Agenda item

Purpose of the item: To provide the Adults and Health Select Committee with a detailed report on the General Practice Integrated Mental Health Service (GPIMHS).

Witnesses:

Georgina Foulds, Associate Director for Primary and Community Transformation, Surrey and Borders Partnership

Rebecca Isherwood-Smith, Interim Mental Health Programme Lead, Surrey Heartlands

Dr David Kirkpatrick, Clinical/Managerial Lead (Integrating Primary and Mental Health Care), Surrey and Borders Partnership

Dr Maria Nyekiova, GP Partner and Mental Health Lead for COCO Primary Care Network

Paris Wilson, GPIMHS Service User

Key points raised during the discussion:

1.    The Clinical/Managerial Lead introduced the report, emphasising the importance of configuring mental health services in a way that was not harmful itself to service users’ mental health (for example, a high threshold for access to the service could cause deterioration of the mental health of someone who has just failed to meet the threshold). The introduction of the General Practice Integrated Mental Health Service (GPIMHS) aimed to help resolve this. The quality of service users’ experience of accessing care was as important as the quality of the care that they were accessing. Social determinants of mental health could not be resolved by the mental health foundation trust alone; this must also involve the community. Surrey was fortunate to have a high standard of mental health services in general and strong links between partners, including the voluntary sector and primary care.

2.    The Clinical/Managerial Lead continued to explain that it was important to have good mental health services in place in GP surgeries so that mental health issues could be recognised at the first point of contact and in order to ensure primary care staff felt supported with the skills to provide mental health support. GPIMHS would allow residents to go to a GP surgery and quickly have access to a mental health professional or Community Connector without having to reach a high threshold. GPIMHS was part of a vision for a ‘no wrong door’ system; in other words, the idea that residents would be able to access consistently high-quality mental health services by presenting initially anywhere in the system. The Clinical/Managerial Lead showed a case study, which illustrated the experience of a GPIMHS service user who was able to access help quickly and felt well-informed. Also, carers were an important part of mental health services, and were often not taken into account as much as they should be. Whether the service user had a carer or was a carer – including a young carer in particular – would always be taken into account as part of GPIMHS.

3.    The GP Partner and Mental Health Lead for the COCO Primary Care Network (PCN) stated that prior to GPIMHS, many patients would experience a disconnect between the criteria for different services, meaning they would become stuck in a cycle and struggle to access the support they needed. GPIMHS, on the other hand, provided a useful bridge between primary care, secondary care and the community, and would hopefully resolve this disconnect. GPIMHS allowed for communication between multiple agencies – including, for example, substance abuse services and housing services – and could therefore be tailored to service users’ individual needs. This may also allow for multiple mental health conditions to be recognised more easily. Since GPIMHS had been introduced, patients’ care had improved significantly.

4.    The GPIMHS Service User detailed her experience of the service. Having been discharged from the community mental health service in a London borough, she was subsequently disappointed in the comparatively inefficient mental health services she experienced after returning to Surrey. In Surrey, she tried to access the Community Mental Health Recovery Services (CMHRS) and Improving Access to Psychological Therapies (IAPT) services but did not meet the threshold of criteria for these. She returned to her GP and asked to stop being referred to CMHRS, as it was proving unhelpful, at which point her GP told her about GPIMHS. Her GP referred her to GPIMHS who were significantly better than other mental health services she had experienced: GPIMHS staff were helpful and kind, she felt listened to and supported by psychiatrists, and she felt that they were comfortable with managing her psychiatric medication, whereas staff in other services had not seemed comfortable with this. GPIMHS focused not on her diagnoses, but rather on the actual symptoms that she was experiencing, which was helpful. Her only concern was that GPIMHS had not been publicised well enough – she had not heard of the service prior to her referral – and she wished she could have been referred there more quickly.

5.    The Chief Executive Officer of the Mary Frances Trust agreed with the comments made so far and stated that referrals to Community Connections services had increased significantly in areas where GPIMHS operated. In the past, Community Connections would struggle to receive direct referrals from GPs, but GPIMHS had helped change this. GPIMHS had provided an important link between primary and secondary mental health services.

6.    The Chair of the Independent Mental Health Network (IMHN) expressed concern that the CMHRS in Surrey did not work well and this could lead to deterioration in people’s mental wellbeing.

7.    The Chair of the IMHN asked who would run the carers’ support groups mentioned in the report. The Clinical/Managerial Lead replied that this was part of the managing emotions pathway (MEP), which could involve self-referral.

8.    The Chair of the IMHN asked whether the reablement pilot mentioned in the report was the same as the enabling independence programme. The Associate Director for Primary and Community Transformation explained that these were different, and the reablement pilot was a new programme. It had been delayed because of recruitment difficulties. The pilot would run for a year and would be integrated with GPIMHS. During this year, the progress of the pilot would be reviewed every six weeks. The pilot would be able to deliver some services that GPIMHS and MHICS (mental health integrated community services) could not deliver, such a conducting home visits.

9.    The Chair of the IMHN enquired what the referral rate to the reablement pilot was for black, Asian and minority ethnic (BAME) people and people with long-term health conditions. The Clinical/Managerial Lead agreed to provide this information.

