Tooling up and gearing up mental health in primary care up and gearing up mental health in primary...

Tooling up and gearing upmental health in primary care

July 2016

Transforming and strengthening the role of mental health in primary care

A primary care workforce training and education framework, checklist, and summary of education and training provided in London

Tooling up and gearing up formental health in primary care

2

Acknowledgements

Tooling up and gearing up mental health in primary careTransforming and strengthening the role of

mental health in primary care

Workforce training and education

framework

Competency checklist

Summary of education and

training in London

This education and training tool kit was developed by the London Clinical Network as part of the Healthy London Partnership Mental Health Transformation Programme. Healthy London Partnership is a collaboration of London’s health and care system to support the delivery of better health in London.

The London Mental Health Clinical Network would like to thank all GP Mental Health Clinical Leads and Community Education Provider Networks (CEPNs) for their time and commitment in providing information to support the development of this primary care mental health education and training guide.

We are grateful to those who took the time to offer insightful comments on earlier drafts, including Dr Geraldine Strathdee, Dr Elisabeth England, Dorothy Gould (NSUN), Sheila Hardy, Lisa Hill, Helen O’Kelly, Dr Neil Ralph, Dr Ian Walton, Leila Woodhouse (Mind), and the GP mental health clinical leads.

Finally, huge thanks to Claire Ruiz, senior project manager, and Dr Phil Moore, primary care work stream lead and clinical co-director, both of the London Mental Health Clinical Network, for their leadership, guidance and vision to develop this education toolkit for primary care staff.


3

Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Purpose of this document . . . . . . . . . . . . . . . . . . . . . . . . 5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Supporting the provision of educaiton and training . . . . . . . . . 9

About the framework and checklist . . . . . . . . . . . . . . . . . .10

How to use the framework and checklist . . . . . . . . . . . . . . .11

Understanding current provision in London . . . . . . . . . . . . . .12

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Usesful links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Appendix 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Table of contents


4

Paul FarmerChief Executive, Mind

The Five year forward view for mental healthi provides a superb opportunity to develop mental health care in primary care. Evidence shows that nine out of 10 adults with mental health problems are supported in primary care.

However, the burden on primary care is increasing and it is important that primary care staff are supported to be fully equipped to provide high quality mental health care. It is recognised that the traditional models and boundaries of primary care are not flexible or sustainable enough to support the innovation and transformation required to help support primary care staff to deliver enhanced models of primary care as outlined in the Five year forward view for mental health.

Despite these challenges, the commitment from the primary care workforce to adapt to improve the care of people’s mental health is to be commended. And we can do much more!

New and exciting models of primary mental health care are emerging that support people’s mental health alongside their other needs, including physical health, employment, housing and social care. These provide a greater emphasis on prevention, self-management, choice, peer support, and partnership with users, carers and other sectors.

Having the appropriate education and training is pivotal to supporting the transformation agenda within primary care. This document is an important piece of the jigsaw in that it aims to improve the provision of mental health education and training for primary care staff across London to deliver a primary care workforce that is fit for purpose, flexible and able to adapt to new models of primary care.

Foreword

Phil MooreDeputy Chair (Clinical), NHS Kingston CCG and Co-Director, London Mental Health Clinical NetworkThere is no doubt that the cause of mental health is of national concern. To fully respond means fully engaging primary care in all aspects of the promotion of good mental health and prevention and early intervention in mental ill health. The ongoing care is already largely achieved by primary care and can be further enhanced.

To achieve this will require an equipped primary care workforce who are committed to making the transformation and are given the capacity to deliver the change, a workforce that is tooled up and geared up! The fuelling up is beyond the scope of this paper.

The purpose of this paper is to highlight education and training in mental health for primary care in its widest sense and to provide some suggested tools to assist educationalists, commissioners and staff. We acknowledge these are likely to need further refinement and development, and will welcome wider input for the future.

The development of the primary care workforce must be approached with great sensitivity. Many recent reports indicate that the mental health of primary care clinicians is already sorely tried and we have no wish to add further burdens to them. However, the need for primary care’s enhanced involvement in mental health will not disappear. We therefore welcome MIND’s current focus on this aspect of primary care and view it as a welcome convergence that we address education and training at the same time as the mental health of primary care staff.

