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A faulty production line

Why we need a mental health worker for every practice

Dr Maureen Baker explains how direct GP access to a mental health professional would enable safer care and ease pressures

GPs urgently need better support

Mental health now accounts for just under a quarter of the health problems that our patients present with. But we simply do not have the resources to provide the best care.

This is why we’re calling for every GP practice to have access to a mental health worker. GPs urgently need better support.

We were encouraged by the implicit recognition of the important role general practice teams play in the recent Mental Health Taskforce report – particularly the proposals to expand child mental health services and provide better support for women with perinatal mental health problems, both of which are clinical priorities for the RCGP.

But the recognition that we urgently need support to deliver this care effectively and confidently needs to be more explicit – and initiatives must be put into motion.

The college is calling for every GP practice to have access to mental health workers who can deliver services and treatments that can really benefit our patients. We would like this to be one of the measures to help relieve the intense resource and workforce pressures in general practice that NHS England is expected to announce soon.

There has been progress over the past few years: the Improving Access to Psychological Therapies (IAPT) programme has successfully increased the number of psychological wellbeing practitioners and high-intensity cognitive behavioural therapy workers available within the NHS.

But we now need to ensure that GP practices have targeted access to mental health professionals – ideally for them to be based in practices as part of the practice team, in a similar way that practice-based pharmacists are currently being rolled out across England.

How would this work?

We are not necessarily talking about one mental health worker per practice but about shared ‘hubs’ employed at CCG level, or within GP federations.

Such professionals could lead on all aspects of mental health delivery as per the recommendations in the taskforce report. They could act as the main liaison between the practice and community mental health teams. They could oversee the focus on physical health screening programmes and they could provide psychological therapies.

Why is this needed?

According to the Health and Social Care Information Service, almost one in four people wait 28 days or more from first referral to access. Our proposals would help to eliminate the delay by increasing capacity and streamlining the process. They would also reduce the pressures on general practice as we and our teams contend with uncertainty over the next steps and watch patients disengage, sometimes with disastrous results.

In addition, the college wants to ensure that our patients have a choice to access psychological support locally, somewhere known to them. This could reduce waiting times as referrals could be made swiftly to locally based colleagues with whom practices have an established relationship. This would also enhance continuity of care for patients, as GPs and our teams would be able to co-ordinate therapy and medication more easily.

It could also help certain groups, such as older people and those with long-term conditions who have comparatively poor access to the current psychological therapies programme, as it would initially engage them through GP services, with which they will already be familiar and feel comfortable.

Our plans are ambitious, but realistic and viable, and our costings have been shared with NHS England as part of its consultation with us about the measures needed to support general practice.

In the long run, like all other services delivered in general practice and wider primary care, practice-based mental health workers will be cost effective and in the best interests of our patients’ safety.

Our patients want care close to their homes, whether it is for their physical or mental health. We now need the Government and NHS England to invest in general practice and ‘recruit, return and retain’ sufficient numbers of GPs and practice staff to ensure we can give as much care and attention to the mind as to the body.

This will be a major step forward in achieving true parity of esteem between mental and physical health.

Dr Maureen Baker is chair of the RCGP

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Readers' comments (8)

  • This is nonsense - a sensible approach for commissioners, but not for the Royal college or practices.

    Better still 'Why we need a fixed GP to patient ratio and a maximum daily consult rate'.

    - Safety
    - Litigation
    - Funding
    - Negotiable solutions to the crisis

    Can you get on with that instead please?

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  • This is just froth on there beer,we need the beer topping up please or else it will be froth and nothing else.

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  • splendid idea - with teams of physician associates, pharmacists and mental health workers at every practice - General Practice will be saved. funding can easily be found from existing budgets. all we need now are physios, podiatry and a district nurse at each practice to complete the team. GPs being the resilient sort will easily be able to fund all of this from existing budgets and it will be fantastic if such services are available 7 days a week 12 hours a day as we know health problems are not 9 to 5. Maybe in the future we will also have consultant psychiatrists at every practice but we have to be careful of not pushing our resources too hard.

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  • Hub is the new horrible meaningless get out of jail free word- suspect ANYBODY who uses it. Any way I don't want a mental health worker I want a DISTRICT NURSE that answers its phone , isn't off sick , turns up at meetings, has just left the trust etc etc etc

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  • who was it who said "its never been a better time to be a GP"??

    If someone said such a thing in todays climate would you take them seriously???

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  • Oh dear oh dear oh dear
    So no weekends or nights
    No terminal care ( we are not around )
    No chronic illness ( all done by nurses )
    No minor illness ( all done by nurses )
    Very little minor surgery ( too risky )
    No obstetrics ( of course )
    Nothing which is important or serious ( better refer remember the GMC is hovering ) refer fast

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  • I'm sorry, I did not quite understand? Was the mental healthcare nurse for the patients or the practice staff?
    With the rubbish going on in gp land, I think the staff will be more needy.

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  • More wise words from the RCGP Ivory Tower. Blah Blah Blah.

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