[PPT] - WELCOME Strengthening Mental Health Commissioning in Primary Care - PowerPoint Presentation

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London Mental Health Strategic Clinical Network Date

WELCOME

Strengthening Mental Health Commissioning in Primary Care - practical solutions and learning from experience

3 July 2014

Twitter: #MHpricare

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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

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A commissioner’s guide to pri rimary ry care mental health

Strengthening mental health commissioning in primary care: Learning from experience

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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

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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)

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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
f 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

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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

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Vie View repo eport ele electronicall lly

Bit.ly/mhpricare

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Tod

day
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

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Co-production in mental health commissioning

Rhiannon England City and Hackney CCG. Stephen Laudat Hackney Peoples’s Network.

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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.

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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.

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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

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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

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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.

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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.

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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.

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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.

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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 .

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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.

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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

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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…

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Integrated care and mental health…context

Kings Fund (2012) Long term conditions and mental health

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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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The way that we support people with mental health problems is based on a flawed paradigm. It assumes that physical and mental health are fundamentally different (albeit each having some impact

n the other), requiring different specialist

approaches, and ignores the common factors in the global determination of health and illness, which have biological, psychological and, in particular, social components. To achieve integrated healthcare, policy- makers, service planners and commissioners need to better understand the indivisibility and unitary nature of physical and mental health, which means that distinguishing between them is likely to lead to an incomplete response to people’s needs as well as flawed thinking about mental health. Integrated care and mental health…

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This ‘mental health treatment gap’, exemplified by lower treatment rates for mental health conditions, premature mortality of people with mental health problems and underfunding of mental healthcare relative to the scale and impact of mental health problems,* falls short of government commitments to international human rights conventions which recognise the rights of people with mental health problems to the highest attainable standard of health; yet it can be argued that this lack of parity is so embedded in healthcare and in society that it is tolerated and hardly remarked upon. Integrated care and mental health…

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Integrated care and mental health…

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Integrated care and mental health…

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Tower Hamlets GPs have organised into 8

networks. The CCG

contracts with networks for delivery of services

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Intervention 1. Discharge support for MH patients from secondary to primary care

Aims and objectives: To develop high quality recovery orientated primary care mental health services, to support service users discharged from secondary care and stepping up from GMS Rationale:

Comparatively high numbers of patients known to

secondary care mental health services, and on the Care Programme Approach compared to other boroughs

Primary and secondary care clinician and service

user views

NHS London Mental Health Case for Change

evidence base

Payment by results

Service model (operational October 2012):

Network incentive scheme with GP’s (focus on care and recovery planning, with incentives to promote smoking

cessation and weight management)

Improved secondary care mental health support to primary care (all practices have regular MDT’s with a consultant in

attendance, single point of access)

ELFT managed Primary care mental health liaison service, including social care
Targeted voluntary sector support

Activity/outcomes:

339 service users registered on the SMI NIS in

2013/14

87.6% had mental health review with GP in year
Reduction in patients on CPA from 1408 in March

2012 to 1150 in March 2014

October 2013 SMI NIS patient survey demonstrates

88% satisfied or very satisfied Financial impact:

Approx £400k investment in phase 1
Significant QIPP and CIP realised to date
Currently undertaking further activity and financial

modelling for future Approach:

Whole system review case for change across City &

Hackney, Newham and Tower Hamlets including activity model

Extensive engagement, bringing together service users,

GP’s and secondary care clinicians to identify

pportunities
Local Medical Committee supported working group of

senior GP’s to develop service model and contract

Trial allocation of dedicated social care support outside of

the CMHTs to this client group (to inform future design)

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Intervention 2. Mental health liaison

Aims and objectives: To improve health outcomes and experience for people with a mental health or drug and alcohol problem admitted to the Royal London Hospital and associated sites; to reduce length of stay, readmissions, and A&E attendances. Rationale:

28% of patients in acute setting have diagnosable

mental disorder, 41% have sub-clinical symptoms

Opportunity to deliver improved whole person care
RAID economic evaluation business case

demonstrating impact of liaison on quality, LOS, readmissions and A&E attendances with cash releasing savings generated

Build on good practice at the Royal London, older

adults liaison team, & Emergency MH Team in A&E Service model (Department of Psychological Medicine operational January 2014):

