GP Led Commissioning of Mental Health Services Dr Alan Cohen FRCGP Director of Primary Care

GP led commissioning

A little background GP fund-holding –Counselling was the most common service purchased by practices –Pilot of purchasing of mental health services PCGs –Commissioned some mental health services

So far… We know that –Mental health services will be commissioned We don’t know –Which services –What happens about joint commissioning? So what are the threats and opportunities? –Where does the evidence take us?

Opportunities Long Term Conditions Medically Unexplained Symptoms

Diabetes Risk Profiling Depression is 2 – 3 times as common in people with diabetes Associated with –Increased health care consumption –Increased self perceived symptom load NOT associated with improved glycaemic control?

Diabetes Potential Efficiency Savings Cost of treating co-morbid diabetes and depression is 250% Cost of all treatment is 400% Proportion of NHS hospital expenditure on diabetes is 10% of total spend

Ischaemic Heart Disease Risk Profiling Depression is 2 – 3 times as common in people with ischaemic heart disease The best predictor of death following MI is the presence of depression QOF indicator

Ischaemic Heart Disease Potential efficiency Savings 40% of admissions can be prevented by providing psychological treatments 50% of revascularisation procedures (CABG and PTCA) can be prevented by providing psychological treatments

Anxiety Risk Profiling Anxiety occurs in 25% of people with COPD People with COPD make up the largest group of “frequent flyers” A fear of becoming of short of breath, or actually becoming short of breath?

Other conditions to be considered for this model of care Neurology Gynaecology Gastroenterology ENT Pain clinics A&E

Chesterfield

Chesterfield Results 25 patients -2 cohorts 6 x PCI saved 3 x CABG saved 1 Angiogram All improved with programme

Savings £43,888 in procedures( not including a transplant ) £40,221 on hospital activity Total £84,109

After Cost 25 Patients £52,250 Overall saving = £31,859 £1,274 per patient

Hillingdon

Cost of admissions (6 month period) –Intervention£71,799 –Control£128,344

Opportunities Improved care for people with long term conditions More cost effective – savings: –OPD –In-patient care –GP attendance –GP prescribing People prefer talking therapies

Medically Unexplained Symptoms Sub-threshold (£ Million) Severe MUS (£ Million) Total Cost (£ Million) Primary CareConsultations Prescriptions Out-patientReferral Follow-up In-patientBed days ,303 A & EAttendance Total2,892 Non NHS14,583

Opportunities For GP commissioners –Cost effective –Reduced consultation rate –Increased skills For MH Trusts –Commissioned liaison psychiatry services For Acute Trusts –Better use of in-patient services

Threats GP commissioning –Knowledge –Expertise –Time MH Trusts –CMHTs? –In-patient services? –Other services?

Questions?

Thank You