{"id":46461,"date":"2020-01-17T12:34:46","date_gmt":"2020-01-17T11:34:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46461"},"modified":"2020-01-21T15:23:51","modified_gmt":"2020-01-21T14:23:51","slug":"kamal-sidhu-primary-care-networks-supported-focus-mental-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/01\/17\/kamal-sidhu-primary-care-networks-supported-focus-mental-health\/","title":{"rendered":"Kamal Sidhu: Primary care networks need to be supported to focus on mental health"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">Primary care networks must not be a missed opportunity to address the disparity between mental and physical health, argues Kamal Sidhu<\/span><\/p>\n<p><!--more--><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-46464\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/01\/kamal_sidhu_2020_.jpg\" alt=\"\" width=\"156\" height=\"147\" \/>Mental health problems account for an estimated 28% of the NHS\u2019s disease burden, yet only <a href=\"https:\/\/improvement.nhs.uk\/documents\/3436\/NHS_Mental_Health_Improvement_Chapter2.pdf\">13% of NHS spending<\/a> goes towards mental health<\/span><span style=\"font-weight: 400\">. <\/span><span style=\"font-weight: 400\">The <\/span><span style=\"font-weight: 400\">Health and Social Care Act 2012 placed a legal responsibility on the NHS to address the inequalities between mental and physical health, and the government subsequently aimed to establish <\/span><a href=\"https:\/\/www.centreformentalhealth.org.uk\/publications\/briefing-46-nhs-mandate-and-its-implications-for-mental-health\"><span style=\"font-weight: 400\">\u201cparity of esteem\u201d<\/span><\/a><span style=\"font-weight: 400\"> by <\/span><a href=\"https:\/\/www.kingsfund.org.uk\/publications\/articles\/big-election-questions-parity-mental-physical-health\"><span style=\"font-weight: 400\">2020<\/span><\/a><span style=\"font-weight: 400\">. The publication of the <\/span><a href=\"https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2016\/07\/fyfv-mh.pdf\"><i><span style=\"font-weight: 400\">Five Year Forward View for Mental Health<\/span><\/i><\/a><span style=\"font-weight: 400\"> in 2016 was, consequently, a welcome move to improve access to, as well as quality of, mental health services. Yet waiting times for mental health services are not showing any signs of improvement. Funding for mental health trusts<\/span><a href=\"https:\/\/www.kingsfund.org.uk\/press\/press-releases\/mental-health-funding-squeeze-has-lengthened-waiting-times-say-nhs-finance\"><span style=\"font-weight: 400\"> appears to have been cut<\/span><\/a><span style=\"font-weight: 400\"> in <\/span><a href=\"https:\/\/www.independent.co.uk\/news\/health\/mental-health-trusts-uk-funding-government-cuts-royal-college-psychiatrists-a8219486.html\"><span style=\"font-weight: 400\">real terms<\/span><\/a><span style=\"font-weight: 400\"> in recent years<\/span><span style=\"font-weight: 400\">. Meanwhile, <\/span><a href=\"https:\/\/www.bmj.com\/content\/368\/bmj.m88\"><span style=\"font-weight: 400\">staff shortages are rife<\/span><\/a><span style=\"font-weight: 400\"> and patients continue to struggle to access care.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For the <\/span><a href=\"https:\/\/www.centreformentalhealth.org.uk\/sites\/default\/files\/2018-12\/CentreforMH_Filling_the_chasm_0.pdf\"><span style=\"font-weight: 400\">vast majority<\/span><\/a><span style=\"font-weight: 400\"> of people seeking help for their mental health, primary care tends to be their only point of contact; an estimated <\/span><a href=\"https:\/\/www.mind.org.uk\/media\/4556511\/13296_primary-care-policy_web_op.pdf\"><span style=\"font-weight: 400\">one in three<\/span><\/a><span style=\"font-weight: 400\"> GP appointments now involve mental health in some way. Nearly <\/span><a href=\"https:\/\/www.bmj.com\/content\/364\/bmj.l1508\"><span style=\"font-weight: 400\">71 million prescriptions for antidepressant<\/span><span style=\"font-weight: 400\">s<\/span><\/a><span style=\"font-weight: 400\"> were dispensed in 2018, nearly doubling in the last decade\u2014a sign of the vital role primary care has in dealing with increasingly common mental health issues, such as anxiety and depression, amid increasing demands.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As a GP, it is often a herculean task to get someone seen in a timely manner by secondary mental healthcare or community mental health services. In some cases, patients have had to wait for more than a year to access options such as <\/span><a href=\"https:\/\/youngminds.org.uk\/blog\/new-figures-on-camhs-waiting-times\/\"><span style=\"font-weight: 400\">children and adolescent mental health services<\/span><\/a><span style=\"font-weight: 400\"> (CAMHS) or <a href=\"https:\/\/www.bma.org.uk\/news\/2018\/february\/the-devastating-cost-of-treatment-delays\">talking therapies<\/a><\/span><span style=\"font-weight: 400\">. Referrals that result in patients being bounced around between various services is not uncommon. Yet the waiting times in mental health rarely appear to draw the same level of scrutiny and emphasis as the four hour A&amp;E target or even the 18 week target for planned treatment.