1. Integrated commissioning - key challenges for CCG Mental Health leads in 2012/13" -
Dr Ian Walton
GP and Mental health lead
(Sandwell and West Birmingham CCG).
Chair of

2. The Challenges Getting Mental Health on the Agenda
Implementing the Strategy “No Health without Mental Health
Relationships
New ones with GPs
Old one’s with Mental Health Trusts
Users and Carers
The Third Sector
Public Health
Social Care
Health and Wellbeing Boards
Payment By Results and Care Clusters
Tendering

3. Principles Driven by CCG needs
Need to develop common understanding across whole system and pathways of care
Using common language
Build on successes of past
Understand implications of new: payment by results, commissioning for outcomes, recovery based models, primary care needs

4. Who deals with what?
Secondary Care
Primary Care

5. Getting Mental Health onto the Agenda
Secondary Care deals with 7% of the patients and has % of the mental health budget
Primary Care deals with 97% of mental health conditions in the NHS with 1-3% of the budget
CCG s are about making better use of the money (QIPP)

6. Current Single Point of Access

7. Joint Strategic Needs Assessment (JSNA ) v Joint Stategic Assets Aproach(JSAA)

8. Needs Analysis Breadth and depth of need at whole population level
GP population and individual
Large amount of sick people and their carers
Correlated with poor and inadequate housing
Worklessness
Physical and Mental Ill Health and Addictions

9. The Challenge – To improve the outcome of the whole population including……
Frequent attendees
Complex needs
Medically Unexplained Symptoms
Prevention and early detection
Those not meeting ‘psychiatry ‘ criteria – sub threshold
Emotional distressed
Socially Excluded
Homeless
Diverse needs
Not mentally ill but emotionally distressed eg Sadness , grief, loneliness– crisis v crysis
Services do not fit the patient

10. What do GPs want? Patient Centred services Quick access:
advice; support; medicines management; collaborative care; social care
removal of barriers, unclear criteria for entry to and exit from services, multiple assessments and rejection of patients
Better provision within, or close to, practices/community
Better collaboration between services around patient and carers needs
Multiple pathology, physical and mental
Some Pragmatism!

11. The Strategy “No Health Without Mental Health” 6 key aims
We want more people to have good mental health.
We want more people with mental health problems to get better.
We want more people with mental health problems to have good physical health.
We want more people with mental health problems to have good care and support to fit in with how they want to live their lives. We want to make sure people are not bullied because they have a mental health problem. We want the public to understand mental health better, so people are not treated differently just because they have mental health problems.

12. What works in Mental Health
Integration
Training and Education which is not Guidelines Based
Service Co-location
Focus on the needs of the individual and listening to the patient - Must include a Social Model
Early Intervention
A navigator
A team that loves the challenge
Values based approach
Measuring Outcomes – Getting Good Data

13. Integrated model of primary care
Advantages
Collaborative care
Co-location
Holistic wellbeing
Family approach
Access to languages
Pro-active outreach
Partnership approach
Empowering
Needs met – prevention
Spiritual and faith networks
Challenges
Health versus social care redress to funds
Non-engagement
Invisible
Where are the girls?
Data sharing
Suicide
Psychiatric and criminal justice role
Housing
Sexual health
Poverty

15. Health Improvement Programmes
Since the services started we have had
over 4,000 people complete prevention,
wellbeing and health improvement
programmes this equates to £800,000
prevention costs.
1007 Stress Awareness
769 Health Improvement programme
351 Food and Mood workshops
333 Laughter Yoga
305 Happiness and Wellbeing
218 Chin-up
102 Music and Wellbeing
89 Yoga
70 Positive Mental Training
67 Tai Chi
64 Happiness and Wellbeing (FLW)
64 Long Term Conditions
58 Relationships
57 Self Defence and Empowerment
56 Workplace Wellbeing
50 cCBT
47 Wellbeing Awareness Training
35 Relaxation
33 EFT - Emotional Freedom Technique
25 Make Friends with a Book
22 Yoga (FLW)
17 Stress and Relaxation (FLW)
16 Flourish
15 Redundancy
12 Laughter Yoga (FLW)
11 Food and Mood Workshops (FLW)
7 Capnography
2 Maternal Mental Health HIP
Plus over 3,000 people access talking therapies which using the same formulae would be £600,000

16. Attendance at wellbeing programmes
people targeted programmes
2011 – 2883 people attended to date targeted programmes
Books on prescription – 4,000 contacts to date
Make Friends with a Book – 949 people
Arty Party 33 adults and 33 children
Laughter Yoga – 63
Community wellbeing – 7,000 contacts

17. Overall Outcome measures
Corenet Data
2010 –
Reliable improvement 58.5%
Clinical Improvement 51.2%
2011
Reliable improvement 63%
Clinical Improvement 52%
IAPT - Recovery rates 52%

19. Accredited Module in Primary Care Mental Health
Includes practical skills useful in the 10 minute consultation
Taught by Local and National experts
Four afternoons set over one year   - case study based
Anxiety , Depression, Psychosis, Dementia, Medically unexplained symptoms
15 University Credits at level 3
50 credits for GP revalidation
Accredited Module in Primary Care Mental Health
basrse

20. Advanced Diploma in Primary Care Mental Health
Eight modules Taught by Local and National experts over 18 months
Module 1- 4 as per accredited module
Module 5 and 6 therapies
Module 7 and 8
Addiction , Alcohol, Eating Disorders, Personality Disorders
60 University Credits at level 3
100 credits for GP revalidation
Advanced Diploma in Primary Care Mental Health
basrse

22. The Esteem Team
Alcohol
Maternal Mental health
Complex Needs
Dementia

23. Works with practices and A and E to identify patients with complex needs and links them to relevant services and navigates them through the system.
Ensures that the services are working together for the patient.
Plugs the gaps.
BUT needs co-ordinated and integrated Confidence and Wellbeing Team to work

24. Single Point of Co-ordination
Open Access
Open Approach
Call Back Service
Single Number
Supervised by clinicians working
in and alongside general practice

25. Secondary Care – the challenge
Business model v Care Model – getting the Values Right
Getting Psychiatrists and GPs to work and plan together without managerial interference
Preventing unnecessary referrals by early intervention and treatment in Primary Care and the Community
The Recovery Model
Breaking some of their bonds with commissioners and councils and reforging them with GPs and Primary Care
Care Clusters

26. Health and Wellbeing Boards – the challenge
Health and wellbeing boards as strategic bodies
Joint commissioners by agreement / consent - not through law
Joint strategies for better spend on prevention and early intervention and reducing acute care in hospitals and nursing homes
Where does Public Health sit?
How do we make the best use of the Third Sector?

27. Conclusion Invest in prevention and not in sick people
Values and Care must be at the centre of everything
Money talks and there is a business case for this
KNAPP Martin; MCDAID David; PARSONAGE Michael; (eds.); Mental health promotion and prevention: the economic caseLondon: Personal Social Services Research Unit, p
df/PSSRUfeb2011.pdf