24/7 RAID style liaison service: Single point of access for referral for all ages, mental health and drug and alcohol, all

areas of the hospital and associated sites

Well resourced for senior clinical leadership, 4.5WTE consultant psychiatrists, Nurse consultant linked with Queen

Mary University to develop and support training and education; Team retains specialisms in adults of working age, old age, and drugs and alcohol, but developing generic competencies for all staff

Records all activity on Barts EPR, metrics to be reported via NELCSU to CCG; UCLP leading two year evaluation

Activity/outcomes:

5,500 referrals p.a.
Reduced LOS, readmissions, re-attendances
Improved patient and carer experience
Improved staff confidence and competence
Increase in alcohol screens and referral on to

Community Alcohol Team Financial impact:

Investment totalling £2.1m, including consolidation of 4

existing separate services and significant new investment

Very significant modelled opportunity for efficiencies

Approach:

Extensive clinical engagement, bringing together GP’s

and secondary care clinicians to identify opportunities

Multi-agency project group, including Barts Health, ELFT,

CCG, social care, Drug & Alcohol Action Team

Analytics to model activity & financial opportunity
CEO led delivery board within ELFT
Governance via multi-agency Integrated Care Board with

senior representation from all key agencies

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Intervention 3. Care coordination

Aims and objectives: To improve identification , assessment, and treatment of mental health problems in patients at risk of admission to hospital; to improve care coordination of patients with multiple morbidities across mental health, primary care, social care, and CHS services Rationale:

12-18% of all spend on LTC’s linked to poor mental

health (Kings Fund)

37% of sample “integrated care” cohort known or

previously known to secondary care

Parity of esteem, whole person care
Emergent evidence from risk stratification
Build on 12/13 pilot of CPN’s working in CHS

locality teams Service model:

Risk Profiling/Avoiding unplanned admissions Direct Enhanced Service incentivises GPs to risk stratify population to

determine integrated care cohort

Coordinated Care Network Incentive Scheme to incentivise GPs to coordinate care for patients at risk, including all

patients with dementia

CHS incorporating an integrated CHT (inc CHS, social care, palliative specialist nurse and community geriatrician)

considering options for full integration reconfigured to link into paired GP networks

Pilot of mental health CPNs during 2012/13; significant new investment in 14/15 to mainstream model, to include

case-finding, consultation/support/training to primary care and CHS staff, assessment and treatment for patients not meeting secondary care MH threshold, supporting primary care and CHS teams to strengthen psychological mindedness and recovery orientation. Target team 4 WTE Band 7 CPN’s, 1 WTE Clinical Psychologist, 0.5 WTE Consultant Psychiatrist, 1 WTE OT.

Use of CQUIN to incentivise workforce development and fair processing.

Activity/outcomes:

To be determined

Financial impact:

Investment £465k

Approach:

Extensive clinical engagement, bringing together GPs and

secondary care clinicians to identify opportunities

Analytics to model activity
GP led design of service model
Governance via multi-agency Integrated Care Board with

senior representation from all key agencies

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Last Modified 04/04/2013 17:40 GMT Standard Time Printed 04/04/2013 09:47 GMT Standard Time

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Waltham Forest, East London and the City 36 36

Integrated care teams: End-state vision

Network Locality Practice

3 4 1 Tower Hamlets will have 4 locality integrated community health teams, aligned to 8 primary care networks Network level Network 3 Network 4 Network 5 Network 6 Network 2 Network 1 Network 7 Network 8 CCG level Social care specialist Mental health specialist Acute specialist Disease specific specialist teams Locality level ICHT 1

▪

Community Matrons

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Senior AHP

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Nurses

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Social workers

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Other AHPs

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Case managers

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Care navigators

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Community Mental Health

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Hybrid health/ social workers ICHT 2 ICHT 3 ICHT 4 Clearly defined interface between networks and ICHT. Single case manager / care navigator accountable for each patient (across primary and community care settings) Team includes dedicated case managers for Very High Risk patients), and care navigation function for High Risk patients (dedicated or part-time role, TBD) Case conferences at network level (GP, practice nurse, HCA, network manager, network administrator, case manager/care navigator, other relevant staff from ICHT / CCG level specialists)

