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CCG 'saves thousands' by moving mental health check-ups into GP practices

A CCG in east London has claimed it is saving thousands of pounds on moving mental health check-ups into GP practices rather than outpatient clinics.

An evaluation of a scheme in NHS Newham CCG, which sees patients with stable severe mental health illnesses having regular check-ups with community psychiatric nurses (CPNs) in GP practices instead of a hospital psychiatrist, has shown just 10% of patients relapsed and had to return to psychiatric care.

It also found that when they were better they wanted to return to the care of their GP.

Three years after it was first launched, the programme now covers 600 patients who have opted into the scheme, spanning 61 GP practices in NHS Newham CCG which have access to four CPN teams on stand-by.

According to NHS England, the initiative has ‘saved thousands of pounds’ for the CCG, which it has been able to reinvest some of the funding towards new services provided by the East London NHS Foundation Trust.

Initiatives include a ‘buddying’ programme, whereby people who have been through similar experiences but are now better help others return to work.

However, one problem identified was that patients are awarded housing or transport benefits following contact with secondary care, and are thus in danger of losing such benefits. The CCG said it is still having to work through this on a case-by-case basis.

Dr Lise Hertel, an NHS Newham CCG GP representative, said there was initially resistance to the scheme from GPs, practice nurses and psychiatrists but that ‘regular discussions’ had helped resolve issues.

She said: ‘This service achieves appointments that are closer to home and the patients can be seen more often. The GPs and practice nurses can also carry out any physical health checks and start treatment immediately with patients and their carers, not done previously at the outpatient checks at the hospital, including vaccines such as flu, blood pressure monitoring and cardiovascular disease and diabetic checks.

‘The GPs’ QOF scores have increased as a result and this has helped fund the primary care mental health development.’

NHS England national clinical director for mental health Dr Geraldine Strarthdee said: ‘Often outpatient clinics can become incredibly busy seeing relatively stable people, and the capacity to respond to crises to prevent a deterioration or prevent an unnecessary admission is then very limited.

‘Where there is no longer a need for people to visit an outpatient unit, it is better for them to have their appointment in their GP surgery close to home. Not only is it better for the patient, but it also frees up appointments with specialists for those who need more serious interventions.’

Readers' comments (7)

  • I presume these patients are on antipsychotic medications. Who makes the decision it is safe to stop these medications? Stable they may be on x dose, but which GP is going to have the confidence and competence to stop medications? Few.

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  • There is little benefit to psychiatric patients in being followed up in secondary care 6months on from an acute illness. It makes more sense to discharge back to primary care with a clear letter regarding a plan and relapse signs. Secondary care then has space to be more responsive so that relapsing patients can be seen in a timely fashion. A gp should be able to pick up the phone and speak to a psychiatrist for advice although there seems to be more and more barriers to this. I. Terms of when to stop medications, those with severe and enduring mental illness probably should've but if it's being considered, a chat between primary and secondary care or an opa should address that?

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  • A similar system to this is place in Brighton. Called SMILES serious mental illness LES. the lES bit is important because it is funded as non-core work. If no funding then we should not be doing it.
    In my opinion antipsychotics should be viewed like methotrexate, requiring specialist follow up as long as the paqtient needs them. If we take on the more specialist role then it must be adequately funded

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  • I totally agree with 1246 - apart from the fact that we know that is not what will happen in reality.
    Plan
    1 - patient care moves from specialist to primary care
    2 - extra space becomes available in specialist care
    3 - GPs can use that space to urgently get the same patients seen, by a psychiatrist, when they are needed.

    Reaslity:
    1 - workload moves to primary care
    2 - funding for secondary care reduced
    3 - GPs forced to sort it out themselves when their complicated patients are waiting weeks or months to be seen.

    Add to that a slow but relentless increase in what is deemed acceptable to dump on to primary care and the whole scheme is just a mess.

    It seems crazy to me that I can pick up the phone and get immediate specialist advice from a consultant in almost every speciality..... apart from psychiatry.

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  • This type of unfunded nonsense needs to stop. Any patient on antipyschotics not initated commonly by the majority of GP's needs to be under psychiatrist care. This dumping needs to stop and we are just as busy as the all important consultant who has commented feels. In my area, the psychiatrist can not even be bothered to write the prescriptions for medications initiation and changes. Sheer laziness and desire not to do any work they can get away with. There nonsense excuse, we do not have prescription pads! who the hell made you a doctor then? Trying to get patients through their "triage" system is like a happy meri-go-round of getting no where. Getting patients who are too often discharged to soon is neigh on impossible except through the crisis team. This needs to stop and psychiatrist needs to do their job properly and not discharge and dump everything back.

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  • happy for the psych nurse to review them in GP surgery as long as thery are still under the psych team and if they pick up any issues they are discussing it with them not the GP weve got enough to do.
    If we were funded to have a role then of course we would need to be able to get same day advice if needed occasionally.

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  • So why do we need psychiatrists at all?

    Over paid, lazy and invisible!

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