We are keen that this paper acts as an impetus to the extensive good work that is already occurring in mental health education and training. We hope that some of the suggested tools will help all concerned to make progress with greater pace and effectiveness.

i. Five year forward view for mental health, The Mental Health Taskforce (2016) | Link

https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf


5


6

Primary care is the bedrock of the NHS and in many places is excellent though variation in quality is recognised and needs to be addressed1. Although the transformation of primary care to deliver a sustainable and NHS has started, there is still a long way to go. This applies particularly to primary care’s role in delivering mental health promotion and mental health care.

The primary care workforce requires support to respond positively and at pace to these changes. This is made clear in the Five year forward view for mental health2 and London workforce strategic framework3. That support includes education and training across all staff and the continued learning through learning sets, mentoring or similar schemes.

This paper sets out to review: » The necessary coverage of that training and suggests a checklist for commissioners and staff to use in

assessing what is required to support the delivery of excellent mental health in their areas » A framework attempting to give some guidance on the aspects of training at each of four levels of staff

engagement with mental health » Examples of mental health education and training already available somewhere in London to enable

commissioners and others to learn from one another’s experience

Whilst we have consulted widely on the suggestions contained within this paper, we recognise that there is still great scope to develop this further and hope that the paper will act as a provocation to many to become actively involved in ensuring London has a primary care workforce second to none for delivering mental health promotion and mental health care.

We have hesitated to add more recommendations to the hundreds already circulating for mental health so would like to submit the contents as suggestions to our colleagues as tools to support us all in improving. This support is intended to: » Help commissioners and staff self-assess against the curriculum checklist. » Ensure mental health training is delivered at least on a quarterly basis » Ensure that mental health training is delivered as an integral part of all ‘physical’ long term conditions

training given the major impact on outcomes and costs » Enhance the provision of mental health training aimed at practice managers and commissioners » Build upon the forthcoming Skills for Health Mental health core skills education and training framework

to help Health Education England (HEE) local teams, community education provider networks (CEPNs), commissioners and community partners to work collaboratively with staff to ensure their mental health education and training needs are appropriately met

» Promote a shared care approach in services arising from increased confidence in primary care staff, secondary care colleagues, and users and carers.

The baseline analysis highlighted that more training is required on early identification and assessment of mental ill health including suicide risk and prevention, maximising recovery caring for people with a serious and enduring mental health illness (including information on the forthcoming access and waiting time standards by 2020) (see Figure 4), perinatal mental health, and children and adolescent mental health services (CAMHS).

Executive summary“The primary care workforce requires support to respond positively and at pace to the

needed changes for delivering mental health promotion and

mental health care.”

http://www.skillsforhealth.org.uk/services/item/332-mental-health-core-skills-education-and-training-framework




7

There is a clear need to improve the delivery of mental health and care at all levels in society. This requires a whole systems approach to achieve excellence in prevention and early identification. Everyone -- whether in the community or primary care (including general practices and community-based specialist mental health services) to complex and specialised care, inpatient stays, local government and partner agencies -- must join together if we are going to reach this level of excellence.

The ambition is for this care to be delivered with a continuity that allows the individual to flow easily from one level to another and back in a way that is entirely appropriate for their care and without any disruption to them. This paper looks at preparing for the development of the primary care element of mental health services by reviewing the education and training available to primary care practitioners and the scope this should cover.

It has been said that the delivery of enhanced forms of care in primary care requires competence, confidence and capacity:

» Competence | Tooling up | gives the practitioners the tools to deliver high quality and best practice interventions. It may be provided in a variety of ways through education, training, mentoring, supervision and other well-established means. The coverage of the training – the curriculum – needs to be established to achieve consistency across primary care.

» Confidence | Gearing up | is three-way: Primary care practitioners need to build their confidence with appropriate support from their specialist colleagues. Secondary care colleagues need confidence in the service provided in primary care to allow patients to remain in or return to primary care and, most importantly, service users and carers need to be confident in the safety and quality of care they will receive from primary care.

» Capacity | Fuelling up | ensures that primary care is not overloaded and has the necessary workforce for this work. It is important, but it is beyond the scope of this paper.

