From April 2021, every PCN will become entitled to a fully embedded full-time mental health practitioner, employed and provided by the PCN’s local provider of community mental health services, as locally agreed. 50% of the funding will be provided from the mental health provider, and 50% by the PCN (reimbursable via the ARRS).
Mental Health Practitioners working in PCNs take on a ‘first contact’ role as this can reduce the workload of GPs in practices. The role will involve liaison with practice clinicians, as well as liaison with secondary care, social workers and voluntary sector staff, where appropriate, and making best use of third sector and other community opportunities for promotion of patient wellbeing and maintenance of mental health.
The mental health practitioner may be any registered clinical role operating at Agenda for Change Band 5 or above including, but not limited to, a Community Psychiatric Nurse, Clinical Psychologist, Mental Health Occupational Therapist or other clinical registered role, as agreed between the PCN and community mental health service provider.
As a guide, the Primary Care Mental Health Practitioner could be responsible for the assessment, structured intervention and signposting of a cohort of patients as follows:
- Those presenting with existing diagnosis of mental illness, who are currently not open to secondary care, inappropriate for other therapies such as Talking Space Plus (Oxon IAPT) and experiencing symptoms which would mean them accessing primary care in the short term or in particular as frequent attenders.
- Those without an established mental health diagnosis who require mental health support and/ or brief intervention and/ or signposting where that would otherwise be provided by a GP.
- Those with diagnosed personality disorders whom have been discharged from other services/ therapies or who are awaiting inclusion in, for example, the Complex Needs Service (and who therefore cannot access specific support such as Talking Space Plus) and who require holding support or signposting.
- Those presenting non-specific, as yet undefined, mental health needs/ distress to reception, for whom a telephone or face to face brief assessment can take the place of a GP triage or brief assessment.
- Individual practices may choose to include other patient cohorts, such as review of those diagnosed with anxiety or depression, who would otherwise require a review with a GP. They may also include annual mental health reviews of those on the practice ‘severe and enduring mental illness’ register (or similar) with conditions such as bipolar, schizophrenia, severe depression with psychosis.
Benefits to patients
- Easier access to mental health services in a community setting, i.e. closer to home
- Improved mental health helps people to better manage their physical health
- Improved recovery – self-referrals tended to require fewer sessions, health outcomes and quality of life
- Improved equity of access for patients with both mental and physical health conditions.
Benefits to PCN’s
- Improved access – therapists can see patients, via self or GP referrals, that would otherwise access their GP, thus balancing workload better and allowing GPs to focus on physical health
- Reduction in prescribing for mental health conditions if patients can access psychological therapies sooner
- Improved clinical reach, eg for PTSD, social anxiety disorder, OCD etc.