Enhanced Primary Care Mental Health Services Overview & Scrutiny Committee 12 th June 2007 NHS Hertfordshire Partnership NHS Trust ITEM 2 JUDITH WATT PRESENTATION

Enhanced Primary Care Mental Health Services - Values Recovery & Social Inclusion Recovery & Social Inclusion Choice of Treatment Choice of Treatment Care Closest to Home Care Closest to Home Working & Learning Together Working & Learning Together

Enhanced Primary Care Mental Health Services - Scope Common Mental Health Problems Common Mental Health Problems Mental Health Problems associated with physical health Mental Health Problems associated with physical health Long Standing complex, non-psychotic mental health problems Long Standing complex, non-psychotic mental health problems People with Psychosis People with Psychosis Those with Cognitive Impairment 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 RecognitionAssessment

Enhanced Primary Care Mental Health Service – who delivers? Graduate Workers Graduate Workers Gateway/Link Workers Gateway/Link Workers Support Time & Recovery Workers Support Time & Recovery Workers Vocational Advisers Vocational Advisers Psychologist Psychologist Consultant Psychiatrist Consultant Psychiatrist

Enhanced Primary Care Mental Health Service – What will it deliver? Screening Screening Signposting Signposting Self Help Self Help Guided Self Help Guided Self Help Computerised Cognitive Behavioural Therapy Computerised Cognitive Behavioural Therapy Individual/Group Work Individual/Group Work Short term interventions Short term interventions Social & Vocational Support Social & Vocational Support Referral on to secondary services Referral on to secondary services

Enhanced Primary Care Mental Health Services – where will it deliver? Within Primary Care setting:- Within Primary Care setting:- GP practices GP practices Alternate, non stigmatising Community Settings eg Letchworth Healthy Living Centre Alternate, non stigmatising Community Settings eg Letchworth Healthy Living Centre

Enhanced Primary Care Mental Health Services in Hertfordshire 3 Primary Care Pilots 3 Primary Care Pilots Letchworth Letchworth Watford Watford St Albans St Albans All 3 Pilots :- All 3 Pilots :- Enhanced Primary Care Services + Improved Access to Psychological Therapies + Enhanced Primary Care Services + Improved Access to Psychological Therapies + St Albans Only – New Ways of Working for Consultant Psychiatrist 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 1 WTE 0.8 WTE Link worker funding Seconded from HPT Funded by HPT GMHW WTE 1 WTE 2 WTE 1 WTE GMHW funding Seconded from HPT PCTPCT Clinical Supervision CMHT Psychologist EMHS Psychologist CMHT Psychologist Base CMHT/ Letchworth’s Healthy Living Centre GP Surgery

Results of PCMHT: Assessment Outcome: Feb – March 2007 LETCHWORTH PCMHT ST ALBANS EMHS WATFORD PCMHT Number referred Number appropriate Number on waiting list Cancelled, DNA or did not make contact Number received an intervention Waiting Time – Ref - Assessment 2653*16

Interventions offered by PCMHT’s

Discharge Information -Letchworth EPCMHS

Discharge Information – Watford EPCMHS

Discharge Information – St Albans EPCMHS

Impact on CMHT - Referrals & Waiting Times LETCHWORTH CMHT ST ALBANS CMHT WATFORD CMHT Population covered 71,684146,000110,000 WTE staff ,42 % change in referrals Impact on referrals to Watford CMHT following DAS closure unclear. 54% reduction Feb-Jul % reduction overall, 35% reduction from pilot surgeries March –Oct % reduction in pilot linked surgeries Sept-Dec 06 6% increase in referrals overall Sept-Dec 06 % change in waiting times 47% reduction for outpatient appointments (73 days average down to 48 days average Jan-Jul 05 and 06) 60% reduction for all non-urgent assessments (52 days average down to 21 days average Mar-Nov 05 and 06) Not available

Conclusions Increase in Service User satisfaction Increase in Service User satisfaction Increase in GP satisfaction Increase in GP satisfaction Increase in range of services available Increase in range of services available Reduction in no.s of referrals to secondary CMHT services Reduction in no.s of referrals to secondary CMHT services Initial indication of improvement in measured mh Initial indication of improvement in measured mh Initial increase in numbers of referrals to EPCMHS + CMHT Initial increase in numbers of referrals to EPCMHS + CMHT Identification of “unmet need” Identification of “unmet need” Inconsistent uptake of service offered in EPCMHS Inconsistent uptake of service offered in EPCMHS Lack of longer term studies to identify repeat referrals Lack of longer term studies to identify repeat referrals Issues of skill mix Issues of skill mix

EPCMHS in Hertfordshire – The Next Steps Joint Commissioning Team – expressed intentions to develop Primary Care Mental Health Services across Hertfordshire; Joint Commissioning Team – expressed intentions to develop Primary Care Mental Health Services across Hertfordshire; To form part of HPT Foundation Trust Contract To form part of HPT Foundation Trust Contract Letchworth, Watford, St Albans to evolve Letchworth, Watford, St Albans to evolve Further developments Further developments Stevenage PBC Pilot Stevenage PBC Pilot Overview CMHS Reconfiguration Project Overview CMHS Reconfiguration Project