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NHS Operating Framework

Up to Additional Mental Health Information
November 24. 2011
Theresa Eynon

One of the key themes for next year is to be

"putting patients at the centre of decision making in preparing for an
outcomes approach to service delivery"



How can this network facilitate informed choices for mental health service users?


The Leicestershire Mental Health Charter, drawn up in 2008, asks service providers to 'stop doing things that are not working'.


Sounds a simple request - but begs a lot of questions.


What can work? (efficacy)


What does work? (effectiveness)


What works without breaking the bank? (cost-effectiveness)


How do we know? How can we measure?


Did it work for me/my patient/my relative?


The answers to all these questions should inform care pathway development. Care pathways need to include service user, carer and primary care perspectives.


How is this happening in your area? Is your mental health trust helpfully (or paternalistically) working all this out for you?


How can we ensure ownership of care pathway improvement by service users, carers and GPs? Are we measuring outcomes at the patient level or relying on assumed effectiveness from trial data?


Now the NOF is out, we need to respond to the challenge.

November 29. 2011
Theresa Eynon

If GP commissioners are going to be brave enough to change mental health services, they had better know about the characteristics of innovations that work in real life.


Service improvements live or die by their uptake into primary care. So many 'good ideas' fall by the wayside.

Why some succeed is well worth discussing. The table on page 4 of this document says it all so much better than I can.

But for those with no time to spare, here is the digest.

GPs like ideas that fit their way of working, are easy to use, give a clear benefit from the outset, that they can try out for themselves, that they can see working in practice, that they can tweak to suit their local needs, make them look and feel good and that they don't have to do if they don't want to.

Thanks to Steve Iliffe et al, I can now see why our local mental health facilitator service was generally popular with GPs.

It's nice when the theory backs up what you have already done in practice!

Eynon T (2011) Providing mental healthcare in partnership with the private and voluntary sector Practical Commissioning 11 Oct 2011


December 03. 2011
Theresa Eynon

A quick summary of some main headliners in the NHS operating framework and possible solutions

PCT clusters need to consider the strategy to support local commissioning

An option being favoured by RightCare is the idea of a pathway budget holder managing an intermediate care service.

integrate service delivery, not only across primary and secondary care between mental and physical health but also with social care organisations

Leicestershire County has a Mental Health Facilitator service in primary care than case manages all SMI patients and works with GPs to manage patient with mental health issues and long term conditions

improving the physical healthcare of those with mental illness to reduce their excess mortality.

The MHF service in Leics County ensures the physical healthcare of all SMI patients is optimised (and GP QOF points too!)

increased availability of psychological therapies for people with severe mental illness and long term health problems

MHFs offer level 1 and 2 interventions in primary care and signpost service users to secondary care as needed. Monitoring outcomes would be a development of their case management role.

service specific outcomes

Moving away from measuring what providers to do to rewarding what works

choice of treatment and provider in mental health services

How to make it all happen?

Modelling on the RightCare approach, an intermediate care service acts as a pathway budget holder to provide an innovative patient-centred approach to commissioning support.

The mental health case manager in primary care assess and manages, signposts to services, listens to service user experience and measures patient reported outcomes.

Through active patient-focussed case management, they facilitate patient choice of mental health provider while ensuring continuity of care and monitoring service specific outcomes.


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