This document is intended to support staff, community education provider networks (CEPNs), health education local teams and commissioners to improve access and understand the key components of good primary care mental health training and education. This guide will also: » Support the primary care workforce to carry out self-assessment of their own development needs » Provide examples of mental health primary care education and training that can count towards professionals

continued professional development » Share examples of how education and training can be developed locally » Influence and support organisations responsible for the effective planning, education and training of primary

care staff to provide evidence based training programmes which are easily accessible, of high quality and have a broad coverage

» Provide a review of the mental health curriculum required by primary care staff.

For the purposes of this document the term primary care includes out-of-hours services and is used to describe:

Purpose of this document

» GPs » Nurses » Liaison perinatal and general services » Other clinicians (eg dentists, pharmacists) » Commissioners » Care home staff

» Practice managers, practice reception and administration staff » Community staff (eg district nurses, health visitors, midwives,

urgent response teams) » Improving Access to Psychological Therapies (IAPT) and

other psychological therapy workers » Social workers


8

Understanding the needLondon has the highest demand for child and adult mental health services of the whole country1. London has significantly higher rates of schizophrenia – 99.8 per 100,000 population, compared to 72.6 per 100,000. Demand for mental health services is increasing. By 2030 there will be approximately two million more adults in the UK with mental health problems than there are today4.

In London, 90 per cent of people with a common mental health illness are cared for entirely within the primary care sector.

Having a mental health illness is also more likely to impact negatively on a person’s physical health -- and vice versa. The mental health and physical health needs of people with a mental health illness are often considered separately and a lack of integration between these services means they are more likely to have their physical health needs neglected.

Figure 1 (right) highlights the need for parity of esteem and integration of care. Primary care has a key role in ensuring the integration of the mental and physical health services available to the service user and carers and families.

The role of primary care healthcare professionals and wider support staffMental health care is multidisciplinary for which GPs are often the first point of contact for a person with mental health concerns. A large proportion of a GP’s mental health workload is caring for people with: learning difficulties and mental health illness; dementia; and older adult psychiatry. Other common mental health problems include depression and other affective disorders, eating disorders, perinatal mental ill health, substance misuse (particularly alcohol misuse), psychoses and other severe and enduring mental illnesses.

Introduction

Source: Integrated physical and mental health care practice and service models: Making clinical and economic sense, Dr Geral-dine Strathdee, National Clinical Director for Mental Health, NHS England, (presentation) | Link

Figure 1: Status of parity in 21st century England

http://www.gmlscscn.nhs.uk/attachments/article/314/GeraldineStrathdeeNorthernregionAandW29.04.15.pdf


9

One in four GP appointments involves significant mental health issues5, yet mental illness still remains under diagnosed and under treated. In addition, only a small proportion of people with a mental health illness will receive the adequate care they need, compared to people with a physical health illness such as diabetes or heart disease. There is wide variation in implementation of the best standards of care in primary, acute and specialist mental health care (MyNHS, Atlas of Variation, RSA Open Public Services Network, national audits etc), but there are exemplars from which we can learn.

In 2013, the Joint Commissioning Panel for Mental Health suggested that mental health problems should be managed mainly by the primary healthcare team working collaboratively with other services and expertise as required5. For too long mental health has been considered by some GPs and practice nurses as a specialist subject. This simply isn’t the case.

All GPs need to recognise that promoting good mental health and wellbeing, being able to identify problems, offering appropriate interventions, support and management, and referring patients appropriately will not only impact positively on their own wellbeing but it will also improve the health and wellbeing of their patients. A good GP doesn’t treat mental health illness in isolation and will think about the person as a whole. For example, if a person has depression, what impact is this is having on their work, finances or family?

In order to achieve parity of esteem and reduce the stigma attached to having a mental health illness it is vital that a whole systems approach is taken to the provision of primary care mental health workforce education and training. Commissioners developing a neurology service, for example, should consider what provision is being made for co-morbid mental health problems, including medically unexplained symptoms. A large proportion of people with a mental illness also have a long term condition. So if training is being delivered on gastroenterology or diabetes, for example, make sure the mental health component is included.

It is important to dispel the myths about mental health:

» Myth #1: Mental illnesses are inevitably long term illnesses. This is simply not true. It’s just that less than a third of people with a mental illness get any access to evidence based effective treatments in the acute phase, which can result in lifelong poor outcomes.

