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From April, each PCN will have access to a full-time mental health practitioner, employed by the local community mental health provider and funded equally by the PCN and local provider.
Our GP federation South Durham Health has had practice-based mental health link workers – all trained community psychiatric nurses – for the past few years. In partnership with Tees, Esk and Wear Valleys mental health trust (TEWV) and with funding from the CCG, we deployed a team of mental health link workers to provide a practice-based service offering advice, assessment, short-term counselling, de-escalation, crisis prevention and referral to secondary care and the voluntary sector. This has given us useful insights and I believe the new mental health practitioner role funded through the Additional Roles Reimbursement Scheme (ARRS) is a good opportunity for PCNs, if managed optimally.
Here are my 10 tips for making the best of this scheme.
1) Relationships are key
The joint funding with your local mental health provider means you need to forge an open and equal partnership, underpinned by mutual trust. These local providers want to work with PCNs to ensure that they can meet demand, which is only possible with early intervention and by investing in the promotion of positive mental health.
2) Enhance access and provision
Make sure your mental health practitioners are delivering an additional service. The ARRS roles are designed to increase capacity in primary care in recognition of the immense pressures on access. The role should be practice based, backed by joint funding and collaboration with the trust. Otherwise, it might end up as a reorganisation of services or extension of local referral teams, causing further confusion for patients.
3) Make ‘first contact’ a priority
Ensure patients can be booked in to see the mental health practitioner directly. This is of utmost importance for those who ‘suffer in silence’ or are experiencing suboptimal care and helps to overcome the stigma of seeking help for mental illness.
4) Promote the new role
Publicise the mental health practitioners on the practice website, newsletter, new patient leaflet, patient participation groups and social media page to help raise awareness and engagement among your population. Consider using the mental health practitioner role in promoting the self-help resources and prevention available in the wider community through social prescribing.
5) Make the mental health practitioner essential to your MDT
It is vital to have seamless links and genuine integration with the wider primary care team, in particular social prescribing, wellbeing and IAPT services, to ensure a good patient experience and optimum engagement.
6) Have a named lead in the practice and PCN
Having support from a named clinical lead in each practice and PCN, for example to discuss challenging or complex cases as well as ironing out any issues with case mix, will help improve patient outcomes and experience. The lead could be a GP or a nurse practitioner with a special interest.
7) Agree no referral is ‘inappropriate’
The practice and partner organisations need to agree how appropriate patients will be directed to see mental health practitioners. Clear criteria for referral agreed in the team and shared with the reception staff and care navigation templates can help ensure the right people benefit.
All services should take responsibility for any referral through any source, to ensure patients do not have to navigate complex (and often fragmented) services themselves. Have a clear policy that no referral will be deemed ‘inappropriate’ or bounced back to the practice or mental health practitioner. PCNs should use the opportunity and discussions about the mental health practitioner role to reduce bureaucracy around referral processes and forms as supported by NHS England.
8) Offer regular training and peer support
The mental health practitioner role has a high risk of staff burnout. Make regular times to debrief and discuss cases so that staff can cope with the stress of challenging cases and feel valued. Your partner trust has probably established processes for this and you will benefit from their insights as well as governance and support network.
9) Involve mental health practitioners in improving care for serious mental illness
Your mental health practitioners may be able to improve engagement with these patients. They can help monitoring of antipsychotic medications, and supporting QOF work, such as ensuring patients are captured on disease registers and have timely and effective reviews.
10) Consider working with like-minded PCNs
This will give a larger pool of practitioners and help with annual leave, sickness cover and training.
Dr Kamal Sidhu is a GP partner and trainer with a special interest in mental health, and chair of South Durham Health CIC, a GP federation that provides practice-based mental health link workers