Mental Health and how it impacts on your Business The role of the GP Dr John Hague Governing Body GP...

Mental Health and how it impacts on your Business The role of the GP

Dr John Hague

Governing Body GP

Ipswich and East Suffolk CCG

What am I going to discuss?

• How big the problem is• What my problems are• What your problems are• Some solutions from a commissioners

viewpoint

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How it all fits together

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The Area

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• Around 72,000 people aged 16-74 with anxiety, depression or both. (Higher than expected)

• Around 9,500 children in Suffolk have a mental health disorder, of which some 5,800 have a conduct disorder

• Self harm prevalence for 15-16 year olds is 10% of girls and 3% of boys.

• Up to 1500 women in Suffolk per year experience depression and anxiety during and after pregnancy.

• Prevalence of personality disorder is around 24,000 people aged 16 to 74

• 66 GP practices• 450 GPs• 2 acute hospitals• 4 community hospitals• A recently retendered community

health provider• A single mental health trust• Children’s universal health services

delivered by the local authority

The Burden

• Only around a quarter of those with mental health conditions are in treatment

• Only 13 per cent of the NHS budget goes on such treatments yet mental illness …..

• Accounts for almost a quarter of the total burden of disease.

• Suicide in teenagers has risen by 12% since the start of the 2007 recession

•  Anti-depressant prescriptions have almost doubled since 2002 and is now over 40 million items per year in England alone

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The causes? (in no order)

• Economic downturn• Bullying (at work)• Poor HR practice• Debt & Poverty• Perceptions of Job Centre / DWP• Bereavement / relationship issues /

physical health• Family History

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The impact, for you

• Poor performance• Reduced profit• Disciplinary issues• Presenteeism• Bullying• Unemployment • Bankruptcy

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The reality, for me

• There is no more money• There are no more clinicians (today, or

tomorrow – recruitment is very, very hard)• There are always more patients• There is always more illness• Acute hospitals always take the money from the

system• Around 14 unfilled GP vacancies in East Suffolk

today• ½ of GP training places locally unfilled• Hard to recruit practice nurses

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The reality, for me

• A GP will have up to 110 patient contacts a day

• 40-60 is absolutely normal• After that there is 20-40 letters, 20-40

repeat prescriptions, and 20-40 laboratory results (each consisting of up to 40 individual results)

• Do the maths!

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The reality, for me

• That is our environment • We are where we are• We would like to be more efficient, offer

more, offer more time etc – but this depends on national solutions, that will take years to implement

• Of course we can do better ourselves• Constant improvement is a given• As is workforce innovation

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The reality

• GP’s do not provide an occupational health service, as the taxpayer does not pay for it

• Employers need to do this themselves

• You could start at NHS Health at work

• (Other providers are available)

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The reality

• Mental illness represents 1/3 of an average GP’s workload

• In my case it’s more like 60%

• I am very keen to explore system wide solutions

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What People Tell Us

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There are gaps

between existing services

Services need to be more

personalised

People should not need to navigate

pathways. Services should be accessible

The wider workforce needs

better understanding of

mental health

The 1st person you speak to should be

skilled enough to get you to the right service

at the right time

I don’t want secondary care

services if I don’t need them

More join up with physical

health services

Should be easy to go back to services

and ask for help

Services should listen and not label

It is helpful to talk to people with similar experiences

Services should not keep discharging me and making it hard to re-refer

More support earlier in schools

Debt, housing and other social issues effect mental health

The reality

• Most medication comes from a GP prescription

• Most ‘fit notes’ are signed by GP’s

• Talking treatment via Suffolk Wellbeing service (and its partners)

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• The wellbeing service sees over 15% of those with anxiety and depression in Suffolk every year

• Around ½ of patients will recover (about as good as medication)

• This is performance as expected• People can self refer by phone or web• No need to take medication as well• Over 80 languages available on website• Free workplace workshops• (Other providers are available)

Primary care & the CCG

• The CCG now co-commissions primary care• Patch wide ‘investors in people’• Work on recruitment and retention with HEE, NHSE, SCC• Monthly education sessions• Regular feedback – example below• Contract query line• Support of CCG for system wide reform• Genuine involvement of 14 GP’s in commissioining, with good relationship with officers and NHS

England

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Primary Care Mental Health: Our Commissioning Approach

• Joined up commissioning• Co-production • Innovation• Developmental• Evolutionary • Outcomes focus• GP’s will continue to do

what they do

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What We Want to Achieve

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Our Vision – From mid 2016

• A stepped care primary care mental health service• NICE requirements and exceeding national IAPT targets • An all age pathway with a strong family based approach• Delivering evidence based interventions • Offering integrated physical and mental health pathways • Promoting recovery and peer support• No gaps between primary and secondary care - integrated delivery• As accessible as general primary care • Partnership based delivery• Developing the universal workforce

Vision for Common Mental Health Problems

Huppert Ch.12 in Huppert et al. The Science of Well-being

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Flourishing Moderate mental health

Languishing Mental disorder

Signs Symptoms and Risks

Who is it for

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An age inclusive psychologically focused service for:

• Adults with mild to severe common mental health problems (with secondary care providing care coordination and risk management when there is high risk)

• Children and Young People with mild to moderate common mental health problems and those with conduct disorders or behavioural problems

• Step down from secondary care

Why is this different?

• A strong family focus• A complete pathway for all common

mental health problems, no gaps• Integrated working between all providers• A strong focus on outcomes and recovery• Good relationships with primary care and

services for children and young people

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Early Intervention: But Not Prevention

• Relationship with 5 steps to mental wellbeing, Action for Happiness, “Happy City”

• This is all a Public Health responsibility

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Workplace well-being programmes

Target Working-age adult population accessed through their place of employment

Inter-vention

Multi-component health promoting programme, including a health risk appraisal and information and advice tailored to the employee’s readiness to change health-related behaviours. Cost = £80 per year employee per year

Outcome evidence

Quasi-experimental evaluation in UK company reported significantly reduced stress levels, reduced absenteeism and improved productivity (Mills et al 2007).

Economic pay-offs

Reductions in sickness absence and presenteeism; reduced costs of avoidable mental health problems to NHS

Findings Total savings = £9.69 for every £1 invested

(Slide from Paul McKrone, LSE)

You could Read…

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You could…

• Pay well• Be an Investor in People• Tackle bullying at work• Practice superb HR practice• Offer debt & poverty advice• Offer help with bereavement / relationship

issues / physical health / stress• Take a long view

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Thank you

Any Questions?

johnhague@nhs.net

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