» Myth #2: Mental illnesses have no effective treatments. This is also not true, as mental health has more NICE/SCIE evidence based health technology assessments (HTAs), guidelines and quality standards than any other speciality. However, there has never been a commissioning or provision strategy to implement them universally, creating a post code lottery.

» Myth #3: Mental illnesses are caused only by social circumstances so they are not the business of the NHS. There is a wealth of evidence that while the onset and continuation of mental illness is influenced by social circumstances, there are well proven causes (genetic, epigenetic, biochemical, hormonal, non immunological) which are just as amenable to prevention and health interventions as any other healthcare conditions.


10

Transforming careGood primary care is widely acknowledged as key to delivering effective and efficient healthcare6. An evolution of how healthcare is delivered is required to improve the outcomes of people with a mental health illness; to improve the mental health of those with physical ill health; and to cope with the increasing demands on primary care and mental health services. The traditional models and boundaries of primary care are not flexible or sustainable to support the innovation and transformation set out in the recommendations of the Five year forward view for mental health2 and the Transforming primary care in London: A strategic commissioning framework7. The former sets out a number of recommendations on how to improve mental health care. The latter provides a framework specification that supports transformation in primary care. Both reports highlight the exciting opportunities that working with new models of care provide in order to drive improvement and quality of care.

Working with new models of care -- such as the primary acute care systems (PACS), multispecialty community providers (MCPs), the at-scale acute care / specialist collaboration developed in the Midlands or the enhanced health in care home vanguards -- to develop enhanced primary care models is vital to ensuring that people’s mental health is supported alongside their other needs, including physical health, employment, housing and social care.

The development of new models of care allows an opportunity to reassess the way that primary care mental health is delivered including: » A greater role for GPs in the shared care of a person

with a mental health illness » The opportunity to develop new clinical and support

staff roles in primary care » More effective integration pathways with community

health services » Closer working with social services and local

communities » Maximum use of the digital revolution to improve

access, safety and standards, allowing professionals more time to care for people with a mental health illness.

The direction of travel must be towards a more integrated system where primary care functions as part of a continuum of shared care alongside community based services and specialist colleagues.

A process that involves admit and discharge from every new service a person accesses is unhelpful, repetitive and unnecessary: » Unhelpful as it makes the user feel as if there is a

series of ‘hand-offs’ rather than shared care; » Repetitive as each service tends to repeat the

tedious data collection required where most of the information has already been acquired;

» Unnecessary as the health service should be capable of integrating care around the person to enable them to flow through the system easily, rather than constantly feeling they are being pushed from pillar to post.

Hopefully, in a few years even the term primary care mental health will fall into disuse as mental health care becomes fundamentally shared care.

A separate guide that reviews the different types of enhanced models of primary care mental health and the principles required to develop effective enhanced primary care mental health models will be published in autumn 2016. However in order for primary care to have a greater role in the shared care of a person with a mental health illness it is necessary to increase the skills of the workforce to diagnose and treat mental health illness8. It is acknowledged that a better trained workforce in primary care can support the delivery of better and more integrated services leading to improved outcomes and experience for service users9. This is consistent with the Five year forward view which recognised that designing innovative care models simply isn’t enough to improve services unless there is a workforce with the right skills, values and behaviours to deliver it10.


11

There are specific concerns about how well out-of-hours services are geared up to deal with mental health issues. Like the rest of primary care it seems that this is variable and there is a genuine desire to support the providers of out-of-hours primary care in delivering ever better mental health responses.

We would therefore encourage those providers and commissioners of their services to increasingly engage with this agenda. We will welcome their further input as we attempt to support implementation of training across the capital.

Supporting the provision of education and trainingHealth Education England (HEE) has a role in providing leadership and strategic planning in the development of the healthcare workforce. Together with its local health education teams across England, they are responsible for the ongoing education and training of all staff and have a shared responsibility for investing in continued professional development in order to improve patient care, promote service innovation and transformation9.

