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A primary care focus for mental health

Exploring the value of a practice-based mental health practitioner at the Brookside practice in Reading.

Why was the initiative launched?

Concern to integrate the three different aspects of mental health services for patients led to the creation of a development project based at Brookside, a large group practice in Reading (practice population 26,500). The project was designed to explore ways to get better links between the primary health care team, the community mental health team, specialist hospital based services and other community agencies. The intention was to review the way that mental health services were provided for the practice population and to provide education, training and support for members of the primary health care team.

What was done?

A full-time post for a mental health practitioner/facilitator was created which carries a clinical workload as well as the facilitation role. The practitioner/facilitator is employed by the local Trust, but responsibility for management and accountability, on both a day-to-day and strategic basis, rests with the practice. The post is based at the practice and was funded initially by the Berkshire Integrated Purchasing Project. The annual cost of the additional post is about £35,000. After the external funding came to an end the practice has continued to fund the post.

The mental health practitioner has from the start been a full member of the primary health care team and, for instance, has access to the team’s IT-based clinical records. The availability of the practitioner has provided triage and rapid assessment of patient needs, leading to more appropriate use of primary, community and secondary services. The practitioner has acted as a facilitator and been able to improve liaison between the practice staff and community and secondary care. Education and support for other members of the primary health care team has been provided to ensure that the full implications of the new approach were understood.

An action research approach was adopted to reflect the need for organic development. An important product of the work has been the development of an interactive, IT based, mental health management system to monitor all patients with serious mental illness registered with the practice (Table).

 


Brookside Mental Health Register:  
Number of patients on the system by diagnosis  
Schizophrenia 37
Depressive Disorders 39
Neurosis 11
Mood Affective Disorders 31
Drug/Alcohol misuse 6
Dementia 16
Total 140

What are the benefits?

After about two years evaluation shows that more appropriate care is being provided for patients with severe and enduring mental illness. This has resulted, at least initially, in a higher level of, and increased expenditure on, secondary care.

The need for liaison to be from primary care into secondary care has been clarified, with adequate information required in primary care for appropriate clinical decisions. Qualitative evaluation by patients, GPs and other members of the primary health care team has been very positive. Specific benefits include:

  1. A new approach to the management of mental health through the use of a clinical IT system. Rather than a static register this integrates the practice systems using Read codes.
  2. Better management of all patients with severe and enduring mental illness.
  3. Better ability to track and maintain links with patients already within the mental health system: all patients are reviewed on a three-weekly basis thus allowing early intervention if necessary.
  4. Better information for patients about referrals and resources.
  5. Better liaison with other agencies including voluntary agencies, the police and social services.

Reflecting the success so far, the model for the mental health practitioner/facilitator post is being adopted as the Wokingham Primary Care Group as it starts to explore the future development of mental health services for its population.

Tips for success

To find out more contact

Sarah Burchell

Brookside Group Practice

Earley

Reading RG6 7HG

Telephone 0118 966 9222


ImpAct bottom line

Look for ways to include clinical and managerial responsibilities within individual posts — a good way to bridge the gaps in understanding between clinicians and managers

 

 

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