Transcript Enhanced Primary Care Mental Health Services

ITEM 2
JUDITH WATT
PRESENTATION
Enhanced Primary
Care Mental Health
Services
Overview & Scrutiny Committee
12th June 2007
Hertfordshire Partnership
NHS Trust
NHS
Enhanced Primary Care Mental
Health Services - Values
• Recovery & Social Inclusion
• Choice of Treatment
• Care Closest to Home
• Working & Learning Together
Enhanced Primary Care Mental
Health Services - Scope
• Common Mental Health Problems
• Mental Health Problems associated with
physical health
• Long Standing complex, non-psychotic
mental health problems
• People with Psychosis
• Those with Cognitive Impairment
NICE Stepped Care Approach
(Anxiety & Depression)
Step 5: Inpatient Care ,
Crisis Teams
Risk to Life, Severe
Symptoms/Need
Medication, combined
treatments, ECT
Step 4: Mental Health
Specialist/Community Staff
Complex & Enduring
Symptoms/Need
Medication, Complex
Psychological Interventions,
Combined Treatments
Step 3 Primary Care Team
Moderate or Severe
Symptoms/Need
Medication, Psychological
Interventions, Social
Support
Step 2 Primary Care Team
Mild Symptoms/Need
Watchful Waiting, Guided
Self help, Brief
Psychological Interventions
Step 1 GP, Practice Nurse
Recognition
Assessment
Enhanced Primary Care Mental
Health Service – who delivers?
• Graduate Workers
• Gateway/Link Workers
• Support Time & Recovery Workers
• Vocational Advisers
• Psychologist
• Consultant Psychiatrist
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•
•
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•
•
Enhanced Primary Care Mental
Health Service – What will it
deliver?
Screening
Signposting
Self Help
Guided Self Help
Computerised
Cognitive Behavioural
Therapy
Individual/Group
Work
• Short term
•
•
interventions
Social & Vocational
Support
Referral on to
secondary services
Enhanced Primary Care Mental
Health Services – where will it
deliver?
• Within Primary Care setting:• GP practices
• Alternate, non stigmatising Community
Settings eg Letchworth Healthy Living
Centre
Enhanced Primary Care Mental
Health Services in Hertfordshire
• 3 Primary Care Pilots
• Letchworth
• Watford
• St Albans
• All 3 Pilots :• Enhanced Primary
•
Care Services +
Improved Access to
Psychological
Therapies +
St Albans Only – New
Ways of Working for
Consultant
Psychiatrist
LETCHWORTH
ST ALBANS
WATFORD
GP surgeries
All 6 within locality
5 out of 13
3 out of 22
Link worker WTE
1.6 WTE
1 WTE
0.8 WTE
Link worker funding
Seconded from HPT
Seconded from HPT
Funded by HPT
GMHW WTE
1 WTE
2 WTE
1 WTE
GMHW funding
Seconded from HPT
PCT
PCT
Clinical Supervision
CMHT Psychologist
EMHS Psychologist
CMHT Psychologist
Base
CMHT/ Letchworth’s
Healthy Living Centre
GP Surgery
GP Surgery
Results of PCMHT:
Assessment Outcome: Feb – March 2007
LETCHWORTH
PCMHT
ST ALBANS
EMHS
WATFORD
PCMHT
Number referred
468
309
196
Number appropriate
366
294
179
Number on waiting list
19
36
10
Cancelled, DNA or did
not make contact
70
30
37
Number received an
intervention
249
216
122
Waiting Time – Ref Assessment
26
53*
16
In
di
v
ed
BT
at
io
n
se
lf
sy
ch
oe
du
c
G
ui
d
P
C
C
Intervention
S
el
f
su
pp
or
t
S
ig
np
os
t in
g
in
fo
rm
at
io
n
ho
ne
he
lp
P
he
id
ua
lp
lP
sy
ch
oed
uc
at
io
n
G
ro
up
Percentage
Interventions offered by PCMHT’s
45
Letchworth
40
St Albans
35
Watford
30
25
20
15
10
5
0
Discharge Information -Letchworth EPCMHS
Employme
nt
Elderley
Other
Voluntary
Counselling
/private
CDAT
ED
CMHT
GP
Discharge Information – Watford EPCMHS
employment
other
voluntary
private
counselling
counselling
CDAT
CMHT formal
referral
Back to GP
Discharge Information – St Albans EPCMHS
Counselling/
private
Drug and
Alcohol
CMHT
Other
Voluntary
Eating
Disorder
GP
Impact on CMHT
- Referrals & Waiting Times
LETCHWORTH CMHT
ST ALBANS
CMHT
Population covered
71,684
146,000
110,000
WTE staff
15.8
30.27
23,42
% change in referrals
----Impact on referrals to
Watford CMHT
following DAS
closure unclear.
54% reduction
Feb-Jul 2006
% change in waiting
times
47% reduction for outpatient
appointments (73 days
average down to 48 days
average Jan-Jul 05 and 06)
16% reduction overall, 35%
reduction from pilot surgeries
March –Oct 2006.
60% reduction for all non-urgent
assessments
(52 days average down to 21 days
average Mar-Nov 05 and 06)
WATFORD CMHT
44% reduction in pilot
linked surgeries
Sept-Dec 06
6% increase in referrals
overall Sept-Dec
06
Not available
Conclusions
• Increase in Service User
•
•
•
•
satisfaction
Increase in GP
satisfaction
Increase in range of
services available
Reduction in no.s of
referrals to secondary
CMHT services
Initial indication of
improvement in
measured mh
• Initial increase in
•
•
•
•
numbers of referrals to
EPCMHS + CMHT
Identification of “unmet
need”
Inconsistent uptake of
service offered in
EPCMHS
Lack of longer term
studies to identify repeat
referrals
Issues of skill mix
EPCMHS in Hertfordshire – The
Next Steps
• Joint Commissioning
•
Team – expressed
intentions to develop
Primary Care Mental
Health Services across
Hertfordshire;
To form part of HPT
Foundation Trust
Contract
• Letchworth, Watford,
St Albans to evolve
• Further developments
• Stevenage PBC Pilot
• Overview CMHS
Reconfiguration
Project