mental health

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Bringing together physical and mental health

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receptionists, to improve support for people with medically unexplained symptoms

and other complex needs.

More fundamentally, the workforce development needs that were highlighted by

our research also point to the importance of ensuring that professional educational

curricula equip trainees with the skills and attitudes needed to support integrated

working. These implications are discussed further in Section 6.

Finance and commissioning

The role played by commissioners

The role played by commissioners in our case studies was mixed. In some sites,

commissioners had played an enabling role, but in general, innovation had been

provider-led. Several of the individuals involved in leading change emphasised how

important it was to involve commissioners at the earliest possible opportunity. In

cases where commissioners were seen to have played a particularly effective role,

this was attributed to a high level of trust in their relationships with providers, built

up over several years of partnership working.

In some cases, commissioners had developed financial incentives to help bring

about changes in practice. For example, commissioners in Bradford and Airedale

have encouraged the provision of physical health checks for people with mental

illnesses using a locally defined Commissioning for Quality and Innovation

(CQUIN) payment, and have also provided funding for a project management team

that supported implementation in primary care. It is notable that similar financial

incentives used by some other clinical commissioning groups (CCGs) have not

always been as effective, suggesting that these need to be combined with practical

support on the ground, as in Bradford and Airedale.

There was a perception among some of our interviewees that the move to clinical

commissioning led by GPs could be credited with an upsurge of interest in liaison

mental health and other forms of integration. The hypothesis here is that GPs see

the way that mental and physical health interact in their clinical practice, and so

are more likely to support the commissioning of integrated services. Clinical leads

within CCGs (for example, mental health leads) might therefore be expected to play

an important role in bringing about closer integration of mental and physical health.

Implementing change: overcoming the barriers 62

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