Primary Care Mental Health Care Services

Introduction

Access to Specialised Mental Health Services has been restricted to severe mental illness with all remaining conditions, mainly mild to moderate depression being managed in Primary care. 

NICE guidelines attempted to clarify the provision of this care so that GPs would be more consistent in their therapeutic approach. They should use the various treatments more effectively and uniformly as described in step 2.

GPs currently provide counselling services, using PCT counselling money, in addition to their own consultation skills and medication. There is no clinical governance applied to this situation, nor is their much consideration of using other types of counselling and other mental health care providers.

A draft redesign document in 13.4.06 described a potential way of delivering services. It was decried by the Dacorum GPs as it was costly to manage, (currently provided free by the Practices), and a much valued counselling service would disappear or be severely reduced.

Current situation

Dr Michael Drake and Angie Biela have run meetings with counsellors and Mental Health workers to attempt to design a service that would accommodate NICE guidance and be acceptable to all GPs.

The work covers various aspects
•	Devise a referral form to Counsellors comprising of considered alternatives and clinical need. (Part of a referral plan)
•	Create an updated “on-line” directory of other services e.g. MIND, Relate etc.
•	Employ Graduate Mental Health Workers, probably attached to surgeries to offer other kinds of advice and services.
•	Vet counsellors for suitability and grade and pay. Identify their specialised capabilities and use these. Possible group work leaders, anger managers, CBT psychologists etc.
•	Directing referrals to appropriate workers according to NICE guidance could be undertaken
•	Consider “Beating the Blues” or alternatives CBT provision.
•	Ensure that the whole service is subjected to clinical governance including audit the service, assess outcome measures with GP follow up using depression scores. Examine significant events and educate all GPs about the different services and how to use their own psychological skills in the consultation.

The Future

There are three sides in place for the completed service.

1.	There is currently £160k available to fund the service. This will need to be increased for further psychological service provision but is a start. How much care can be obtained for this amount? AB or LE (Angie Biela or Lyn Eng) can work this out.
2.	Devise contracts and working arrangements to fit in with these needs - ? LE, AB or successor in the nPCT.
3.	DacMan can devise a SLA for each practices access to the service.

All we now need to complete the service delivery is the next step;

4.	DacCom needs to commission the service to a Provider. 
a.	Who will this be? 
b.	How much is available, compared to other PCTs?
c.	Can DacCom provide this service and/or how would it support he venture?

Distillation of a discussion with Mike Drake, Sandy Gower
and Richard Gallow 22.1.07, to be presented to DacCom on 22.1.07