Primary Care

Co-location of mental health therapists with primary care supports patients by offering a broader range of integrated services for patients in their communities. The creation of Primary Care Networks provide an opportunity for IAPT services to work closer with primary care and increase awareness of IAPT services.

Many IAPT services have worked in a more integrated or partnership way with GP practices by:

  1. Where possible, co-location of IAPT practitioners within a GP surgery – even if for only a few hours a week – can really help build relationships and increase referrals.
  2. Attending practice meetings to provide information and updates on IAPT services, including how to refer.
  3. Running ‘masterclasses’ for GPs – providing MH training and raising awareness of IAPT services.
  4. Some services have a named IAPT practitioner for each GP practice, and operate separate waiting lists for each GP surgery. Clinically this is a very good way of working but does add complexity and inefficiency.
  5. Become ‘embedded’ within Primary Care Networks (PCN), if possible, to increase integration of IAPT with primary care. For example, Tower Hamlets have partnered with GPs at the PCN level to develop joint multi-disciplinary team care pathways in primary care for COVID survivors affected by chronic fatigue [see case study].

A few examples:

  • The Primary Care Link Working Team works across all Barnet GP practices. The team has embedded links with Mind Matters (formerly IAPT services), the Local Authority Network Service and the newly developed Wellbeing Hub (a collaboration of Barnet’s voluntary sector services), with alignment and a clear pathway across all three services.
  • West London CCG’s core Primary Care Mental Health service comprises Primary Care Liaison Nurses and Consultant Psychiatrists input, together with talking therapies (IAPT and Step 4 psychology, and a voluntary sector provided Mother Tongue service for Arabic and Farsi speakers) and facilitated social events, also provided by the voluntary sector.
  • Tower Hamlets have found that building strong connections and relationships with key people such as GPs and social prescribers is important, as they can then connect with others.
  • Ealing IAPT work and meet with social prescribers in Ealing borough, potentially suitable IAPT cases are discussed at these meetings. The social prescribers are co-located with PCNs and GPs and have been a link to primary care
  • Case study: Islington iCOPE – close working with GPs
  • Case study: Setting up an integrated GP clinic in North East Hampshire
  • Case study: Calderdale – Integrating mental health therapy in primary care
  • Putting up posters and leaving flyers in GP waiting rooms, advertising the range of IAPT offers available – including in different languages.
  • GPs sending out texts to patients informing them about IAPT services and how to access them (including self-referral).
  • Send a circular to GP practices in the area, as a reminder of the services IAPT offers – via regular local GP communication channels.
  • Producing ‘IAPT prescription pads’ that GPs can fill in and hand to patients, with information about how to access IAPT services.
  • Working with GP surgeries to promote access to wellbeing services, which are an appealing service for those who are unsure about their need for IAPT services. [Case study: Merton, Sutton & Wandsworth]
  • Offer evening drop in ‘welcome sessions’ in GP surgeries for those whose first language is not English, or are working during the day, so patients can find out more about IAPT services. PWPs undertake a basic risk assessment and then book patients in for a main assessment.
  • Monthly newsletter to GPs stating explicitly, the number of referrals to the IAPT service from each GP surgery and the recovery rates for such patients. This data has created a form of competition amongst the GP surgeries to increase referrals.

There were also a few challenges identified:

  • Very few IAPT services are currently engaging with emerging Primary Care Networks; this could result in IAPT being left out of discussions about local mental health care pathway redesign and may weaken relationships with primary care. [see case study]
  • Some IAPT services have struggled to engage with GP surgeries; GPs have many demands on their time so are not often available to speak with. In addition, in surgeries where there are many locum or temporary GPs, it reduces the ability of IAPT services to form relationships with them.
  • Some GP surgeries aren’t able to able to offer a room for a few hours a week to an IAPT practitioner, due to space constraints (some also aren’t willing). Also, the costs of hiring a room in a GP practice can be costly.
  • In some cases, IAPT links with the GP Confederation have been lost (due to re-structuring/re-configuration); this reduces the efficacy of working in a more integrated way, as structures and roles are unclear.

NHS England guidance on co-locating mental health therapists in primary care.

NHS England guidance on the new Community Mental Health Framework for adults and older adults.

NHS England guidance on Primary Care Networks and the Primary Care Network Directed Enhanced Service.

Healthy London Partnership undertook a review of the scientific literature informing the development of models of primary care in mental health. The report provided a review of new initiatives where specialists and primary care staff are working together with community-based organisations to provide an enhanced primary care mental health offer. Key findings include:

  • Intervention patients had fewer psychiatric relapses compared to control patients – in a relatively large study of 335 patients. The intervention consisted of a new role of Specialist Mental Health Worker and planning chronic disease management systems in the practice. The intervention was also felt to have improved partnership working between primary and secondary care. Byng et al. (2004)
  • Integrated mental health primary care (which incorporated brief, low level psychological therapy), reduced depression and improved self-management (modest effect size). Coventry et al. (2015)
  • For older primary care patients with less severe forms of depression, integrated primary mental health services may be more effective than speciality referral. Krahn et al. (2006)
  • Implementation of a shared model of primary/specialist mental health care resulted in 70% of patients feeling at least ‘somewhat better’ and 61% of patients said they had acquired some biopsychosocial understanding of their problems. More than 70% of patients also indicated that shared care treatment had improved their ability to cope with their illness and in general. McElheran et al. (2004)
  • Moderate beneficial clinical effect in trials of depression. Beneficial effects on mental quality of life, social role function, physical quality of life and social role function Woltmann et al. (2012)
  • Of the patients provided with enhanced care, 45% had a 50% or greater reduction in depressive symptoms at 12 months compared to 19% of those receiving usual care. Patient satisfaction with treatment was higher in the intervention group and had lower levels of functional impairment at the end of the study. Unutzer et al. (2002 & 2008).
  • A moderate to large effect on reduction in symptoms of depression through uptake of an enhanced primary care model. Richards et al. (2008)