Improving access to mental health care in general practice

Introduction

As a registered mental health nurse, I could not have predicted a move into general practice when I first mapped out my career plans. Little did I know, general practice was exactly where my passion for nursing would reignite. Within weeks of working in this general practice, I noted the high numbers of patients who were booking GP appointments due to stress, depression, anxiety or mood disorders, as well as parents and carers who harboured concerns about children’s behaviours and moods. These high numbers emphasised limitations that frustrated my GP colleagues such as 10-minute appointments to address mental health problems, and a lack of available support services.

As a result, in August 2015 we started the Wellbeing Clinic, a weekly service that gives patients access to mental health services at their local GP. We now run four clinics a week, each of which sees eight patients. We also have a telephone follow-up clinic on Fridays that patients can use to receive support before the weekend.

The clinics are staffed by a registered mental health nurse and a practice nurse who can address physical health needs, with a GP providing prescribing support. We receive referrals from health visitors, school nurses, midwives and other professionals in the community, but patients can also book an appointment without a referral. The Wellbeing Clinic operates during normal working hours, but, to improve access for patients who cannot get time off work, it also offers extended hours.

Patients are assessed and treated at the clinic; treatment could include medication or a referral for talking therapies. We ensure that patients discharged from a community mental health team have a named health professional at the Wellbeing Clinic who can provide ongoing support. When patients do not meet criteria for referral to the CMHT, the Wellbeing Clinic is able to offer support and risk assessment in a surrounding that is safe and familiar.

Most patients are seen three or four times in the clinic over the span of several weeks or months. Sickness certificates, medication and referrals to secondary services can be provided.

The aims of the Wellbeing Clinic are outlined in Box 1.

Benefits

In the past 12 months, there has been a reduction of 25% in referrals to secondary care services. We have also seen a 23% rise in patients under the age of 18 accessing the clinic. Most people attending have anxiety, stress and depression. They can now access an extended appointment so that a comprehensive assessment can be carried out, treatment plans can be discussed and onward referral can be completed.

The benefits of the Wellbeing Clinic include:

• Better monitoring of vulnerable patients who are not engaging with the CMHT or other agencies;
• Increased engagement with patients who report depressive symptoms and anxiety;
• Improved access to mental health care for women who are pregnant or postnatal;
• Reduced referrals to child and adolescent mental health services;
• Fewer people ‘falling through the gaps’ between secondary and primary care.

Conclusion and future plans

The Wellbeing Clinic has been a huge success, but is not commissioned or funded by the clinical commissioning group. This means we cannot expand, despite the Care Quality Commission’s conclusion in its recent report that it is an “outstanding example of care” . The service costs £40,000 each year in staffing costs; these are funded by the practice because it recognises the beneficial effect the service has on patients.

From our perspective, the service exists to transform the way mental health care is delivered in our community. It empowers patients to engage in recovery in a meaningful way through signposting, monitoring and encouragement.