Increasing complexity is one of the major factors responsible for the rising workload in general practice (Baird et al 2016) and involves patients presenting with two or more health conditions which also interact with other social difficulties such as poverty, trauma, isolation etc.
Often these difficulties are considered in isolation when people try and access services meaning patients often fall through the gaps between specialist mental health services, social care and Improving Access to Psychological therapies with their management being held by their local GP.
As part of the NHS long term plan, which NHS England published in 2019, local areas are being asked to realign community mental health services with primary care networks, creating ‘new and integrated models of primary and community mental health care’ by 2023/24 (NHS England 2019, p 69) resulting in the establishment of primary care networks (PCNs).
A diverse range of mental health needs are seen in primary care, with general practices supporting people with a wide range of diagnoses and complexities, including people with psychosis, bipolar disorder, personality disorders and other needs. (The Kings fund, 2020 )
Examples of population needs may include:
- People with complex needs that do not fulfil criteria for specialist mental health services
- Child and adolescent mental health needs that do not fulfil criteria for secondary care services
- Mental health needs among older people
- People with long-term mental health conditions discharged from secondary care
- People with persistent physical symptoms which impact on their mental wellbeing
- Psychological needs of people with long-term physical health conditions
- People at risk of suicide, but not in contact with specialist mental health services
With the establishment of the PCNs, an increasing number of roles are emerging for occupational therapists to work within these newly established teams which often comprise of a mix of GPs, social prescribers, peers support workers, coaches, counsellors and psychological practitioners.
Within primary care mental health services occupational therapists are involved in activities such as
-Risks assessments for acute distress
-Personalised care planning for self-management
-Patient activation to achieve personal goals
-Social prescribing, and signposting or referral onto recovery support and services
With services in their infancy and roles being developed in practice with opportunities to shape our own unique contribution, we look forward to hearing form the wider community about their thoughts about how occupational therapists can develop this opportunity to promote their skills to others, identify gaps, develop new ways of working and become imbedded as partners in their local communities.
Questions that will be discussed during this #OTalk are:
- What help or support do you wish patients had in primary care mental health services?
- What key skills can OTs utilise to be most effective in their roles?
- How can OT’s be effective and timely with complex presentations?
- What might be the best ways for OTs to demonstrate their outcomes to others both within the GP surgeries and beyond?
Baird B, Charles A, Honeyman M, Maguire D, Das P (2016). Understanding pressures in general practice [online]. The King’s Fund website. Available at: http://www.kingsfund.org.uk/publications/ pressures-in-general-practice (accessed on 21st July 2021).
The Kings Fund (2020). Mental Health and primary care networks: understanding the opportunities. The Kings Fund website. Available at: https://www.kingsfund.org.uk/publications/mental-health-primary-care-networks (accessed 26th July 2021)
NHS England (2019). The NHS long term plan [online]. NHS England website. Available at: http://www.longtermplan.nhs.uk/publication/nhs-long-term-plan (accessed on 20 July 2021).
RCOT. Occupational therapy in primary care. RCOT website Available at: https://www.rcot.co.uk/occupational-therapy-primary-care (accessed 20 July 2021)