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

2. GP led commissioning

3. 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

5. 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?

6. Opportunities Long Term Conditions Medically Unexplained Symptoms

7. 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?

8. 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

9. 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

10. 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

11. 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?

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

13. Chesterfield

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

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

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

17. Hillingdon

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

20. 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

21. Medically Unexplained Symptoms Sub-threshold (£ Million) Severe MUS (£ Million) Total Cost (£ Million) Primary CareConsultations74096837 Prescriptions28536321 Out-patientReferral414283 Follow-up26727294 In-patientBed days6936101,303 A & EAttendance322354 Total2,892 Non NHS14,583

22. 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

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

24. Questions?

25. Thank You Alan.cohen@wlmht.nhs.uk