Viewpoint: How primary care can take on more mental health from specialists

As mental health issues at last begin to move up the political agenda, one CCG is showing the way forward with a revolutionary approach to service provision.

Dr Phil Moore explained the intensive workforce development being undertaken at Kingston CCG, at our Commissioning Primary Care conference.

Dr Moore, deputy chair (clinical) at the west London CCG, said that 90% of people with a mental health disorder were predominantly cared for in primary care but with less than 10% of the budget. ‘That’s a low proportion of the mental health budget and at the same time specialist mental health services are very overstretched, meaning that access is limited.’

GPs can take on more stable mentally ill patients

But Dr Moore said that primary care could take on more, with the right staffing levels and skills: ‘I think we can take on a lot of the stable mentally ill, who are seriously ill, providing they are reasonably stable, but we need quick and easy access to specialist advice and support if we are going to do that.’

This was possible despite primary care being ‘on its knees,’ said Dr Moore. ‘We need to take care of not only the mental health of our patients and their carers but also the people who are delivering that service.’

Dr Moore, a board member of NHS Clinical Commissioners and chair of the Mental Health Commissioners’ Network, said taking on more specialist mental health work would improve the sustainability of primary care and in turn free specialists to provide the advice that GPs and their teams needed.

‘I am suggesting that we actually put more work into primary care because I want to see it survive. But if we do not pay attention to the workforce then none of it’s going to happen – workforce development has to be a top priority if we want to see mental health shift in the way we want it to.’

Co-commissioning can transform mental healthcare

Dr Moore said co-commissioning provided a major opportunity: ‘If we can bring the elements of care together - the long term condition care that we do with some of the additional work that specialists are doing that they do not need to do - and we enhance the workforce, it’s going to help us to be much more efficient and effective.

‘And if we can align all of the different quality targets that we need to meet, then we will make life a lot better for ourselves as well as our patients.’

Dr Moore said the change would require competence in the necessary skills, confidence in dealing with patients, and extra funding to increase staff numbers.

Kingston CCG has already begun a major transformation of the workforce, with 19 GPs (one per 100,000 patients) undertaking a diploma in mental health. Practice nurses and nurse practitioners are also improving their skills, and 48 clinicians are receiving further training in suicide prevention.

Educational updates are available for all GPs, practice staff have undergone mental health awareness training, and all local commissioners had taken a university-accredited course.

‘That’s a lot of training,’ said Dr Moore, ‘but this will provide the basis for us to move forward and begin to shift mental health. And everyone is really enjoying the learning.’

  • Colin Cooper is Editorial Director for GPonline

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