How to make the most of the new mental health practitioner role

GP partner and Federation lead Dr Kamal Sidhu offers tips on how your Network can make the best use of the new mental health practitioner role available through the additional roles scheme

The Covid-19 pandemic is exacerbating the crisis in mental health, with research suggesting that patients are delaying presentation in primary care, storing up more severe mental illness for the future.¹

It has long been accepted that the provision of mental health support in primary care is inadequate, reinforcing the disparity with physical health care such that ‘parity of esteem’ remains a distant dream. The creation of primary care networks (PCNs) has been described as an opportunity to close the gaps in provision of care.² From this April, each PCN will have access to a full-time mental health practitioner (MHP), employed by the local community mental health provider but with funding of the role shared equally between PCN and local provider.³

Locally, we have been fortunate to have practice-based mental health link workers – all trained community psychiatric nurses – for the past few years. This initiative started as a suicide prevention pilot to support an over-stretched crisis team and reduce the risk of patient harm and suicide. Following early and clear benefits, our GP Federation South Durham Health, in partnership with Tees, Esk and Wear valleys mental health trust (TEWV) and with funding from the CCG, deployed a team of mental health link workers to provide a practice-based service offering advice, assessment, short-term counselling, de-escalation, crisis prevention and onwards referral to secondary care and the voluntary sector.

The service has received very positive feedback from patients and practices and acted as a source of support for many vulnerable patients, while helping to reduce pressure on the practices as well as secondary care services.

This has given us some useful insight into the challenges as well as opportunities for improving mental health services to our population. I believe the new MHP role funded through the Additional Roles Reimbursement Scheme (ARRS) is a good opportunity for PCNs, if planned and managed optimally.

Here are ten tips for making the best of this scheme to support your practice teams and patients.

1. Relationships are key

The joint funding with your local mental health provider means it is vital to forge an open and equalpartnershipunderpinned by mutual trust. These local providers want to work with PCNs to ensure that they can meet the demand which is only possible with early intervention and by investing in the promotion of positive mental health.

2. Enhance access and provision

Make sure your MHPs are delivering an additional service to existing provision. It is important to remember the ARRS roles are designed to increase capacity in primary care in recognition of the immense pressures on access. The role should be very much practice-based, backed by joint funding and collaboration with the Trust. Otherwise, there is a risk this simply ends up as a reorganisation of services or extension of the local referral teams causing further confusion for patients.

3. Make ‘first contact’ a priority

Ensuring patients can be booked in to see the MHP directly is of utmost importance to enhance care for those who ‘suffer in silence’ or are experiencing suboptimal care. Facilitating self-referral and direct booking also helps to overcome the stigma around seeking help for mental illness.

4. Promote the new role

Publicise the MHPs on the practice website, newsletter, new patient leaflet, patient participation groups and social media page to help raise awareness and engagement among your population. Consider using the MHP role in promoting the self-help resources and prevention available in the wider community through social prescribing.

5. Make the MHP essential to your MDT

It is vital to have seamless links and genuine integration with the wider primary care team, in particular social prescribing, wellbeing and IAPT services, to ensure a good patient experience and optimum engagement.

6. Have a named lead in the practice and PCN

Having support from a named clinical lead within each practice and PCN , for example to discuss challenging or complex cases as well as ironing out any issues around case mix of patients, will help improve patient outcomes and experience. This could be either a GP or a nurse practitioner with a special interest.

7. Agree no referral ‘inappropriate’

The practice and partner organisations need to agree how appropriate patients will be directed to see MHPs. Clear criteria for referral agreed within the team and shared with the reception staff and care navigation templates can help ensure the right people benefit.

All services should take responsibility for any referral through any source, to ensure patients do not have to navigate complex (and often fragmented) services themselves. Have a clear policy that no referral will be deemed ‘inappropriate’ or bounced back to the practice or MHP. PCNs should use the opportunity and discussions about the MHP role to reduce bureaucracy around referral processes and forms as supported by NHS England.³

8. Offer regular training and peer support

The MHP role can be quite intense and isolating, with a high risk of staff burnout. Making time for regular opportunities to debrief and discuss cases will help staff cope with the stress of challenging cases and feel valued. Your partner trust will likely have established processes for this and you will benefit from their insights as well as governance and support network.

9. Involve MHPs in improving care for serious mental illness

Your MHPs may be able to help to improve engagement with these patients. They can be involved in activities such as monitoring of antipsychotic medications, and supporting with QOF work, such as ensuring patients are captured on disease registers and undergo timely and effective reviews.

10. Consider working with other like-minded PCNs

This will give a larger pool of practitioners and help with annual leave and sickness cover, and could provide better training and peer support compared with being solely focused on your own PCN.

The choice of practitioner will depend on the PCN’s individual circumstances. Under the ARRS, quite a wide range of salary bands (Agenda for Change 5-8A) could apply.³ A PCN wanting primarily to expand capacity and reduce waiting times may choose to employ a practitioner at a lower band to work principally as a mental health care navigator. These practitioners can provide initial assessment, low level support and self-help and refer further into the system when patients have more complex needs. Alternatively, your PCN may require a more skilled and experienced practitioner at a higher band to provide expert input with frontline patient care, although the workforce pool will be more limited in some areas.

More generally it is important to take a holistic view of your local mental health services and make use of community mental health transformation funding and resources.⁴

In future years, you may wish to build on extending the roles to older patients, for example to boost dementia care, or to child and adolescent mental health, depending on local priorities. We must draw on all the resources we have to continue to fight for parity of esteem in mental health.

Dr Kamal Sidhu is a GP partner and trainer with an interest in mental health. Dr Sidhu is chair of South Durham Health CIC, a GP federation that provides practice based mental health link workers in collaboration with the Tees Esk and Wear Valleys Mental Health Trust

References

1. Carr MJ, Steeg S, Webb RT et al. Effects of the Covid-19 pandemic on primary care recorded mental illness and self-harm episodes in the UK: a population based cohort study. Lancet 2021; 6: e124-135

2. King’s Fund. Mental health and primary care networks – understanding the opportunities. July 2020

3. NHS England Letter. Supporting General Practice in 2021/22. 21 January 2021

4. NHS National collaborating centre for mental health. The community mental health framework for adults and older adults. September 2019