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The result of these access problems is a huge <\/span><a href=\"https:\/\/www.mentalhealth.org.uk\/statistics\"><span style=\"font-weight: 400\">unmet need<\/span><\/a><span style=\"font-weight: 400\"> among patients and an unmeasured loss of people\u2019s quality of life, in addition to the loss in productivity. Struggling mental health services place substantial additional demands on primary care, especially when the capacity within primary care is already under strain too.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Increasingly, we\u2019re witnessing a big gap between primary, community, and secondary care\u2014a \u201cno one\u2019s land\u201d in which patients are left as we all mark our territories firmly. This is a direct result of the strain on all healthcare services, higher thresholds for accepting referrals, and lower thresholds for discharging them early.<\/span><\/p>\n<p><span style=\"font-weight: 400\">General practice will soon see paramedics, physiotherapists, pharmacists, and social prescribing link workers join primary care networks under the <\/span><a href=\"https:\/\/www.england.nhs.uk\/gp\/investment\/gp-contract\/\"><span style=\"font-weight: 400\">new GP contract<\/span><\/a><span style=\"font-weight: 400\">. Yet there is no central initiative to involve mental health services in the extended primary care team. Although there has been <\/span><a href=\"https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2018\/08\/guidance-co-locating-mental-health-therapists-primary-care.pdf\"><span style=\"font-weight: 400\">guidance<\/span><\/a><span style=\"font-weight: 400\"> around co-locating mental health therapists and integrating them within primary care, there has been no resource to back it up. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Many areas have taken the initiative to introduce their own arrangements that do this. These <\/span><span style=\"font-weight: 400\"><a href=\"https:\/\/www.centreformentalhealth.org.uk\/sites\/default\/files\/2018-12\/CentreforMH_Filling_the_chasm_0.pdf\">local services typically embed mental health support<\/a> within primary care\u2014in the form of community psychiatric nurses, psychologists, social prescribing link workers, or psychiatrists\u2014and have shown early positive outcomes. Yet a lack of support nationally means that it has been left to the commissioners at the local level to decide if they will try to implement this from very constrained budgets, leading to a variable provision of service.<\/span><\/p>\n<p><span style=\"font-weight: 400\">There is a strong argument for providing support for people who, frankly, are being discriminated against for having a mental health illness in contrast to a physical illness. <\/span><span style=\"font-weight: 400\">Support for people\u2019s mental health conditions needs to be prioritised in the area where it will have the most impact\u2014in the community and focused around patients and the practices they visit.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Primary care networks <a href=\"https:\/\/www.kingsfund.org.uk\/blog\/2019\/07\/primary-care-networks-mental-health\">need to be supported<\/a> to focus on mental health. We need mental health therapists in our teams and this needs to be funded by new investments, and not by recycling money from other already overstretched services. We need urgent measures to address this untenable situation. Our words on achieving parity of esteem between physical and mental health must be matched by action.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Kamal Sidhu<\/strong> is a <\/span><span style=\"font-weight: 400\">GP in Durham. He is chair o<\/span><span style=\"font-weight: 400\">f South Durham Health CIC, a GP federation that provides practice based mental health link workers in collaboration with the Tees Esk and Wear Valleys Mental Health Trust. He is v<\/span><span style=\"font-weight: 400\">ice chair of the County Durham and Darlington Local Medical Committee. He was p<\/span><span style=\"font-weight: 400\">reviously the mental health and dementia lead for the Durham Dales, Easington and Sedgefield clinical commissioning group. <\/span><span style=\"font-weight: 400\">He writes in a personal capacity. Twitter <a href=\"https:\/\/twitter.com\/sidhuGP\">@sidhuGP<\/a><\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> Nothing further to declare.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary care networks must not be a missed opportunity to address the disparity between mental and physical health, argues Kamal Sidhu [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/01\/17\/kamal-sidhu-primary-care-networks-supported-focus-mental-health\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38741,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223,236],"tags":[],"class_list":["post-46461","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Kamal Sidhu: Primary care networks need to be supported to focus on mental health - 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