▪

Community Matrons

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Senior AHP

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Nurses

▪

Social workers

▪

Other AHPs

▪

Case managers

▪

Care navigators

▪

Community Mental Health

▪

Hybrid health/ social workers

▪

Community Matrons

▪

Senior AHP

▪

Nurses

▪

Social workers

▪

Other AHPs

▪

Case managers

▪

Care navigators

▪

Community Mental Health

▪

Hybrid health/ social workers

▪

Community Matrons

▪

Senior AHP

▪

Nurses

▪

Social workers

▪

Other AHPs

▪

Case managers

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Care navigators

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Community Mental Health

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Hybrid health/ social workers

CARE COORDINATION: FUTURE

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Understanding the population

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Building a picture of the population…

Tower Hamlets VHR – 1662 (1%) HR– 11871 (4%) Total – 261,536 SMI Register Dementia register High Risk 832 High Risk 400 Very High Risk 105 Very High Risk 95 Depression register Alcohol (Audit C 8+) High Risk 2439 High Risk TBD Very High Risk 312 Very High Risk TBD TBD

Total depressio n 20841 Total dementia 722 Total SMI 3267

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Diabetes CHD COPD 4211 2616 1806 Depression Depression Depression 3123 3123 3123

989 553 504

32% 24% 18% 21% 16% 30%

SMI SMI SMI Diabetes CHD COPD

35% 8%

338

974 4211

8% 3%

81

974 2616

10% 5%

95

974 1806 Dementia Dementia Dementia Diabetes CHD COPD

33% 4%

165

495 4211

25% 5%

123

495 2616

12% 3%

59

495 1806

Building a picture of the population: Intersection between MH and LTC registers for very high and high risk patients (as at 28/02/14)

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Understanding the population

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Service model:

Mental health coordinated care team Identified competencies regarding identification, assessment and brief intervention in CHS staff 4 WTE Band 7 CMHN’s working as part of each locality CHS team 1 WTE CMHN based in each locality CHS team to provide case-finding, consultation/support/training to primary care and CHS staff, assessment and brief interventions for patients not meeting secondary care MH threshold, supporting access to and communication with secondary care teams. Occupational Therapist working specifically to care homes Supporting care homes to develop person-centred care and support for people with mental health problems living in care homes Clinical/health psychologist working across the borough Supporting primary care and CHS teams to strengthen psychological mindedness and recovery

rientation

Consultant psychiatrist working across the borough 1 year pilot post to provide senior clinical leadership, developing the service model, supervising team members, providing consultation/support/training to GP’s, providing clinical support to primary care psychology.

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Contracting approach:

WELC Collaborative (Pioneer Status)
14/15 focus on relationships and engagement:
Development of integrator service specification
Providers have formed a collaborative (primary care,

acute, CHS, mental health, social care)

Non-competitive assurance process with existing

providers

Specification contracted via existing contracts
Integrated care CQUIN (acute, CHS, mental health –

developing competencies)

15/16 focus on outcomes, move to element of

performance related payment

Benefits pool
16/17 and beyond…move to weighted capitation basis of

payment

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Design questions……

How should care coordination and case management across multidisciplinary and multiagency

generic CHS, primary care and specialist mental health teams work effectively for patients with complex multiple co-morbidities? (a) Where patients meet the threshold for specialist mental health services (b) Where patients do not meet the threshold for specialist mental health services (c) Where transitioning from a system in which different needs have been coordinated by separate teams ; e.g. dementia; mental health needs – specialist MH; social/practical needs – dementia advisers, physical health – GPs (although progress has been made);

To what extent does this require consultant leadership?
What should the balance of case-finding/consultation/training and direct clinical work be?
What are the appropriate pathways into IAPT and primary care psychology? What should the

function of CHS health psychology be in this context?

What range of skills and knowledge should mental health staff working in an integrated care

setting have? (i.e. with adults and older adults with a mental health problem and people with drug and alcohol problems)

What should the specific therapeutic skills of mental health staff working in generic settings be?
What range of skills and knowledge should generic staff working in an integrated care setting

have? What is the relationship between the integrated care mental health function and primary care liaison teams?

What is the impact on the design of CMHTs and other community mental health services for
lder adults (and adults)? How should social work roles be designed in this context, and how

can access to other Council services such as Housing be maintained?

What can we learn from the recovery movement in mental health to inform the way in which

integrated care services are delivered (hope, control, opportunity), and what are the

pportunities of recovery orientated services such as recovery colleges?
How does this fit with development of MH payment system?

