How this PCN developed mental health services

Warwickshire East PCN is one of the seven networks shortlisted for PCN of the year. It has developed a range of mental health services for patients in its area. Clinical director Dr Faris Al-Ramadani explains what they did and the impact of their work.

Warwickshire East PCN brings together five GP surgeries and encourages an inclusive and integrated ARRS team. An example of how this has helped the local community is the development of mental health services.

During the pandemic, there was a rising need for mental health support, as there was in many areas.  Waiting times were long, services were disconnected, and some patients were unable to access the support they were offered, which was creating health inequalities.

In response to this, the PCN has helped develop and deliver a Healthy Minds Hub, which is an integrated model of care that can be accessed by all local surgeries. It allows staff to deliver more personalised care to patients, helping them access psychological therapy support sooner, more effectively and tailored to individual patient need and preference.

The PCN was able to develop a sophisticated, integrated offer of digital, telephone, face-to-face and group offerings which were all integrated and accessible via the Hub.

Aims

The idea for a new approach came about when we became aware of the limitations of the existing pathway for mental health support during the pandemic. The increased need for help led to very long waiting times, often in excess of nine months, and we became aware that the pathway for support created a health inequality by excluding some patients. People without transport could not travel to treatment centres and those who worked were unable to access mental health services during the working day.

We wanted to address this problem.

The aim was to redesign the patient pathway with the patient experience at the centre. We sought to improve the quality of patient care by ensuring there is a single access point for people in need. From there, we aimed to work together with partners to build out that pathway in a way that benefits all providers whilst ensuring patients receive a better quality of care.

We wanted to take a novel approach to building a co-developed and integrated model of care with a number of organisations. This included integrated support from GP surgeries, MIND, Coventry and Warwickshire Partnership Trust, which provided talking therapies, Warwickshire College, and Silver Cloud. All parties have supported the development of the model under PCN leadership.

Healthy Minds Hub

Partnership working was key, and to help support the integration of various services, we created the Healthy Minds Hub. GPs would then be able to book patients directly into the Healthy Minds Hub for an extended appointment with a care coordinator who would help explore psychological therapy options with the patient, ensuring personalised care was offered.

We commissioned Silver Cloud to deliver an online mental health service to all of our patients. By funding this, the PCN gave immediate access to mental health support to more than 32,000 patients and removed some of the barriers to care. It gives patients access to an online support option without the need to see a GP.

This is a model of proactive care delivered at a population level. The online support model ensured patients could access online self-help programmes which were based on CBT methodologies and overcame barriers created by transport and working hours. All patients could freely access the online support programmes themselves, and the care coordinators were also able to offer patients additional support through the process.  

We also partnered with Warwickshire College to enable local psychological therapy trainees to train with our PCN and help support our patients with quicker access to counselling. We further increased our mental health services offer by working with MIND to recruit and implement active monitors who are practitioners able to help patients develop skills to improve their mental health and wellbeing.

A partnership with Talking Therapies via Coventry and Warwickshire Partnership Trust followed. Talking Therapies practitioners helped to develop the model and an assigned practitioner worked within the Hub. Care coordinators could screen patients eligible for Talking Therapies and book them directly into the service. This removed the barrier of self-referral and ensured only patients who met the criteria would be seen.

The Healthy Minds Hub is the linchpin for it all. It supports GP referrals into mental health services as well as patients who are seeking help. GPs can book a patient into the Hub to speak to a care coordinator who discusses treatment options with the patient and then makes the necessary referrals. This enables integrated and coordinated personalised care.

As a result, we have a co-developed model of care that is patient-centric, personalised, and easy to navigate. It ensures patients can easily and quickly access a broad array of treatments for the best possible outcomes.

Mental health support

In addition, we have developed other services.

Our health and wellbeing team have developed group sessions, mostly focusing on patients wanting to improve their weight and those who suffer from chronic pain and menopause. These are delivered by health and wellbeing coaches.

The social prescribing team has also developed support services for specific groups of patients.

They support patients and families recently diagnosed with dementia as well as provide support to patients with a new diagnosis of cancer. They also help those who may be experiencing health inequalities, such as those who reside on narrow boats.

They welcome self-referrals as well as referrals from our practices and other healthcare organisations.  

Outcomes

We have been able to reduce waiting times for treatment.

In the case of the digital solution, Silver Cloud, there is no waiting time, as patients can immediately access the mental health service. Appointments with the care coordinator in the Healthy Minds Hub normally occur within seven days and the waiting time into talking therapies is now reduced from several months to several weeks. Counselling can now be offered by our counselling trainees and active monitors in a matter of weeks, whereas counselling services outside our PCN can take in excess of four months for an appointment.

Between June 2023 and March 2024, 711 patients were served by the Healthy Minds Hub, which represents nearly 3% of our local population per annum. Patient satisfaction with the Hub was recorded as 87%, and 94% of patients reported that services were well explained to them.

Our trainee counsellors saw 188 patients and 88-90% of patients recorded an improvement in their symptoms (as recorded by improved PHQ and GA7 scores). And we had 504 registered users of the Silver Cloud platform with a user satisfaction rate of 84%. Of those who used the service, 69% of users recorded an improvement in their wellbeing scores.

There were 303 patients seen by a MIND active monitor, and 80% of them recorded an improvement in their symptoms. And between April 2023 and March 2024, our health and wellbeing coaches provided group therapy sessions to 170 patients and 672 individual appointments to patients.

Over a similar period, our social prescribing link workers have provided 3,308 appointments. Their work has released over £70,000 back to patients through attendance allowance, pension credit and disability allowance claims made on patients’ behalf.

Interestingly, the Hub has resulted in a significant increase in the number of patients accessing Talking Therapies services, especially from harder-to-reach groups. Referrals into this service have increased by 87%. The number of males accessing Talking Therapies has increased by 146%, the number of referrals for those aged over 65 has increased by 200%, and for those aged 18-25, it has increased by 109%. This has likely been achieved by the integrated model of care which increased the ease with which patients can access services.

Impact

GPs have said that the Hub has helped them improve the care they deliver to their patients and may have reduced demand for GP appointments.

Partners have also found it a good experience. Gaynor Boileau, psychotherapy subject leader at Warwickshire College University Centre says the placement opportunity was beneficial to both patients and student trainees.

‘It is clear that the wellbeing of your patients is your priority. We are proud to be a part of this endeavour, helping to take the pressure off the essential tasks and priorities of busy GP practices with our focused mental health support,’ she says.

Feedback from patients has been positive too.  One said: ‘This is the first time in almost six months I feel like someone has understood what I need and explained everything clearly and had the time to give me an appointment. I’m incredibly grateful.’

Another said: ‘Very understanding, empathetic, calming, caring’.

In keeping the patient at the centre of everything we do and talking to partners about how to best meet challenges, it has become apparent that we can build creative solutions which meet the needs of everybody. This is integrated, personalised, patient-centric care.

Profiles of the shortlisted PCNs will feature on Pulse PCN in the run up to the awards night on December 6.