The additional roles reimbursement scheme (ARRS) offers £430m in 2020/21 for PCNs to recruit staff including pharmacists, physios and occupational therapists. Networks will not be reimbursed for mental health practitioners (MHPs) roles until April 2021.
But clinical directors leading PCNs argue that funding for this position should be released now to provide patients with better support and to release GP time. Some GPs are warning that mental health consultations make up 30-40% of their appointments at present, with people going to see their doctor after months of social distancing.
Calls to bring mental health staff recruitment forward have been strengthened by an NHS Confederation report, which warns that a rise in people suffering from anxiety and depression ‘is likely to impact most severely on primary care’.
Mental health impact
Nearly two thirds of people across England say that their mental health has got worse during lockdown, according to a poll by mental health charity Mind. It also found that one in five adults with no previous experience of poor mental health now say that their mental health is poor or very poor.
In its report ‘Mental health services and COVID-19: preparing for the rising tide’, the NHS Confederation said GPs were often the ‘first port of call’ for people with mental health problems.
It argued that the creation of PCNs could help to meet the additional demand created by COVID-19, but highlighted warnings from network leaders that they need the appropriate staff to deliver this work.
Clinical director of Tower Hamlets Network 4 PCN in London Dr Kamilla Kamaruddin said: ‘Mental health issues have risen quite a bit during the pandemic. At the start it wasn’t as bad, but now - and four or five months down the line - you are seeing many, many more patients presenting with these issues.
‘The CGG providers in our case are not coping with the demand. Although they are putting in more resources, the demand is actually quite high. We should be able to recruit mental health practitioners now. They will allow us to cope with the demand. It’s something that we GPs need a lot of resources to address - we can’t deal with these patients in 10 minutes.'
Dr Kamaruddin added that network managers in the area had ‘unanimously agreed’ that reimbursement should be brought forward and had written a letter to their local CCG, which would be passed on to NHS England.
Clinical director of Whitewater Loddon PCN near Basingstoke in Hampshire Dr Tim Cooper echoed calls for the ARRS rules to be relaxed.
‘I think it’s a good thing, our social prescribers have been invaluable during the pandemic and beyond. My only wish would be that we could bring forward our mental health workers to this year,’ he said.
‘Our big concern is the mental health fallout from COVID-19 and the impending recession. Social prescribers can support this but having access to community based mental health and wellbeing workers to support this would be ideal,’ he added.
The NHS Confederation report found that mental health referrals dropped by more than 30% during the pandemic. It predicts a rise in mental health problems will increase demand for services 20% higher than pre-COVID levels.
BMA GP committee chair Dr Richard Vautrey, said: ‘The BMA has consistently said that mental health practitioners are required in general practice as a matter of urgency, and given the mental health impact of the COVID-19 pandemic on patients, this is more crucial now than ever.
‘CCGs and mental health trusts should already be working to align mental health workers with practices so that they provide much more direct support to practices and their patients.’
He continued: 'In the light of COVID-19, we want full flexibility for ARRS so that PCNs can, in addition, recruit the staff they need right now based on their patients’ needs, rather than having to wait for months or years. As the body that negotiates the PCN DES, we continue to raise this important issue on behalf of clinical directors in our talks with NHSE/I.'
PCNs have been told by NHS England that they are entitled to 'overrecruit' for the final 6-9 months of the year (i.e. beyond the average 7-8 staff) in order to use their full ARRS funding allocation. PCNs have also been offered extra funding in a bid to accelerate the recruitment of social prescribers.
But GPonline has reported that networks are struggling to recruit to additional roles due to rising workload pressures created by continuing COVID-19 efforts and an expanded flu programme.