A new vision for community mental health services
Surrey and Borders Partnership NHS Foundation Trust (SABP) is leading the way in introducing an innovative, new model of community mental health care for adults and older adults with severe mental illnesses.
For the first time, any adult with significant mental health problems are able to get help from their GP practices, as services transform to better meet the holistic needs of local communities. People are given advice by a multi-disciplinary team about looking after their wellbeing and coping with stress and anxiety. They are also connected into a wide range of voluntary sector and community services, such as employment and debt advice, and will have easy-in access to specialist mental health treatment as and when needed. The intention is to provide quick and easy access to support to many in real need who do not meet the referral criteria for specialist services.
Surrey Heartlands and Frimley Health and Care integrated care systems (ICS) have been awarded £11.2m by NHS England for SABP to transform existing community mental health services in Surrey and North East Hampshire in line with this vision. The Trust is rolling out these new a multi-professional services to GPs’ surgeries across Surrey, where it is called the GP Integrated Mental Health Service (GPimhs), and in Surrey Heath and Farnham, Hampshire, where it is called Mental Health Integrated Community Services (MHICS). The services operate from nearly 80 GP practices, covering a population of more than one million people. The services are a partnership, designed and delivered with local GPs, people who use our services and carers, as well as social services at Surrey County Council and third sector providers Community Connections Surrey and Andover Mind.
A key aim of the service is to ensure people who fall in the gaps between GPs and specialist care, or are ‘bounced’ between them with multiple rejected referrals, can be seen quickly and easily. The service’s ‘No Wrong Door’ policy means any patient referred by their GP will be seen, breaking down barriers to care. The intention is to provide evidence-based treatments and access to community support, help people before they reach crisis point and reduce waiting lists.
These new teams in primary care are just one part of a bigger puzzle of transforming community mental health services. They will be combined with redesigned secondary care services for adults, so together they work as ‘one team’ serving groups of GP surgeries, called primary care networks. Routine patients will be seen in primary care. When in crisis they will be referred to specialist teams, returning to primary care when stable – ‘easy in, easy out’.
The services have been shortlisted for the Mental Health Innovation Award category of the HSJ Awards 2021. Twelve of the teams launched during the pandemic.
What we’ve done so far
SABPT’s Community Mental Health Transformation programme is delivering this transformation as part of the early implementation sites in Frimley and Heartlands ICSs. It started out as a pilot with three GPimhs teams in Surrey Heartlands in Spring 2019 and is expanding to Primary Care Networks (groups of local GP practices) across the two ICSs. Nearly 80 practices were providing the service by August 2021. The new model of care is being rolled out to every GP practice in Surrey and NE Hampshire by the end of 2023.
We are developing these seamless, integrated and recovery-focused services with GPs, the third sector and social care. People with lived experience and their carers are shaping the service through co-design.
The benefits for patients
The benefits are:
- Easy access to specialist mental health care without needing to meet secondary care thresholds and face long waiting lists
- Timely access to evidence-based treatments, such as psychological therapies, better care for co-existing physical health problems and advice about medicines
- Support is offered from the first appointment, so patients don’t have to wait a long time for secondary care assessments while their mental health worsens
- Support for wider life issues that can trigger mental ill-health such as unemployment, housing and financial worries
- Help to manage their own condition and improve their quality of life, supported by families and carers and linked into community activities promoting social connectedness and wellbeing
How is the service performing?
The service has seen more than 7,000 patients with significant mental health issues in its first two years. Patient satisfaction with the service is extremely high. Patients say they can access the service quickly, feel heard and are better able to manage life challenges. Only a small proportion (1% to 5%) have been referred on to adult secondary care. Preliminary analysis in sample sites has found GPs with GPimhs/MHICS have had a reduction in referrals to adult secondary care.
Why do we need to change community mental health services?
Patients often complain they have to repeat their stories at repeated assessments. This service is designed to prevent this. Another frequent complaint is that patients fall between the gaps, considered not ill enough for secondary care but too severe for IAPT. Some patients currently face a ‘cliff-edge of being discharged to no support. The new service will provide more flexible support for ongoing needs. They will also address the social roots of people’s mental ill-health, taking a “What’s happened to you?” instead of a “What’s wrong with you?” approach.
The wider policy context
These changes have been envisaged by NHS England as a way of ‘revitalising’ community mental health services. The NHS Long Term Plan envisaged integrated models of primary and community mental health care for adults and older adults with severe mental illnesses, integrating mental health, physical health and social care. The Community Mental Health Framework for Adults and Older Adults, published in 2019, called for a move away from siloed, hard-to-reach services towards placed-based, joined-up care and whole person, whole population approaches. It calls for more focus on people ‘falling through the gaps' and the problem of patients being ‘bounced’ between primary and secondary care. This ambition is supported by an additional £1 billion funding nationally per year by 2023/24 to transform the provision community mental health care for adults and older adults with severe mental illnesses.
Next steps
The vision over the next year is that these services will more closely integrate with Community Mental Health Recovery Services, and other community services and groups to create ‘one team’, centred on the patient, providing seamless care.
We’re currently undertaking a pilot of how the service should integrate with secondary care in Epsom before these primary care-based services are integrated with the existing Community.