Leicestershire’s Mental Health Facilitator Service

Dr Theresa Eynon MBChB MRCPsych DFFP MRCGP

CLAHRC Clinical Translation Fellow and Lead GP

 

Commissioning the Service

The Leicestershire Mental Health Facilitator Service was commissioned in 2009 and rolled out from September of that year alongside the Improving Access to Psychological Therapies Service.

 

Good Thinking is a partnership between Rethink Mental Illness, Leicestershire Partnerships NHS Trust and the GP-led Leicestershire AssuraLLP.

 

The Mental Health Facilitator service covers 84 practices in Leicestershire County and Rutland. There are 11 experienced Band 6 Mental Health Practitioners and one Band 8 Team Leader.

 

Delivering the Service

Each Mental Health Facilitator (MHF) covers a cluster of practices with an average sized practice having one session a week of dedicated MHF time.

 

The core component of the role of the Mental Health Facilitator is to conduct the annual mental health reviews, which are offered to all patients registered with GP practices with a diagnosis of a psychotic illness or Bi-Polar Affective Disorder, or who are receiving Lithium treatment.

 

The reviews are a component of the Quality Outcomes Framework (QOF) for mental health in primary care. The reviews consist of a mental state assessment, physical health checks (blood pressure, Body Mass Index, waist circumference, relevant blood tests and urinalysis) and lifestyle assessment and advice (i.e. smoking, drug and alcohol use and exercise).

 

The MHFs use the standardised ‘PHC - Physical Health Check’ developed for Rethink Mental Illness by Dr Michael Phelan. Data is shared directly with the GP surgery and populates their Quality and Outcomes Framework. A letter is also sent to the service user’s secondary care co-ordinator if they have one.

 

Mental Health Facilitators are able to offer follow-up appointments or signposting to appropriate services if an unmet need is identified in the review. It was also agreed that mental health facilitators would offer non-urgent mental health assessments for people presenting with mental health problems which are a cause for concern and/or assistance may be required with signposting/referral to the most appropriate service. Mental Health Facilitators work primarily in GP surgeries but are able to offer home visits if necessary.

 

Measuring the outcomes

The service measures its success objectively alongside the GP practices using the Quality and Outcomes Framework as well as using qualitative reviews of GP, staff and service user satisfaction.

Overall GP satisfaction with the service in 2011 was high with many positive comments

 

 

Very flexible to the needs of primary care”

           “Meets patients individual needs”

 

General Practice Quality and Outcomes Framework Mental Health Indicator MH9

The percentage of patients with schizophrenia, bipolar affective disorder and other

psychoses with a review recorded in the preceding 15 months. In the review there

should be evidence that the patient has been offered routine health promotion and

prevention advice appropriate to their age, gender and health status

 

Year

Good Thinking

Denominator

England Average

Range

Ranking

2008-2009

94.1%

2943

92.5%

78.4 – 98.3

25th

2009-2010

93.6%

3137

92.2%

86.0 - 96.2

37th

2010-2011

95.5%

3157

92.6%

86.8 - 95.8%

2nd

In their first year of operation, the MHFs added nearly 200 patients to GP registers through case-finding. Despite increasing the denominator population LCRPCT were second in England for MH9 last year.

 

Future Developments

Benchmarking data showed Leicestershire Partnerships NHS Trust was retaining significantly higher caseloads in secondary care than peers.

 

Good Thinking worked with Dr Girish Kunigiri (LPT) to set up a steering group to conduct a discharge project in one locality (NWLeics) from Feb 2011-Jan 2012.

A tool was developed to help identify SU who could be potentially discharged back to GP. It identified service users who had been stable for one year or longer with no interventions.

The team gave advice to primary care included (medication, early signs of relapse, risks and its intervention)

32 patients were discharged via the project to primary care. GPs reported no adverse outcomes or increased workload in primary care.