How primary care can help address physical and mental healthcare together
Lucy Marks, independent consultant clinical psychologist, describes the benefits that can come when clinical psychologists work closely with GPs to address both physical and mental health.
Primary care has a crucial role to play in proactively managing physical health and mental health. We know that these two aspects of health go hand in hand and that addressing them together in a holistic way improves health outcomes; The NHS England Long Term Plan and its equivalents in Wales, Scotland and Northern Ireland all highlight the need for a collaborative approach with increased focus on prevention, mental health and wellbeing, but there are a number of factors that make this hard to do. One factor is the ever-increasing demands on GPs’ time. Even before the pandemic, pressures on primary care have been at an all-time high and it is concerning that over half of GPs are at risk of ‘burnout’. Another factor is the high volume of consultations that involve mental health. According to Mind, this is about 40 per cent of GP consultations, but GPs often report that they do not have sufficient training or support to help them deal with this.
We welcome the plans in the community mental health framework and recognise they are likely to make a difference to primary care mental health provision, but we need to fully appreciate what GPs are facing and find new ways to support them.
There is evidence that patients with persistent physical complaints take up a disproportionately large amount of time, accounting for an estimated 15 to 30 per cent of all primary care consultations. Given their problems often do not get resolved, this is emotionally draining for these patients and their GPs.
Why clinical psychologists in primary care can help
Clinical psychologists have particular skills to make a significant contribution in this area, through collaborative working, specialist advice and support. They have a broad training across the age range, ability spectrum, and different specialist areas such as neuropsychology, health psychology and complex mental health. Such ‘expert generalists’ are able to apply psychological expertise to the range and complexity of primary care presentations.
The British Psychological Society’s Division of Clinical Psychology have been exploring the benefits of clinical psychology in primary care and are working closely with the NHS Confederation and the Centre for Mental Health. We now have a growing body of evidence about best practice and the efficacy of psychological models. Two service models have been evaluated by the Centre for Mental Health, showing very promising results, demonstrating good patient outcomes, high GP satisfaction and cost savings.
- The Bradford Primary Care Wellbeing Service
GPs in Bradford and Airedale noticed that they often spent significant amounts of time with small numbers of frequent attenders; 20 to 25 per cent of these frequent attenders present with persistent physical complaints. GPs recognised that a psychological formulation would be far more helpful to these patients’ rehabilitation than further medicalising their difficulties. The Primary Care Wellbeing Service is a clinical psychology-led interdisciplinary team set up to support GPs with patients with persistent physical complaints and long-term conditions who benefit from a psychological formulation. They have evidenced significant savings, demonstrated improved quality of life and reduced unnecessary attendance and interventions.
- The Catterick and Shropshire model
Psychologists in Catterick and Shropshire pioneered a General Practice Psychology Service with a lead clinical psychologist seeing patients in rapid succession in surgery with no waiting lists. They demonstrated high patient and GP satisfaction with reduction in referrals overall, while those who were referred were more likely to be accepted
Potential benefits for primary care
- More effective management of patients with complex problems who can be hard to help and use a lot of resource.
- Seeing patients according to need rather than referral criteria, managing the gap between IAPT and secondary care.
- Addressing GPs’ need for more training in managing mental health through providing specialist advice/joint consultations.
To find out more, sign up for our NHS Confederation webinar, New Ways of Working with Physical and Mental Health’ on Thursday 13 May, 12-1pm.
