London Mental Health Strategic Clinical Network WELCOME Strengthening Mental Health Commissioning in Primary Care - practical solutions and learning from experience Date 3 July 2014 Twitter: #MHpricare
Please note … • Toilets located on this floor • Refreshments/break 1030am • Lunch 1300 • No planned fire alarms • Exits – through hallway and follow signs • Feedback/evaluation sheet in delegate pack Twitter: #MHpricare
A commissioner’s guide to pri rimary ry care mental health Strengthening mental health commissioning in primary care: Learning from experience
Sec econdary ry Car are Men ental l Heal ealth • Nationally • 30% of those that need effective care for mental illnesses able to access it • Great variation in standards of care • 50% of mental ill health starts before age 14 years • Yet investment in prevention / early identification in children and young people’s services limited • 1 in 3 GP appointments involve significant mental health issues Joint Commissioning Panel for Mental Health, Guidance for commissioners of primary mental health care services (Feb 2013) • Up to 70% variation in balance and levels of spend between hospital and community care between neighbouring CCGs Public Health England, Mental Health, Dementia and Neurology Intelligence Network webpage (Jun 2014) • £7.5bn spent annually in London to address mental ill health • Includes health, social care, benefits, education, criminal justice The King’s Fund, Managing people with long -term conditions (Feb 2010) • Yet services are overstretched and historically underfunded • Can be loaded with the stable making access more difficult
Prim rimary ry Car are Men ental l Heal ealth • First line interventions that are provided as an integral part of general health care, and • Mental health care that is provided by primary care workers who are skilled, able and supported to provide mental health services. Department of Health, No health without mental health: A cross-government mental health outcomes strategy for people of all ages, (Feb 2011) • Major variation in use of the mental health spend across UK • But in the main, the majority is on inpatient and specialised care • An example in SW London is 7% of total MH spend is spent on primary care • In London, 90 per cent of people with a common mental disorder are cared for entirely within the primary care sector Gask L, Lester H, Kendrick T and Peveler R. (2009) Primary care mental health. London: Royal College of Psychiatrists, vol 4: no 1 (Mar 2012)
The The rep eport • Recognises that • primary care mental health is growing rapidly • commissioners are very stretched and introducing new ways of working is time and energy consuming • providers are working at full stretch and need to be convinced to change ways of working • learning from those who have already done it is not easily accessibly • Set out to look at what help is available • for commissioners to build on much existing good work • to make the learning easily available • to encourage and provoke some changes in the 15/16 commissioning intentions across London
The The cas ase stu tudie ies • Much more out there than we anticipated • 108 London, UK and internationally • some commissioner led; some provider led • more available and still coming in but ran out of time! • hope to keep updating the list • Aim to • summarise the learning from the experience in the case studies • make the case studies accessible with outline details • 60 expanded into a 1-page overview • provide contacts for the leads in every study for contact and advice
Vie View repo eport ele electronicall lly Bit.ly/mhpricare
Tod oday • Hear from several people who are well advanced in their delivery of primary care mental health • Network with other colleagues to share ideas and problem solving • Work at tables to encourage each of you to think about your own area and your next steps
Co-production in mental health commissioning Rhiannon England City and Hackney CCG. Stephen Laudat Hackney Peoples’s Network.
Why does the user voice matter? To maximise efficiency of MH services patients need to want to use them. Mental health needs a partnership approach more than any other speciality. Moving to choice in mental health means more “user power” and this requires the user voice to be well informed.
The City and Hackney model Jointly commissioned with the Local authority. Facilitated through a voluntary sector organisation- Social Action for Health Built on preparatory workshops run by NSUN Users offered training and support all along the line. An advisory group formed from the service user group meets regularly with Commissioners.
What has the advisory group done so far? CQUINS- input to this year’s CQUIN requirements Prescribing project- working with Healthwatch to look at medication issues. Emphasised need to work with carers Spoken at a Hackney wide conference about mental health. Spoken at a mental health CCG leads workshop. Patients Charter Recovery care plans
CQUINS SAFH ran 3 workshops- 8 local groups and reaching 101 people. Key issues- carer support, inpatient meetings minuted and copies to patients, recovery care plans held by patients and updated regularly. Need for more community and social provision. Dementia- early diagnosis and support
CQUINS: Actions Carer support- monthly phone calls and signposting Recovery care plans embedded in Enhanced primary care service and entered on GP records. Dementia audit in primary care, dementia CQUIN for acute trust, dementia care advisors. Inpatient charter.
Prescribing project Extensive investigation of views on medication through workshops. Key issues: too much of a medical model, not enough partnership working about medication, not enough pharmacist input on wards, need for GPs to be better informed- both by good communication and by education.
Prescribing: Actions Move towards pharmacist review as compulsory part of discharge process on inpatient wards. Specialist pharmacists working in general practice- audits and education. Recovery care plans to include specific medication information and questions about side effects 20 other recommendations to work on.
Carers: Actions CQUIN requiring monthly contact for those with relatives on CPA. Greater emphasis on recording carer details. Signposting to support groups/social prescribing. CQUIN requiring identification of child carers and signposting. CQUIN requiring parents/carers of patients in CAMHS services to be offered support.
Recovery care plans: Actions All patients stepped down to EPC have recovery care plans based on recovery STAR. GP education around recovery- service user led. First session done. GPs to concentrate on service user led issues in the “extra” health check - including recovery/community links/volunteering/training .
Patients charter 1. Have a bed and know where you will sleep. 2. Be asked how you are each day. 3. Be recognised and acknowledged by name. 4. Be able to take part in groups and interact. 5. Be given information on healthy living-tailored for the individual 6. Be able to get privacy when needed. 7.To be helped to look at aspirations/skills/hopes. 8.Be part of a clinical conversation about the tensions between risk and recovery.
Integrated care and mental health in Tower Hamlets Dr. Judith Littlejohns, CCG Governing Body lead for mental health, NHS Tower Hamlets CCG Richard Fradgley, Director of Mental Health and Joint Commissioning, NHS Tower Hamlets CCG Deborah Cohen, Service Head Commissioning & Health, London Borough of Tower Hamlets
Integrated care… We state that integrated care must: • be organised around the needs of individuals (person-centred) • focus always on the goal of benefiting service users • be evaluated by its outcomes, especially those which service users themselves report • include community and voluntary sector contributions • be fully inclusive of all communities in the locality • be designed together with the users of services and their carers • deliver a new deal for people with long term conditions • respond to carers as well as the people they are caring for • be driven forwards by the commissioners • be encouraged through incentives • aim to achieve public and social value, not just to save money • last over time and be allowed to experiment
Integrated care and mental health…context Kings Fund (2012) Long term conditions and mental health
Integrated care and mental health… Kings Fund (2012) Long term conditions and mental health Kings Fund (2012) Long term conditions and mental health
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