In London there are three local health education teams: » Health Education North Central and East London

(HE NCEL) » Health Education North West London (HE NWL) » Health Education South London (HE SL)

The local health education teams have been responsible for funding a number of innovative mental health training programmes across London, including HE NCEL, which was responsible for supporting the establishment of a sustainable network of nurse educators, the development of 10-module training with a train-the-trainer component, and educating practice nurses within London. The local health education teams also commission local borough based CEPNs to support them with delivering their strategic aspiration of improving population health through the development of the current and future primary and community care workforce9.

CEPNs aim to empower community organisations to work with higher educational institutions to assess workforce training needs, expand capacity for training in the community, innovate in the field of training and deliver multiprofessional training.

The Five year forward view for mental health2 makes a number of recommendations regarding how to strengthen mental health training. One such proposal is that the Department of Health and NHS England should work with the Royal College of General Practitioners and HEE to ensure all GPs receive core mental health training and to develop a new role of GPs with an extended Scope of Practice (GPwER) in Mental Health by 20202. The GPwER in Mental Health should support their colleagues in delivering good mental health. GP registrar vocational training should include a clearly defined mental health component that is commensurate with its importance in future professional practice.

The education and training curriculum checklist developed within this report is intended to support organisations responsible for planning and delivering education to understand what core mental health training should be offered in order to deliver a primary care workforce that is fit for purpose, flexible and able to respond to new models of primary care. There is a collective need for healthcare staff to work with their employers, local health education teams, CEPNs, commissioners and professional bodies to ensure education and training needs are appropriately met. Collaborative action is required to help reduce the burden on mental health services and to transform the care for Londoners experiencing mental health challenges. This will require increased capacity within primary care to deliver extended mental health promotion and care. Effective primary care education and training will enable these service changes.

The education and training curriculum checklist compliments the mental health core skills education and training framework being developed by Skills for Health, Skills for Care and Health Education England12.


12

Primary care workforce education and training framework and curriculum checklist

In assessing the needs of primary care for development in mental health, two aspects were recognised: » The scope of the training needed and what had

to be covered to produce competent primary care mental health practitioners – the curriculum checklist

» The spread of training that should be available for all the various practitioners involved in primary care that would allow access at various levels or tiers – the framework

How the curriculum checklist was developedThe curriculum checklist was adapted from a learning needs assessment developed as part of a tool by the Mental Health Institute LETC and Health Education West Midlands13, and used as part of Advanced University Diploma in Primary Care Mental Health from Staffordshire University14. The checklist is also based on the Royal College of GPs mental health curriculum15. Additional components were identified and added from the baseline analysis of education and training. (See Appendix 1.) Within the checklist is a recommendation of the level of training required for each tier.

How the workforce education and training framework was developedIn order to understand the current provision of mental health education, training and mentoring a baseline analysis of mental health education and training models currently in use within primary care was carried out between May through December 2015 with the aim of identifying: » Existing good practice across London » Potential gaps in training provision.

The data was collected from London mental health clinical commissioning leads and community education provider network (CEPN) leads for each borough. A response rate of 87 per cent was achieved across all the London boroughs.

A review of online resources for primary care mental health education and training was also undertaken. This included training courses recommended and provided by healthcare professional bodies such as the Royal College of General Practitioners, the Royal College of Psychiatrists, and the Royal College of Nursing. A review of available training and education courses was conducted on the e-learning websites from the health education local teams, academic health science networks and BMJ.

From the baseline analysis a primary care mental health education and training framework was developed. This identifies the key components of mental health education and training across the primary care workforce (See Figure 2, next page.)

The information obtained from the baseline analysis is summarised according to the primary care mental health education and training framework. (See Appendix 1.)


13

How to use the education and training framework and curriculum checklist

The primary care mental health training and education framework is summarised into four tiers. Each tier represents different roles within primary care:

» Tier 1 - Education and training components relevant to everyone who may as part of their day-to-day work come into contact with a person with a mental health illness (eg GP reception staff, care home staff)

» Tier 2 - Education and training components relevant to everyone who may as part of their day to day work come into contact with a person with a mental health illness and who have a role in supporting service development/improvements (eg practice managers, commissioners)

» Tier 3 - Further education and training components for clinical staff who are not mental health specialists but who have responsibilities for making decisions about patient care or who provide other support to people with a mental health illness (eg practice nurses, nurse practitioners or social workers)

» Tier 4 - Additional components for clinical staff that are often the first point of contact for diagnosing, managing and providing care for a person with a mental health illness (eg GPs, GP registrars and other clinical staff).

