Project partner: Bay Primary Care Network and HEENW

Project team: Dr Andrew Craven (GP), Dr Miranda Budd (Consultant Clinical Psychologist) and Clare Baguley (Psychological Professions Network Programme Manager)

 

Project background information:

The Five-Year Forward View for Mental Health (1) followed by recent publication of the NHS Long Term Plan (2) and the NHS Interim People Plan (3) identify the need for significant growth of the GP workforce along with improving primary mental health care as key objectives for the NHS.

 

The Royal College of General Practitioners (RCGP) curriculum (4) recognises the demand relating to mental health that is presenting in general practice. Mental health is a core area of the curriculum and the capabilities map explicitly onto the General Medical Council’s generic professional capabilities framework. ‘The 2022 GP. A vision for general practice in the future NHS’ (5) recognises the weaknesses in the current GP training in relation to those with mental health problems. The paper supports the idea of additional training for GPs in order to support the development of expertise in community-based medical care and whole person holistic care.

 

A Parliamentary briefing from Mind about improving mental health training for GPs (6) raises concern that, on average, less than half (46%) of trainee GPs between 2013-2015 undertook a training placement in a mental health setting. Furthermore, the only mental-health related option offered to trainee GPs was in Psychiatry, based in hospitals or secondary care-focussed. Their ‘Better equipped, better care: Improving mental health training for GPs’ paper calls for improvements to be made to pre-qualifying training for GPs, ensuring every trainee is able to undertake a rotation in a mental health setting. The placement also needs to reflect the kinds of needs and treatment that many with mental health problems are likely to need in primary care. Yet, despite the significant growth of primary care mental health and psychological therapy services (e.g., IAPT), opportunities for placements within primary care mental health settings for GP trainees have not followed the same pattern. IAPT and associated primary care and third sector mental health services may be an ideal starting point to transform learning opportunities for GP trainees. There is also recognition that there are rich opportunities for reciprocal learning between GP trainees and IAPT trainees to be explored.

Ensuring GP’s qualify with the appropriate experience and skills in mental health management is important for individual care and GP confidence and resiliency. Primary care services are most people’s first and most frequent point of contact with the NHS (7) and the prevalence of mental health difficulties presenting in primary care is high. If we are to push towards ‘parity of esteem’ and truly recognise that there is no health without mental health, it seems paramount that those who often have first contact with someone in distress has the skills, experience and confidence to provide meaningful advice and support.

 

  • Around one in three GP appointments involves a mental health component. (8)
  • 61 million prescriptions for antidepressants were administered in 2015, an increase of more than 56% since 2012. (9)
  • People with physical long-term conditions are two to three times more likely to experience mental health symptoms. (10)
  • Medically unexplained symptoms account for up to a fifth of GP consultations. (11)
  • In a survey of 1000 GPs published in 2018, 66% reported that the proportion of patients needing help with their mental health had increased over the previous 12 months (Mind 2018). (12)
  • 90% of people with mental health problems are cared for in primary care. (13)
  • The Covid-19 pandemic mean the case for change is stronger than ever, with intense workload pressures being experienced in both primary care and mental health services, and with potential increases in mental health needs in the population.
  • GP’s are in a good position to provide mental health prevention and promotion advice. There is a vital must for a focus upon mental health prevention and promotion. If more is not undertaken, it is predicted that by 2026 providing services that meet mental health demand will become unaffordable (12).

The project aims to understand what currently is offered to GP trainees in terms of place based learning relating to mental health, particularly within a primary care setting in the North West. The project also aims to facilitate a pilot of place based learning for a GP trainee in primary care mental health within the Bay Medical Primary Care Network. It is hoped that this will then lead to the development of a model for the implementation of primary care mental health placements. This will support the ‘Healthier Lancashire and South Cumbria’ delivery plan and the potential facilitation of larger scale implementation of primary care mental health placements for trainee GPs across the NW region.

  1. A briefing paper which presents:

a.) A review of research evidence and literature that identifies the core knowledge, skills and attitudes required for GP trainees to effectively integrate working with mental health conditions and promote mental wellbeing into routine clinical practice.

b.) A summary of current policy that underpins the professional guidance and skills frameworks that outlines the content and structure of effective mental health placements for GP trainees in primary care mental health.

c.) A framework that maps the (i) key clinical competencies (ii) GP training curriculum outcomes (iii) type of primary care mental health placement required.

d.) A compendium of examples of good practice drawn from local, regional and national intelligence.

  1. A gap analysis of the current status of provision of mental health training placements for GP trainees within the NW.

  1. Identification of mental health place based learning opportunities within the locality of Bay Medical and scoping of opportunities for the development of a comprehensive suite of mental health placements, including IAPT and informed by a stepped care, bio-psychosocial model of primary care mental health.

  1. Provide specialist clinical support to GP trainees located in Bay Medical Primary Care Network to undertake identified the mental health placements within the pilot phase.

  1. An evaluation report of the acceptability and effectiveness of the place based mental health placements pilot.

(1) NHS England, Care Quality Commission, Health Education England, Monitor, Public Health England, Trust Development Authority (2014). NHS five year forward view. London: NHS England.

(2) The NHS Long-term plan (2019). NHS.

(3) Interim NHS People Plan (2019). NHS.

(4) The RCGP Curriculum: Being a General Practitioner (2020). Royal College of General Practitioners.

(5) A Vision for General Practice in the future NHS. The 2022 GP (2013). Royal College of General Practitioners.

(6) Better equipped, better care. Improving mental health training for GPs and practice nurses (2016). Mind.

(7) Durcan, G. (2020). Clinical Psychology in Primary Care. Centre for Mental Health.

(8) London Strategic Clinical Network for Mental Health (2014). A commissioner’s guide to primary care mental health.

(9) NHS Digital (2015) Prescription Cost Analysis, England, 2015.

(10) Naylor, C., et al. (2012). Long-term conditions and mental health: the cost of co-morbidities. The King’s Fund and the Centre for Mental Health.

(11) Forum for mental health in primary care (RCGP and RCPsych) (2011). Guidance for health professionals on medically unexplained symptoms (MUS).

(12) Mind (2018). ‘40% of all GP appointments about mental health’. Mind website. Available at: www.mind.org.uk/news-campaigns/news/40-per-cent-of-all-gp-appointments-about-mental-health (accessed 19th August 2020).

(13) England, L. (2017). RCGP Position Statement on mental health in primary care. Primary care mental health steering group, September 2017.