. So, it’s just to note there’s lots of good work going on out there and there’s lots of support and help for patients when they need that.
Time’s running short. I think we could have done a whole podcast series just on this topic, to be honest. So why don’t we do a 5-minute discussion now on some of the 10-year plan and the big shifts, the three big shifts that we’re seeing. Steve, I can see you’ve got your hand up.
Steve Wright
Yes, there was just one thing I wanted to just get across around that crisis, the difference around crisis response and crisis prevention, really and particularly around what we’re offering as an alternative. So alternatives to admission, particularly providing support and one of the things that I’d really like to highlight, I suppose, is carer burnout and the need to be supporting carers more effectively and we’re finding that that’s something that there is more and more need for and independently providing support so carers themselves can come to our hubs, for example, and provide we have dedicated staff for carer support. The role of the voluntary sector is, you know, is crucial in this, but in terms of providing genuine alternatives to admission, we’re finding that that’s something that is often overlooked and yet it’s some of the most effective work goes into how we can support people in their families in the community. So, I just really wanted to highlight that as something that we perhaps not touched on up until this point.
James Gossow
I think that’s a really important point, Steve, and we know that patients do much better often in the home environment, don’t you? When I hear about patients being admitted and particularly out of area placement sometimes and how difficult and challenging that can be for patients, but also for family if they want to visit or they want to get support. So, I think that’s a really important point. Thank you, Steve.
Over to the panel. Any thoughts, any comments on the 10-year plan?
Nick Timlin
One of the areas that we’ve been looking at in Hartlepool is we have like a very good drug and alcohol service, called Start and they’ve started introducing spirometry checks aimed at prevention of COPD. So, I’m going down the preventative work and they will, because a lot of these patients tend to hide away and don’t really want to interact with us. Once they look for help and go to Smart, they can do the spirometry in the actual centre and then send us the results and then we’ll deal with it and we can ring them up. And it just sort of creates a sort of you know, interface between us and the patients and maybe gets them to engage. And so, we can help with sort of the physical health.
Another initiative in Hartlepool has been that we’ve took on a nurse between us and Tees Esk and Wear Mental Health Trust who goes out and engages with the severely mentally ill patients and gets their blood pressure checked and cholesterol blood tests done so that they can be looked after in the same way that the rest of the population, because some of these patients are hard to get to. One of the sorts of big patient successes was – there was a patient with bipolar disorder who wouldn’t engage. She would ring the surgery about bleeding in her urine. She would sort of send a sample in but wouldn’t actually come into the surgery for a smear or get checked and because this nurse went out and went to her home and did her blood pressure, engaged with her, she got her in and found out she had cervical cancer and she then was able to access treatment. And so, there’s certainly initiatives that sort of look at helping sort of mental health patients access physical sort of health and reducing inequalities and problems in the future.
James Gossow
Well done, Nick. And you’re right. I think when we talk about three big shifts, we talk about that hospital to community and you’re talking very much about the community, that sickness to prevention. And again, you’re talking about that prevention. And then there’s the analogue to digital, isn’t there? In my own GP practice, it’s phenomenal some of the digital changes we’re seeing. We’ve now got AI writing our notes if you want to use AI to write your notes. We’ve now got AI carrying out triage for us and we’ve now got AI looking at results as well. You know, if you’d asked me 10 years ago, I wouldn’t have believed it. It’s phenomenal, some of the digital changes that we’re seeing coming through. Libby –
Libby Collins
I didn’t want to leave without mentioning the ADHD Task Force report, because along the same lines as the big three shifts from the 10 year plan, I think the ADHD Task Force really identified the areas that the ADHD care should be moving in and the sort of the idea of the cross-governmental issues and, you know, embracing healthcare, education, employment and justice as well. So, it’s not just a healthcare problem. And I think that’s really important to mention from an ADHD point of view. There are already some projects that are happening, for example, in schools, there’s a project called PINS, which is the Partnership for Inclusion of Neurodiversity in Schools. And that’s a joint project with the Department of Education and the NHS that’s basically looking at how any needs can be met within schools at a very early age. And that fits in with the prevention rather than treatment with the 10-year plan and the early identification of neurodivergent problems is really going to be key, I think, for the future and how ADHD is managed going forwards. So, I just didn’t want to leave the discussion without mentioning that as well.
James Gossow
Libby, I think that was a really good call because I think that ADHD task force report is really important and the content is as well. I think it matches, as well,the 10-year plan as well a lot of what we say. Steve, anything you want to add with your secondary care hat on.
Steve Wright
Well, I think it all it’s all about primary care and it’s about having a seamless system and I think with the challenges of the 10-year plan, it’s great that we’ve got some pilots and we’re lucky that within our region we have three of the six national 24-7 neighbourhood mental health pilots in Sheffield and in York and in Whitehaven, Copeland. And at Hartlepool, I have to say, it’s great to hear how that’s joining up, Nick, and I’ve been aware that that’s really another pioneering area for neighbourhood mental health at the same time. What I would say is the overall worries for me are how it’s funded and how we how we can realise the benefits as a system where we’re making effectively, we’re potentially making savings in one part that are realised in another and how we how we get that to join up so that if we’re if we’re working hard on the prevention, we are able to move that resource from the secondary services and I think that’s still the challenge that has blocked this progress over decades rather than years.
James Gossow
Well done, Steve. And that was a really good point you’ve made. You’ve talked about pathways, flow and joined up working, which we have to get right. You’re absolutely spot on. Okay, so we’re reaching the end of our podcast today. I’m going to give each panel member a minute just if there was something you really wanted to say or a summary point that you really wanted to get across. Nick –
Nick Timlin
Having the mental health team members in the practice is immense. You can just call them, ring them, sort of task them, IM them, and so communication is the big plus, I would say, that we have realised in Hartlepool. Certainly, the social prescribers are a big part of that, keeping everybody in touch, knowing what’s going on, what help can be accessed – it’s great.
James Gossow
Brilliant. Thank you, Nick. Importance to team and communication. You’re absolutely right. Libby, over to you.
Libby Collins
From my point of view, the biggest thing I would say is that I feel really positive about the future of how things are moving. So there are obviously, you know, concerns and things that need to be worked on, but that is starting to happen and looking at moving things from secondary care to primary care and looking at a support-based pathway rather than a diagnostic based pathway. I think things will start to tie in as time goes by in the next few years and we’ll see a lot of changes in how ADHD is managed and I think it’s all for the better.
James Gossow
Thanks you Libby. So really, just to say thank you to the panel members, I found that a really enjoyable podcast. It’s been really fascinating. We’ve covered the challenges, which we know. We’ve also talked about some of the amazing work and innovation that’s taking place across the region. And I think it’s going to be a very exciting area going forward, particularly with those three big shifts that we’ve talked about with community, prevention and also digital.Thank you everyone.