A leadership programme to help London CCG mental health leads commission more effectively was the result of a major collaborative effort, writes Stefanie Radford and colleagues
Following the government’s NHS reforms and the establishment of clinical commissioning groups, the role of GPs has evolved to include strategic leadership, commissioning, service transformation, performance management, service quality and safety improvement across the healthcare system.
GPs are now responsible for managing commissioning budgets focused on achieving the best possible outcomes for patients and their carers. This requires them to make strategic choices about long term changes to service provision based on robust evidence.
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In London, 90 per cent of people with a mental health disorder are cared for entirely within the primary care sector. Mental health problems form a large and growing proportion of primary care presentations.
A significant issue
One in three GP appointments involves significant mental health issues. Common mental health problems include depression and other affective disorders, learning difficulties, eating disorders, substance misuse (particularly alcohol misuse), dementia and severe mental illness.
With nearly 11 per cent of England’s annual secondary care budget now spent on mental health, it is essential that commissioners have the confidence and ability to develop effective and efficient services to transform the lives of people with mental health problems.
‘It is essential that commissioners have the confidence and ability to develop effective and efficient services to transform lives’
In 2012, to anticipate these challenges, a leadership programme was developed to meet the needs of the new NHS commissioning landscape. It brings together GP mental health leaders from across London and supports them to address the capital’s mental health challenges.
A partnership was formed - led by Geraldine Strathdee, NHS England national clinical director for mental health - between NHS London, Lucent Management Consulting and the UCL Partners Academic Health Science Partnership.
The collaboration produced a competency based leadership model. It brought together service user and carer voices, academic expertise about the evidence base and interpretation of mental health informatics, primary care and mental health commissioning experience, and the clinical expertise of primary care and secondary care providers.
Case study: Mental health urgent assessment pathway redesign project
Eight clinical commissioning groups in north west London have been working closely with providers, local authorities and criminal justice agencies. They formed a mental health programme board, which drives strategic change in mental health service design and delivery across the population of 2 million.
The success of the initial project on urgent mental health assessment and care has quickly led to the identification of other priorities for work “at scale”, including physical and mental health integration, commissioning of liaison psychiatry into all nine acute hospital sites and further work to boost the quality of mental healthcare that GP practices are able to provide.
The confidence and knowledge initiated by the programme has been a springboard and has forged effective joint working across CCGs and its partner agencies in the name of improving the “mental health deal” for all who live in north west London.
The aim was to create a knowledge based leadership programme for mental health CCG leads, which could enable them to achieve excellent mental health outcomes for patients through effective commissioning and local delivery. To do so, it created a leadership development, focused around the following:
- engagement and co-production with service users, carers, and stakeholders;
- personal leadership development;
- knowledge about evidence based care and ability to discern what “good” looks like; and
- a sound foundation in the technical commissioning competencies and using live examples of commissioning local transformational change to support a value based approach (best outcomes per pound spent).
The programme was designed with practical application in mind and with a reflective practice approach being core to the curriculum design and delivery. The NHS leadership competency framework was used to inform the design and content of the programme.
An expert reference group drawn from primary care, mental health, public health, commissioners and user/carer representatives shaped the programme, advising on the content and delivery of the course, as well as course evaluation.
Over 60 London and national clinical, commissioning, managerial and academic experts gave their time to share information on best practice, care pathways and making implementation a reality. Learning was active and solution focused.
Case study: Enhanced primary care service for mental illness health project
Three CCG mental health leads in east London – City and Hackney, Newham and Tower Hamlets – came together to develop a local enhanced service for those with severe and enduring mental illness. The project aimed to shift the centre of mental health provision from secondary care into primary care, in an attempt to get services facing into the community rather than into hospital settings.
To do this, patient data was collected under community mental health teams, guidelines were developed to determine eligibility for stepping down and communication channels were established between primary and secondary care clinicians for permissions and contacts to be agreed. Clear guidance was derived for GPs and patients to understand processes to follow, such as appointments, recovery care plans and physical health checks.
Easy, fast access back into secondary care was also identified if necessary. As a result, more than 800 patients in the past year have been successfully discharged through the enhanced primary care service across the clinical commissioning groups.
Patients said it felt good to be talking about recovery; they felt they were improving and it was nice to have a named contact worker and set appointments. In Newham there has been a positive impact on carers, as GPs can carry out physical health checks on them as well.
The GPs have reported an increase in confidence in dealing with mental health issues through support and learning from consultant psychiatrists and community psychiatric nurses. As a result, the primary care workforce has enhanced team working, better communication within teams and with providers and has achieved better patient outcomes.
Agreement on change
A requirement of the programme was that participants agreed with the CCG chair and accountable officer of their sponsoring CCG an improvement or transformational change programme that the course tutors and experts could help plan and implement.
Participants were supported to complete projects to improve their local mental health services to increase the practical value of the programme to their local health community. To increase the challenge, the projects were assessed.
Projects gave the CCG GP leads the confidence, conversations, encouragement and skills needed to take an idea and put it into practice. Building on the solid foundations provided by the leadership programme, the local projects are still active and continue to evolve.
‘Projects gave the CCG GP leads the confidence, conversations, encouragement and skills needed to take an idea and put it into practice’
These projects, alongside core components of the programme (commissioning support, leadership development, peer engagement and promotion of new transformation initiatives), continue to be delivered through the London Mental Health CCG Network, hosted by the London CCGs, UCL Partners and the London Strategic Clinical Network.
In response to the success of the London programme, a national programme of mental health CCG leadership development was created based on the programme model, and informed by local needs and informatics. It will be rolled out later this year, funded by NHS England.
In addition, part two of the London Mental Health Leadership Programme will be launched, hosted by the London Mental Health Strategic Clinical Network. The initiative to bring CCG mental health leads together has proven once again that the whole, when working to a common purpose, can be much more than the sum of its parts.
Stefanie Radford is senior project manager of the NHS England London Mental Health Strategic Clinical Network; Dr Anna Moore is director, integrated mental health, and Professor Peter Fonagy is programme director, integrated mental health, of UCL Partners; Dr Peter Ilves is a GP in south west London and a consultant for Big White Wall; Dr Geraldine Strathdee is national clinical director for mental health at NHS England; Glen Monks is managing director of Lucent Management Consulting