Linked to each tier is a summary of what education and training has been undertaken across London for that tier of professionals. The purpose of this information is to provide an opportunity to share the breadth of mental health primary care education and training that is taking place across London and to suggest how education and training can be developed locally.

Further contact details and links to relevant websites have been provided to encourage local areas to contact colleagues across London to share materials or provide further detail about how the education and training sessions were conducted. The training summaries are coded against the curriculum checklist to support the primary care workforce to carry out self-assessment of their own development needs.

The tiers developed as part of the framework are generic enough to apply across the wide and diverse range of roles within the primary care. Each tier is designed to be additional and complementary to the previous tier. For example, people with tier 2 education and training components should also have tier 1 education and training components. These are additional components, not alternative ones.

Tier 1 - Education and training components relevant to everyone who may, as part of their day-to-day work, come into contat with a person with a mental health

illness.

Tier 2 - Education and training components relevant to everyone who may as part of their day to day work come into

contact with a person with a mental health illness and who have a role in supporting service

Tier 3 – Further education and training components for clinical staff who

are not mental health specialists

Tier 4 - Clinical staff who are first point of contact

for care of a person with a mental health illness

Figure 2: Primary care mental health education and training framework


14

Understanding the current provision of mental health education, training and mentoring across London

The baseline analysis provides a snapshot of the provision of mental health education, training and mentoring available across London, and thus may not reflect the full breadth of training that is taking place. However, we are encouraged that the analysis and review of online resources for primary care uncovered an extensive range of existing opportunities, ready for staff to access. The available training varies greatly, spanning general GP updates sessions (some of which extend to nurses) through advanced diploma level programmes aimed at GPs, CPNs, practice nurses, commissioners, practice managers, pharmacists, social workers, and registrars. We also found general mental health awareness training aimed at primary care practice staff and mental health and wellbeing training masterclasses for practice nurses.

Whilst there are various formats of training, many of the training courses aimed at Tier 3 and 4 staff tend to be e-learning opportunities. This contrasts the anecdotal feedback received as part of the baseline analysis, which found that GPs prefer to learn via case study reviews and practical skills training.

Provision and uptake of training varies considerably, too. For example, we found that just a third of London CCGs (11 of 32) reported provision of general mental health awareness training for the wider primary care workforce staff.

Although a large proportion of boroughs reported that they were undertaking regular GP general update sessions , the frequency of these ranged from every week to twice per year, and the length ranged from brief lunchtime updates to half-day training sessions. If a GP is required to undertake 50 hours a year of continued professional development, it is appropriate that a proportion of this is spent on mental health.


15

Figure 3: Number of GPs and practice nurses that have undertaken the Mental Health GP diploma (Staffordshire University 2015/16)


16

Understanding the current provision of mental health education, training and mentoring across London

The baseline analysis highlighted that whilst the GP general updates often covered all areas relating to mental health, there were gaps in training courses undertaken on early identification and assessment of mental ill health.

Topics which may be omitted or lightly covered include: » Suicide risk and prevention » Maximising recovery » Caring for people with a serious and enduring

mental health illness (including information on the forthcoming access and waiting times standards)

» Perinatal mental health » Children and young people’s mental health and

wellbeing.

Education and training on perinatal mental health and children and young people’s mental health and wellbeing is particularly important because of the associated adverse effects and costs associated with inadequate treatment -- not only for the parents, child and wider family.

Adequate education and training will hlep support the needs of mothers and their children with a mental health illness, as early intervention can reduce the likelihood of children requiring long term use of mental health services.

Failing to meet these needs has a wide ranging impact not only on health but also social care, education, welfare and the criminal justice services.

Figure 4 (next page) provides a useful guide to help prioritise training needs according to the roadmap for access and waiting time standards for 2020.

The baseline analysis also highlighted the lack of mental health training aimed at and available to practice managers and commissioners. Managers of services and commissioners should undertake mental health training. Basic training such as mental health first aid training should be considered a minimum requirement for training for these groups of people.