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On a final note…

Mental and physical health services delivered separately People with a mental health problem have their physical health problems identified, assessed and treated, and people with physical health problems have their psychological needs met All health encounters provide holistic care, regardless of setting

Sohrab Panday, Chair of Parity Working Group

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Educating the Primary Care Workforce

Dr Ian Walton ianwalton@btinternet.com

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Gotland

Rutz W, Walinder J, Eberhard G, Holmberg G, A-L. von Knorring ,B-L.von Knorring, Wistedt B, Aberg- Wistedt A. 1989 An Educational Program on Depressive Disorders for General Practitioners on Gotland: background and evaluation Acta Psychiatr Scand vol. 79 (19-26)

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Hampshire

Thompson C, Kinmonth A, Stevens L, Peveler R, Stevens A, Ostler K, Pickering R, Baker N, Henson A, Preece J, Cooper D, Campbell MJ. 2000 Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial. Lancet vol 355 (185-91). January Kendrick T, Stevens L, Bryant A, Goddard J, Stevens A,Raftery J and Thompson C. 2001 Hampshire Depression Project: changes in the process of care and cost consequences, British Journal of General Practice 911-913 November.

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Kroenke K, Taylor-Vaisey A, Dietrich A, Oxman T.2000 Interventions to improve provider diagnosis and treatment of mental disorders in primary care. A critical review of the literature. Psychosomatics. Vol 41/1 (39-52) January. Dixon R, Roberts L, Lawrie S, Jones L, Humphreys M. 2008 Medical students' attitudes to psychiatric illness in primary care. Medical Education, vol. 42/11(1080-1087), November .

No straightforward answer to improving
utcomes for patients
Interventions directed at the individual

tend to be more effective than a systems approach

Primary care often deals with complex

patients with medical co-morbidity and somatisation

Stigmatisation of mental disorders.

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What are the causes of mental health problems in primary care?

KEY DETERMINANTS ARE SOCIO- ECONOMIC

Worklessness
How we are treated at work
Debt
Poverty – Its not psychological or social but how people try to

manage when in poverty

Inadequate housing
Being an immigrant

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Primary Care is different to Psychiatry

50

More art than science
Patients present with somatic

symptoms

The border between distress and

psychiatric illness is hard to define

Needs to include Wellbeing

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Psychological and Physical health are linked

51

The only way to separate the

mind from the body is with an axe.

Physical illness causes stress
Stress may result in functional

symptoms and organic alteration

The mind and body are one

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52

Secondary Care Primary Care

There is lack of investment and support in Primary Careeals with what?

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To be effective education in Primary care must...

Develop the skills to deliver an integrated

model for mental health in primary care

Challenge stigma
Ensure that the patient is heard
Teach effective risk management
Teach effective skills which can be used in

a 10 minute consultation

Include wellbeing and resilience

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What next……

07/07/2014 www.mentalheathdiploma.com 55

Advanced Diploma in Primary Care Mental Health Masters Science in Primary Care Mental Health

07/07/2014

Certificate In Primary Care Mental Health Mental Health in Primary Care training days

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Outcomes

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Mental Health Admissions

0.5 1 1.5 2 2.5 3 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 Sandwell PCT National

Standardised rate of admissions per 1000 population Sandwell and England Data suggests a decline in admissions in years 2010-12 in Sandwell compared to England

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Further Information

lisa.hill9@btinternet.com ianwalton@btinternet.com www.primhe.org.uk

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London Mental Health Strategic Clinical Network Date

Panel Q & A

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London Mental Health Strategic Clinical Network Date

Break

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View report electronically

Bit.ly/mhpricare

Twitter: #MHpricare

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Initial Response Team & Principal Community Pathways

Dr Carole Kaplan Transformation Programme Director Elizabeth Moody Nurse Director & PCP Programme Director

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Northumberland, Tyne and Wear NHS Foundation Trust

Population of 1.4 million people

in the North East of England

Six geographical areas of

Northumberland, Newcastle, North Tyneside, South Tyneside, Gateshead and Sunderland

One of the largest mental health

and disability organisations in the country

Income of circa £300 million and

circa 6,000 staff

Over 130 sites and provide a

range of comprehensive services including regional and national specialist services

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Phase 1: The case for change

Sunderland was chosen as the location for the development of a new access model following discussions with service users, carers, GPs and commissioners. A key issue was that the Crisis team, commissioned to deliver assessment and support for serious mental health problems, was not responsive as it was saturated with responding to a wide variety of requests. A scoping exercise identified that only 35% of all contacts needed the response of the Crisis Team. 43% of the inappropriate contacts were for advice or help and often these were people clearly in need

f support and signposting, but considered to be at low risk of

requiring hospital admission.

