How PCNs are preparing to deal with the mental health tsunami, part one

With warnings of a post-pandemic tsunami of mental health to hit the NHS, PCNs are working out how to best meet the needs of their local population. But with difficult to navigate joint-funding arrangements and recruitment headaches – which are unlikely to be solved by the update to the Network DES stating they can now higher an extra mental health practitioner via the ARRS – PCNs are also investigating different ways to meet the wave of need that GPs say is already here.

Emma Wilkinson looks at what they’re putting in place and the challenges they’re facing.

What is the demand?

In 2021, modelling by the Centre for Mental Health suggests an additional 10 million people in England will need support for their mental health as a direct result of the pandemic within the next three to five years.

Key groups who are likely to need support are those who survived severe Covid-19 illness, those who have been bereaved, health and social care workers and those hit economically by Covid-19. Then there are those with existing mental health problems that have been exacerbated by the circumstances of the past two years. It equates to two to three times current NHS capacity, the Centre warned.

Children and Young People’s Mental Health Services (CAMHS) are seeing double the referrals to their services with GPs reporting referrals are often rejected. Mental health is making up a large and increasing proportion of consultations with the coming financial squeeze likely to make this even worse, GPs warn.

Olly Parker, head of external affairs at YoungMinds points out there is a massive unmet need surrounding young people’s mental health. ‘GPs can play a crucial role for young people, making referrals to specialist support and working hard to provide advice and guidance. Yet in a survey we carried out with GPs, only one in 10 felt confident that a mental health referral would result in treatment and most wanted more community support to stop young people becoming more unwell.’

Across the board, there are significant gaps in services with people either not ill enough or too ill to quality for talking therapies or psychiatric care. Dr Hussain Gandhi, clinical director for Nottingham City East PCN, estimates that mental health now accounts for 40-50% of his workload ‘Even pre-Covid mental health was a huge part of our workload but it has grown massively.’

 Is joint funding working?

Hiring a mental health practitioner through the joint funding scheme has proved challenging for PCNs because of a lack of applicants and in some cases because of reluctance of mental health trusts to support the scheme when they are so short staffed and under pressure themselves.

As yet NHS Digital have no data on mental health practitioner recruits. Despite this lack of information PCNs are now able to hire twice as many adult mental health practitioners, subject to the approval of their provider, through the ARRS in the update to the Network contract announced on March 31. There is no such increase for child and young people’s mental health provision.  

Where a PCN and Community Mental Health Provider agree, networks with fewer than 100,000 patients will be allowed to request two whole-time equivalent (WTE) adult MHPs, rather than the one they are currently eligible for.

Similarly, the number available to PCNs with a patient list greater than 100,000 will double to four. The roles that can be recruited under this banner have also been broadened out to include peer support workers and mental health community connectors or other role from band 4 to 8a under Agenda for Change pay scales.

Dr Emma Rowley-Conwy, clinical director at Streatham PCN said they had not gone for a mental health practitioner under the ARRS funding because they knew it would be so hard to recruit to.

Another local PCN who had been leading on it for six networks locally has struggled to make any progress with the local mental health trust with one person recruited in November still going through HR processes. ‘I think the model whereby they have to be 50/50 local mental health trust/PCN is never going to work effectively,’ she said.

Dr Gandhi is in one of the ten most deprived areas outside London. and from the very beginning is PCN had a business plan for at least six mental health workers to try and free up GP time for other work. They have calculated this would have a significant impact yet because of limitations on ARRS roles they could not fund it.

They now have one mental health practitioner in place who enjoys the role but is spread between seven practices and as a result can make little headway. ‘We need a minimum of one per practice,’ he says.

For his PCN, the joint funding scheme has been a hinderance because of the pressure on mental health services. A plan to get a second practitioner in place from April which he has been pushing for months is not going to happen he has been told. ‘I would love to offer this service to patients, but the local mental health trust cannot support us.’

Beccy Baird, senior fellow at the King’s Fund notes that while the joint funding arrangements in theory provides an opportunity for collaboration on aspects like mental health pathways, and was put in place to stop moving of staff around the system, it doesn’t solve the fact there is an overall workforce crisis in the NHS.

‘I can see that mental health trusts are really under pressure and they are worried about people who are really really ill. It’s hard for them to do this and it’s about coming together and finding the forum to talk to each other and think about how you make this better.’

She adds: ‘The danger comes when you use PCNs to patch up other bits of the system.’

Dr Annie Lee, a GP in Newquay and lead for mental health at Watergate PCN, said they had now employed their first community psychiatric nurse through the ARRS funding and she is due to be in post soon but their aim is to recruit a small team because the need is so great.

‘Mental health has gone through the roof and even with quite a lot of physical illnesses when you start asking, there is anxiety behind them. There is a massive opportunity to expand mental health support in primary care.’