Primary Care Mental Health and Education

PRIMHE time for mental health in the NHS by Dr Terri Eynon

Saturday, February 19, 2011

PRIMHE time for #mentalhealth in the #NHS

Someone once described PRIMHE as the paramilitary wing of NIMHE. The PRIMHE conference on 17th February 2011 was a great inspiration to this ‘psychoterrorist’.

Clare Gerada RCGP Chair kicked off with a keynote speech that pulled no punches and her call to GP action reverberated through the day.

For those of you who didn’t make it, what does the jobbing GP need to know?

Firstly, we can’t duck our responsibilities, or if we do the NHS is stuffed. The health costs of medically unexplained symptoms, without accounting for lost earnings or benefits, is £2.88 billion, according to health economist David McDaid. The cure for this malaise is down to GPs.

The economic case for primary care mental health, getting somatisers out of the health system and back to work, is indisputable. The only question is, are GPs up for the challenge?

The cost of treating somatoform disorders with CBT is, for each Quality Adjusted Life Year, minus (yes, minus!) £101. The cost of treating sub-threshold disorders is greater but at £8k still well below the NICE threshold of £30k.

Do we have the guts, as commissioners, to claw back the money we need to do this from secondary care?

Do we dare to challenge Acute Trusts currently over-investigating people who, if only we had assessed them better in the first place, might not have found themselves in a crazy circle of ‘reassuring’ investigations that only serve to heighten their fears?

Clare Gerada was clear that GPs are going to need allies.

Proper resources should be provided, she said. We need to innovate more, not less. We need co-operation and collaboration from our secondary care colleagues but equally we should not take our eye off the provider Trusts.

She gave a clear message that GPs need to get involved with district and county council colleagues who have the political clout to make this work saying, “If we are going to get anything moving it will be through local government.”

GPs also need to ensure the PCT legacy leaves them with the tools to contain costs in secondary care mental health.

Recovery has to be measured according to what is important in peoples lives – like work, housing and relationships. Trusts who have lagged behind on using outcome measures like HoNOS and Recovery Star need to get up to speed. Care clusters and PbR cannot be left to psychiatrists to sort out.

As Hugh Griffiths (DoH) said ‘we need to change the data architecture to get better outcome measures’. Truly a man after my own heart.

Closer to home, will GP consortia be prepared to challenge GPs?

Consultation style matters. Chris Dowrick’s research shows it is quality not quantity that matters. GPs who offer long consultations, who value their patients, value somatic interventions like blood tests and medication and who devalue their own psychological skills are more likely to overinvestigate and refer.

On the other hand GPs who use “expanding explanations” that help patients find a meaningful link between bodily symptoms and their thoughts, feelings, behaviour and situation are less likely to collude with unhelpful somatisation.

We are rolling out this kind of training in Leicestershire using IAPT money. But it doesn’t have to be a Five Areas conversation. As Venetia Young (GP and family therapist) showed, the model can be systemic too.

What matters is that the GP facilitates the patient finding their own psychosocial take on the issue and doesn’t ram some kind of ‘explanation’ down their throat.

Where does that lead us, as the Health Bill wobbles its way through parliament?

Don’t imagine for one minute that, if it falls, we can go back to our old ways. The economic case for joined up thinking with social care and for containing secondary care led demand was made long before Lansley. Public health is aligning itself with local government and GPs need to know that, if the NHS is going to survive, clinical behaviour change and pathway redesign is the only game in town.

If you think primary care mental health matters, get online at PRIMHE .

If you really care, get onto your consortium and make a difference.

click here for Dr Terri Eynon log link

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