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Initial Response Team South of Tyne and Wear

REQUEST FOR HELP

ROUTING

ST UCT

OPS LD ICTS

SL UCT

OPS LD ICTS

GH UCT

OPS LD ICTS

Home Based Treatment Assessment Gatekeeping Home Based Treatment Assessment Gatekeeping Home Based Treatment Assessment Gatekeeping

Information Collection, Triage & Routing

11

Gateshead

Rapid Response Nurses

11

South Tyneside

Rapid Response Nurses

11

Sunderland

Rapid Response Nurses

Approximately 4% of referrals are from the Police, 2% from the Ambulance service.

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Initial Response Service

Urgent Routine Huddle Triage Team

Single Point of Referral

Non- complex Clinical Diary Complex Clinical Diary

11

Triage & Action

IRT

Rapid Response Nurses

UCT

Home Based Treatment Assessment Gatekeeping

ROUTING

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IRT in numbers

Typical weekly activity

1750

Outbound telephone calls

1500

Inbound telephone calls

1000

Total Contacts

400

Home-based Treatment contacts

50

Crisis Assessments

100

Rapid Responses

84% calls answered within 15 seconds
>80% rapid responses achieved in under one hour

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Service User and Carer GP

Wonderful support! You listened and told me what to do Fantastic – a huge improvement!! You should have done it before

Staff

More manageable Skills are valued I’m a lot happier Spend more time The day I met the IRT was the day I decide to give life a second try. Keep this very valuable service going The service is responsive and friendly I felt listened to and was delighted I cannot imagine where I would be today if you had not been there for me. You do an amazing job! I couldn’t have got this far without your help

Service Feedback

100% of IRT callers responding to our survey indicated they:

would recommend the service to a friend in need of similar help
felt the IRT demonstrated kindness and compassion
were provided with the help or information needed

6 months to March 2014

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Principal Community Pathways

A programme to design and implement new, evidence-based community pathways for adults and older people. Our ambition is high and is matched by the expectations of service users and carers. The new pathways will:

Significantly improve quality for the patient
Double current productive time of community services by redesigning

current systems

Enhance the skills of our workforce
Improve ways of working and interfaces with partners
Reduce reliance on inpatient beds and enable cost savings

This is not achievable in isolation and to be successful we need it to be part

f integrated work with partners

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Design Workshop

Workshop Product Specification Scope Boundaries Principles Benefits People Constraints

Reasonable adjustment for pathway

Check

Does this meet the Product Specification?

Sign

ff

Ready to test Design and Standard Work #1 Design and Standard Work #2

Gather data Invite people

Refine

Week 0 Week 6 Week 7 Week 8

Check

Does this reflect previous discussion and principles?

The design workshop process

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Principal Community Pathways – How people have been involved

So far 362 people have attended the 27 clinical and supporting systems workshops, these have included: GPs, Local Authority staff, Acute Trust staff, Community and voluntary sector staff, CCG staff, NTW staff and most importantly our service users and carers.

Our Trust-wide Service User and Carer

Reference Group has been involved throughout

We have presented our plans to various groups

including HealthNet and South Tyneside GP Education Forum

We’ve been ‘walking the wall’ with all of our

stakeholders and have so far run sessions for

ver 1500 people – with more to follow

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The “Wall”

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Benefits of PCP

Service Users and Carers CCGs Workforce Partners

Quicker, easier access
Recovery focused,

collaborative care

Enhanced packages of

care

Alignment of care across

partners

More efficient, safer

systems

Integrated care
No ‘bouncing’
More time spent with service

users

Clear roles and

responsibilities

Increased job satisfaction
Enhanced skills
Improved communication

and information sharing

Reduced duplication

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What to expect - the Numbers (adult & older people)

What Current Future

Community clinicians

% direct time with patients
% time non-patient activity
% record keeping
% Travel

20% 45% 25% 10% 49% 36% 5% 10%

The difference we can make by having more time with patients

Contain patient risk; little

pportunity for evidence-

based interventions Focus on a range of evidence- based interventions that support recovery and improved

utcomes

System of Access for patients (non-urgent referrals)

Variable system, team allocation meetings, bouncing Simple, standard system; early allocation of pathway; booked directly; no bounce

Typical Waits

To first contact
Assessment to treatment

4-6 weeks 6 weeks (range 2-10 wks) 1 week < 2 weeks

% split of resources Community to Inpatient 48% 52%

60% 40%

SLIDE 76

How will we know what difference has been made?

