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With warnings of a post-pandemic tsunami of mental health to hit the NHS, PCNs are working out how to best meet the needs of their local population. But with difficult to navigate joint-funding arrangements and recruitment headaches – which are unlikely to be solved by the update to the Network DES stating they can now higher an extra mental health practitioner via the ARRS – PCNs are also investigating different ways to meet the wave of need that GPs say is already here.
Emma Wilkinson looks at what they’re putting in place and the challenges they’re facing.
Taking a different approach
Mental health is incredibly broad and it depends what bit PCNs are trying to tackle as to what the best approach will be, says Baird. ‘Putting aside how difficult it is to get the staff, PCNs are going to have to think about what their need is, how they implement staff and what are they going to be doing and how to make the best use of them.’
Dr Simone Yule, clinical director for The Vale Network PCN in Dorset explains recruiting to the jointly funded role – which has just gone out to another round of recruitment – has been impossible.
‘But in the meantime, we sat down with the community mental health trust and Dorset Mental Health Forum and the CCG and set up a pilot with peer support workers coming into primary care.’
The scheme which is funded by the CCG has been running for about 15 months and its success means more PCNs are now looking to get involved. The peer support workers are trained and were already working in the community mental health trust. They have 45 min to an hour appointments and have open access to the GP or mental health team if needed.
‘What we’re seeing is a lot of low-level mental health issues related to social, economic, emotional distress and they want someone to offload to. The feedback from patients has been brilliant.’
They also have social prescribers and some support from local organisation Steps 2 Wellbeing and the PCN has a good relationship with the community mental health provider who are based in the same building.
Dr Yule also notes that the latest contract specification from March broadens the definition of what is allowed under the ARRS to include peer support workers and mental health community connectors which could help PCNs identify the right role for their patient needs. ‘We did have a mental health practitioner we recruited and she was very high level at band 7/8 and a prescriber and she found it really very unfulfilling because it wasn’t the type of work she was used to.’
Children and young people needs to be thought about says Dr Lee. She has been running a GP-led service with two local schools for four years. Now funded by the PCN, demand among the 16-18-year olds who can access the scheme, has tripled with issues like eating disorders and anxiety. They signpost, encourage counselling and offer a single point of access. It has reduced referrals to their mental health service, says Dr Lee. This is a perfect scheme which a CPN could be involved in but the one they have recruited cannot treat under 18s.
‘We have a social prescribing team but patients also have to be over 18. This is a big area of need. We are hoping to recruit a CAMHS CPN to the team.’
Kentish Town South PCN is one of the wave one sites for the new community framework for mental health. PCN clinical director Dr Jonathan Levy says that has meant more foot soldiers on the ground with increased CPNs and peer support workers from the mental health trust as well as psychiatrist time for those with severe mental illness of which their PCN has one of the highest rates in the country.
The predicted wave of anxiety and depression from the pandemic has definitely arrived, he adds. ‘One project we are doing is around increasing the uptake of physical health checks for people with serious mental illness. The rate of these being completed has fallen through the floor during Covid and we need significant assertive outreach to help improve these. Another project we are undertaking is to look at those patients with serious mental illness that are also in waiting lists for joint replacements. Patients are usually really motivated help ensure the best outcomes from their arthroplasties so we’re seeing if we can capitalise on that and engage SMI patients in the pre-operative period to improving their physical health and seek to improve other wider determinants of their wellbeing e.g., around their accommodation, friendship circle, hobbies or employment.
In Kentish Town South PCN they have their own in-house social prescribing charity called the Freespace Project which links patients with community support but also providing a range of wellbeing activities and art therapy.
‘It’s been in place for 14 year and recognises that the patient’s wellbeing is determined by not just their physical and mental health, but the impact of wider determinants of wellbeing such as social isolation which we see a lot in a lot in urban areas,’ says Dr Levy.
In their experience centralised funding does not necessarily recognise the specific needs of their population. ‘A lot of the initiatives that we are doing are not funded through the core contract or locally commissioned services but through applications to charitable funds and more recently the health inequalities funds.’
The latest example is their work as a Complete Care Community programme pilot site for tackling health inequalities, a project they have been working on for 10 months that is about to launch. ‘We’re trying to address the stigma associated with mental ill health in our BAME communities. We are working with a local charity called Hopscotch, who work with particularly our local Bengali community at the interface of racial and gender inequality. We know in these communities there’s a lot of stigma around mental health and we are seeking to empower these communities try to increase awareness of mental ill health, to seek help and become aware of services are available.’
Mental health charity Mind believe that additional roles funding through PCNs will bring much needed additional capacity into primary care and help people access early intervention and they are well-placed to support that.
Vicki Ensor, Mind senior policy and campaigns Officer added that the new contract offers much more flexibility for voluntary sector organisations to provide services.
‘They have a strong track record in providing high quality, innovative services that are tailored to the needs of their community and are well placed to support primary care through the ARRS scheme.’
Their Active Monitoring programme of a six-week guided self-help intervention for people with mild-to-moderate symptoms has recently been scaled up and delivered in over 80 GP surgeries with 84% of patients showing improvement in their mental health.
‘Local Minds have significant experience providing mental health practitioner roles, including peer support workers and mental health community connectors,’ she says adding they welcome the expansion of the ARRS roles.
But there are several factors that need to be taken into account including sufficient funding, training and support for practitioners, shared commitment and collaboration from primary and secondary care and data sharing, Mind point out.
But, says Dr Gandhi their fantastic third sector providers in Nottingham are struggling with the same issues as everyone else. ‘A lot of our local third-party providers their waiting lists are astronomical as well. They collaborate will with us but they don’t have the staff either.’