Dealing with patients with mental health problems in South Durham, I became concerned about the long waiting lists for support services. In some cases, patients were waiting months after I referred them.
A combination of dwindling investment in mental health and the desperate levels of deprivation in the area contributes to the North-East of England having the highest rate of suicide in England. So to access better support for patients, my practice took part in a pilot set up and run by South Durham Health Community Interest Company (CIC), which put community psychiatric nurses (CPNs) into GP practices to work with patients with mental health needs.
Funding the pilot
As chair of South Durham CIC, a federation of 24 GP practices in the region, I helped bid for transformation money from our CCG. The pilot began in June 2014, when we employed two CPNs to work between my practice in Newton Aycliffe and two others in the town. It cost £54,000.
Now, a patient who has mental health needs, but is not in a state of crisis, can be referred directly to a CPN, in most cases within 24 hours. The nurses are highly trained and experienced in dealing with mental health conditions. As well as providing CBT and counselling, they can help patients with difficult issues such as bankruptcy hearings and employment tribunals.
If the CPNs deem a patient to be a risk to themselves, they can then direct them to more appropriate services.
In April this year, South Durham Health CIC tapped into a separate pot of funding to extend the pilot for a further six months. This gave surgeries in neighbouring Easington, Blackhall and Thornley access to three more CPNs.
We do not advertise the service in waiting rooms or on practice websites because it’s important not to encourage patients to think about harming themselves. However, we offer patients a same-day appointment at our surgery and the GP can refer the patient to a CPN on that day.
Most of the funding goes to paying the CPNs. We were lucky that CPNs can retire at 55 with their pension, but can still work two days a week with us. Other practices seeking extra mental health support for patients could employ a CPN two days a week for £24,000-£27,000.
It’s imperative that the right CPN is chosen for the job. The CPNs in our practice underwent mandatory training before they started work, completing the ASIST suicide-prevention course and training on the practice computer systems.
The pilot has seen 173 referrals so far and it has reached 44,000 patients.
A total of 16 patients so far have been prevented from self-harm or suicide by the pilot. These patients had not initially been deemed to be in crisis, but their mental health had deteriorated. Had the pilot not been in place, these patients might have been on long waiting lists or unable to access help at all.
GPs in my practice now spend much less time following up mental health referrals. South Durham Health CIC is hoping that further successful funding bids will give all 24 practices in the group access to the scheme. It’s estimated that a suicide costs the health service £1.76 million and this scheme is an excellent way to start addressing this.
Dr Robert McKinty is a GP in Newton Aycliffe and chair of South Durham Health CIC