mental health



Bringing together physical and mental health

1 2 3 4

5 6 7

and other chronic mental health problems (see Appendix C for more details). A

core objective of the service is to strengthen capabilities and build confidence in the

practices they work in – for example, psychotherapists perform joint consultations

with GPs and conduct developmental work with the wider primary care team. An

economic evaluation found that the service was highly cost effective, with improved

patient outcomes and a 25 per cent reduction in GP attendances among people

using the service (Parsonage et al 2014).

A new integrated persistent pain pathway in Oldham means that GPs – who

have often managed patients with chronic pain largely through the prescription

of painkillers or referral for medical treatment – are being supported to take a

biopsychosocial perspective. People with persistent pain that is hard to manage,

despite treatment, are referred by GPs to an integrated assessment hub delivered by

Pennine MSK Partnership. For patients at the lowest level of severity, GPs then play

an important role in co-ordinating care delivered by community physiotherapists

and psychological therapists (see Appendix B).

A further example is a primary care liaison wellbeing service currently operating

on a pilot basis in three general practices in the Bradford and Airedale area (see

Appendix G). The service supports patients identified by GPs on the basis of

high levels of service use and possible mental health needs. It provides a mix of

psychological and social interventions, delivered by a multidisciplinary team led by

a clinical psychologist and including a psychiatrist, physiotherapist, occupational

therapist and auxiliary support worker. The team is co-located with general practice

and works closely with the primary care team, including through the provision of

training sessions on generic skills (eg, communication, behaviour change) as well

as specific symptoms (eg, chronic pain). An economic evaluation of the service is

currently being conducted by the Leeds Institute of Health Sciences.

Physical health checks for people with severe mental illnesses

A further important role for general practice, as stressed in Section 3, is to

help improve the physical health of people with severe mental illnesses such as

schizophrenia, as part of efforts to reduce premature mortality in this group. One

means of doing this is through provision of annual health checks, assessing common

risk factors such as obesity, cholesterol and glucose levels, and behavioural factors

such as smoking and diet. Until 2014, GPs in England were financially incentivised

Integrated service models: current developments and trends 49

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