1. PRISM – PRImary Service for Mental health

2. Why?
The gap between what GP can offer and secondary care threshold is getting bigger.
IAPT can’t solve everything
Secondary Care is inundated – Limited capacity to deliver interventions
People are dying – poor physical health monitoring and sitting on waiting lists

3. The idea

4. Characteristics of PRISM
Population based service – see and intervene philosophy
Prism to support GPs. It is not a separate service to refer into – “request for service”, not referral to PRISM
Informal conversations to provide GPs with advice and support
Joint Prioritisation – upskilling GPs
GP remains responsible clinician
Integration with third sector services and social care – reduced story telling

5. The Patient Journey GP monitors patient, offers support & medication
GP seeks advice from PRISM to support patients
Patient sees PRISM team in GP surgery for support and brief interventions
PRISM refers onto relevant ream/pathway to support individual in secondary care
PRISM directly books into 3rd sector recovery services for interventions
PRISM Peer worker supports access to community resources
Step patient down to PRISM for ongoing monitoring
GP monitors patient
Supported discharge with Recovery Coaches
Rapid re-access to secondary care if required

6. What will this mean for the System?
The final state of PRISM will see the vast majority of patients assessed and treated in “primary care”
True delivery of parity of esteem – quick access
Patients will be put in the right part of the system at the right time – reduction of re-referrals
Reduction in healthcare utilisation – GPs, A&E etc.
Better use of health and social care investment
Capacity released in specialist services
Offering complete pathways

7. What will this mean for the patient?
Support will be available at every stage of MH journey
Early intervention will reduce crisis and escalation of need
Better experience of the system – not being bounced around
Direct booking into IAPT and 3rd sector – reduced need for story telling
Stable SMI patients with enhanced MH needs will have improved physical health outcomes

8. What does this mean for secondary care?
Demand reduced so ability to deliver interventions as opposed to hold risk
A truly integrated physical/mental health approach
Easier to discharge patients when there is adequate support with the GP to support the discharge

9. The core PRISM team Mental health specialist – band 6 + 7
Consultant psychiatrist support (for advice)
Peer support worker – recovery focus
Physical health care worker – SMI, screening and intervention
Management and Admin
Exploring pharmacist role

10. Early outcomes
There is a small subset of data available from GP surgeries with PRISM. Initial feedback and data shows:
Time to assessment dropped from days in Sept 2016 to days in Nov 2017.

11. Early outcomes
Positive GP feedback on consultant involvement and pilot of case discussions
Reduction in referrals to secondary care. Chart shows referrals on to secondary care from PRISM where GP surgery now has PRISM service compared to baseline data from 2016.

12. The Plan Phase 1 – delivery underway Phase 2/3
Align mental health staff to and base within practices
Clinical records on GP systems
Rolled out to 90 of 106 surgeries – full roll out by end Dec 17
Phase 2/3
Consultants aligned.
Step-down patients managed in GP practices collaboratively.
Physical health role/medication monitoring.
Integration of Recovery service (jointly commissioned LA and CCG)
Integration with social care
Review of secondary care treatment pathways/model

13. Future aspirations A primary care wellbeing pathway! To include:
PRISM – mental and physical health
Other relevant community mental health services e.g. PD, perinatal, EIP
Psychological wellbeing service
LA services – including drug/alcohol services
Third sector/community services

14. Reflection Tips so far…..
Delivery
Engagement – to deliver in Primary care, PC have to be on board. This is not another place to dump MH referrals otherwise you continue to get same problem
Regular comms – Hit Squad for problems
Operational
Culture change – LANGUAGE (PRISM dictionary), PRISM principles
Pragmatic approach – one size does not fit all, need to allow for local variance in operations. Not allow process to clog the system

15. Reflection Tips cont. Commissioning and Contracting
Culture Change – do the KPIs work for/against the vision?
Impact can be measure elsewhere in the system i.e. secondary care waiting times, don’t get fixated on FPEs and waiting times for PRISM
Relational versus formal contract management
Know your contracts and use them to hold your solutions together
Explore your currencies to support your payment models

16. PRISM Project Team
Kaeron Dodson – PRISM Programme Manager
Liz Lingley – Project Manager
Ree Wood – PRISM Service Manager
Caroline Meiser-Steadman – Associate Clinical Director
Pamela Peters – Consultant Psychiatrist supporting PRISM
Simon Mitchell – Consultant Psychiatrist supporting PRISM
Emma Tiffin CCG Adult Clinical Mental Health Lead
Adele McCormack – CCG Commissioning Manager
More information can be found by visiting-

17. Questions? We are always happy to be contacted!