Quality and Safety Data Suite

Developed by senior clinicians to monitor and measure the impact of transformation across the Trust, designed to answer:

Does the PCP model work?

Improved patient outcomes
Enhanced service user & carer experience
Delivers evidence-based interventions
Recovery focussed
Reduced reliance on inpatient beds
Reduced waiting times
More patient-facing time for clinicians
Skill-mix matches service demand

Is Transformation safe?

Out of area referrals
Readmissions and re-referrals
Delayed discharges
Average length of stay
Community workload
Incidents
Staff – sickness, morale, vacancies

SLIDE 77

Service user and Carers

Service User led narrative interviews will form a long term picture of cultural and behavioural

changes including recovery focus, collaboration, co-production, self-management

Assessment of service user and carer satisfaction using existing feedback sources including

Points of You and the Family and Friends questions

Staff

An evaluation of the impact on staff morale and wellbeing
An assessment of staff feedback on the PCP model covering efficiency, effectiveness,

quality and safety of services. Current feedback sources include the Staff Survey and the Family and Friends questions

Partners

An assessment of the impact of the PCP model on the range of partners we work with

including Commissioners, GPs, Social Care and other health providers. To include ease of access to services, satisfaction with service response as well as overall satisfaction with services

How will we know what difference has been made?

SLIDE 78

View report electronically

Bit.ly/mhpricare

Twitter: #MHpricare

SLIDE 79

A commissioner’s guide to pri rimary ry care mental health

Strengthening mental health commissioning in primary care: Learning from experience

SLIDE 80

I know who is in charge

f coordinating my

care I am treated as a person and helped to stay well, and so is my carer I am supported through difficult times I manage my conditions myself and am in control of decisions about my care I live safely and well where I want to be I feel part of a community I know where I can get help and support The care I receive is built around me My independence is respected

Better care for service users

Better er car are for

r ser

servic ice use users

SLIDE 81

Patient Core Carer Primary care Secondary care Community Voluntary sector Social services Mental health Intermediate care GP plus Secondary care Secondary care

SLIDE 82

Voluntary sector Social services Mental health Intermediate care GP plus Secondary care

How do we ensure real coordination & integration?

Community

SLIDE 83

Whe here clin

clinical commissioning is is heading …

1-4 – IAPT 99 – missed review 0 – pre-diagnosis 18-21 – dementia 17 – difficult to engage 16 – dual diagnosis 13-15 – ongoing / recurrent psychosis / crisis 11-12 – ongoing / recurrent psychosis 10 – first psychotic episode 7-8 – enduring, severe, challenging 5-6 – after initial assessment Secondary care Primary care Overlap + third sector

SLIDE 84

Adult social care in England: overview – National Audit Office HC 1102 SESSION 2013-14 13 MARCH 2014

SLIDE 85

The The ten en lesso lessons

Local champions drive forward

implementation

Effective Health & Wellbeing Boards

can be enormously helpful

Primary Care education and training

will enable change

Money needs to move with the

patient

Co-production will deliver ownership

by people who use services and carers as well as better services

Services need to cover all ages
A mosaic of services needs to be

provided to wrap around individuals and carers

Specialists’ time should be freed to

look after those with complex needs and to be available for rapid advice and help for primary care

IT-enabled communications between

primary care and mental health is vital for a fully functioning service

Managing the whole person

including long term conditions

SLIDE 86

Vie View repo eport ele electronicall lly

Bit.ly/mhpricare

Twitter: #MHpricare

SLIDE 87

Table discussions

Reflections

Reflect & review the mental health primary care guide &

presentations. Your views/comments? What has struck you?
Action

How will you take this agenda forward locally? How will you incorporate learning's into your Commissioning Intentions?

Dissemination

Ways of promoting, sharing & disseminating the guide & key messages among peers, colleagues & others?

SLIDE 88

View report electronically

Bit.ly/mhpricare

Twitter: #MHpricare

SLIDE 89

London Mental Health Strategic Clinical Network Date

London Mental Health SCN’s vision for primary care Dr Matthew Patrick

SLIDE 90

London Mental Health Strategic Clinical Network Date