10.  The Chair of the IMHN questioned why GPIMHS could not conduct face-to-face appointments during the Covid-19 lockdown, while other services such as safe havens and some GP appointments were offered face-to-face. The GP Partner responded that, if it was deemed necessary for the patient, GPIMHS appointments could be held face-to-face, but this required a large room with the windows open, and the wearing of face shields, in order to decrease the risk of coronavirus transmission. While GP appointments were typically only around seven minutes long, GPIMHS appointments lasted from 30 minutes to an hour, meaning the risk of transmission was higher. The Clinical/Managerial Lead added that there was certainly value in face-to-face appointments, and it was important to give patients the choice between having some appointments face-to-face and others as telephone or video appointments. As Covid-19 restrictions were lifted, this would be communicated to PCNs.

11.  The Chair of the IMHN suggested that, as well as telephone appointments, video appointments should continue to be offered to people with known mental health needs, even after the pandemic. The Associate Director for Primary and Community Transformation agreed to explore this.

12.  A Member praised the report and the success of the GPIMHS programme. He asked whether there were funding issues, how likely it was that the service would receive sufficient funding, and how staffing issues could be addressed early to ensure that funding would not be refused due to staffing issues. The Associate Director for Primary and Community Transformation stated that funding issues had not yet been resolved. At present, the decision on the amount of funding to be provided to the transformation programme was being processed across NHS system partners. The service was doing everything it could to support sufficient funding for GPIMHS, and GPIMHS representatives would be meeting with NHS England soon in order to understand funding streams over the next few years. While this was not yet resolved, it was being worked on and the Select Committee’s support in pushing for the funding was appreciated. The plans for the GPIMHS service had been approved and the service was preparing to mobilise expansion in the next one to two years; it was just the detail of the finances that remained to be resolved. Moreover, there was concern about staffing and recruitment to GPIMHS. The service had been fortunate in recruitment so far, and the innovative way of working was attractive to potential staff. While the Associate Director could not give complete assurance on recruitment in future, the service had done well with recruitment so far. It was also important to ensure that GPIMHS did not drain staff from core services.

13.  The Select Committee expressed its eagerness to support GPIMHS. In addition to supporting the programme in the recommendations of this meeting, further ways that the Select Committee could offer its support would continue to be explored.

14.  The Clinical/Managerial Lead explained that a potential challenge for GPIMHS that was currently being overshadowed by the Covid-19 pandemic was the stock of rooms and clinical spaces at primary care sites that could be used for face-to-face GPIMHS appointments. This would prove a key issue once the pandemic had subsided. A Member suggested that community or high-street spaces could be used for GPIMHS appointments if there was not sufficient space in GP surgeries. The GP Partner responded that the possibility of holding some appointments in community or high-street spaces could be explored, but when seeing some higher-risk patients, GPs may require access to an alarm bell for their own safety. There were lots of benefits to hosting multiple services in the same building, but the services offered had simply outgrown the buildings.

15.  A Member asked what support was offered to people in the 18-25 age group specifically. The Interim Mental Health Programme Lead responded that a young adult reference group had been created in order to incorporate young people’s views into mental health work. These groups included a variety of stakeholders, such as carers and CAMHS (child and adolescent mental health services) staff. The work of the reference group had included workshops, surveys, focus groups and user voice participation groups. A key outcome of this work was the notion of providing transition packs to young people to prepare them for the transition from children’s to adults’ services. Another finding was the importance of training for clinicians on the use of language, particularly when interacting with people who had recently transferred from children’s to adults’ services. Moreover, the service was looking at creating a young adults’ section on the Healthy Surrey website or somewhere similar, to make it easy for young adults to access tailored information in one place. The GPIMHS Service User, who had been involved in the young adult reference group, added that the group had discussed piloting young safe havens especially for young adults, as young adults sometimes felt that they could not access the more general safe havens that currently existed. The Select Committee requested more information about young safe havens and written copies of the introductions witnesses had provided to this item, if possible.

16.  A Member asked whether the service was engaging with young adults on platforms such as TikTok, with creative and fun content for young people. The Interim Mental Health Programme Lead stated that the young adult reference group fed into work on this.

Recommendations:

The Select Committee:

1.    Offers its support for the GPIMHS and MHICS approach and will explore ways to assist its continued development;

2.    Acknowledges that in Surrey Heartlands conversations are happening about the acceleration of the GPIMHS rollout and encourages a rapid implementation of the service across the entirety of Surrey;

3.    Requests a further update on the progress made regarding funding and workforce at a future meeting.

Actions/further information to be provided:

1.    The Clinical/Managerial Lead (Integrating Primary and Mental Health Care) for Surrey and Borders Partnership is to share with the Select Committee the reablement pilot referral rates for BAME residents and people with long-term health conditions;

2.    The Associate Director for Primary and Community Transformation for Surrey and Borders Partnership is to liaise with GPs on the possible continuation of offering video appointments for patients;

3.    The Interim Mental Health Programme Lead for Surrey Heartlands is to provide the Select Committee with more information on the work being done regarding young safe havens;

4.    Witnesses are to provide the Select Committee with written versions of the introductions they gave at the start of the item.