Commissioners and providers of training should consider opportunities to engage with education management and commissioning staff when developing training sessions. By ensuring that all groups receive this vital training, we encourage a whole systems approach, which will improve mental health care for all people.


17

Figure 4: Proposed mental health pathway and infrastructure development programme


18

References

1. Transforming London’s health and care together, NHS England (2015) | Link

2. Five year forward view for mental health, Mental Health Taskforce (2016) | Link

3. London workforce strategic framework, Healthy London Partnership Workforce Transformation Programme (2016) | Link

4. Improving England’s mental health: The first 100 days and beyond, Centre for Mental Health, the Mental Health Foundation, Mental Health Network, Mind, Rethink Mental Illness and the Royal College of Psychiatrists (2015) | Link

5. Guidance for commissioners of primary mental health care services (volume two): Practical mental health commissioning, Joint Commissioning Panel for Mental Health (2012) | Link

6. The future of primary care: Creating teams for tomorrow, Primary Care Workforce Commission (2015) | Link

7. Transforming primary care in London: A strategic commissioning framework. Healthy London Partnership Primary Care Transformation Programme (2015) | Link

8. Walton, I. Educational needs in primary mental health care services. Prog. Neurol. Psychiatry, 13: 4. doi: 10.1002/pnp.105 (2009).

9. Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values, Department of Health (2015) | Link

10. Five year forward view, NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014) | Link

11. Health Education North Central London | Link

12. Mental health core skills education and training framework, Skills for Health, (draft April 2016) | Link

13. Mental health learning needs tool, Health Education West Midlands Primary Care and Mental Health Institute LETC | Link.

14. Staffordshire University website | Link

15. GP curriculum overview, Royal College of General Practitioners | Link

https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2015/03/lndn-prospectus-upd.pdf


https://www.myhealth.london.nhs.uk/system/files/London%2520Workforce%2520Strategic%2520Framework_March%25202016.pdf%20

http://www.nhsconfed.org/~/media/Confederation/Files/public%2520access/MHPG%2520the%2520first%2520100%2520days%2520and%2520beyond.pdf

http://www.jcpmh.info/wp-content/uploads/jcpmh-primarycare-guide.pdf

https://www.hee.nhs.uk/sites/default/files/documents/WES_The-future-of-primary-care.pdf

https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2015/03/lndn-prim-care-doc.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/203332/29257_2900971_Delivering_Accessible.pdf

http://www.england.nhs.uk/wp%20content/uploads/2014/10/5yfv-web.pdf

https://ncel.hee.nhs.uk/about-us/

http://www.skillsforhealth.org.uk/services/item/332-mental-health-core-skills-education-and-training-framework

http://mh-care-pdp.appspot.com/%3Fq%3Dabout

http://www.staffs.ac.uk/

http://www.rcgp.org.uk/clinical-and-research/toolkits/~/media/B9B066784CED42518D2E5F80E141D504.ashx


19

Glossary

CAMHS Children and adolescent mental health servicesCBT Cognitive behavioural therapyCCG Clinical commissioning groupCPD Continuing professional developmentCPN Community psychiatric nurseCEPN Community education provider networksCYP Children and young peopleEIP Early intervention in psychosisGPwER GP with extended roleHEE Health Education EnglandHE NCEL Health Education North Central and East LondonHE NWL Health Education North West LondonHE SL Health Education South LondonHTA Health technology assessmentIAPT Improving access to psychological therapiesLD Learning disabilityMCPs Multispeciality community providersMDT Multidisciplinary teamMUS Medically unexplained symptomNICE National Institute for Health and Care ExcellenceNIHR National Institute for Health ResearchNSF National service framework PACS Primary acute care systemsRCGP Royal College of General Practice SCIE Social Care Institute for ExcellenceSIGN Scottish Intercollegiate Guidelines Network


20

Useful links

Barnet, Enfield and Haringey Mental Health NHS Trust Primary Care Academy www.beh-mht.nhs.uk/gps-and-referrers/primary-care-academy.htm

Camden and Islington NHS Foundation Trust Psychologically Informed Consultation and Training (PICT) sitewww.candi.nhs.uk/health-professionals/resources/psychologically-informed-consultation-and-training-pict/training

Central and North West London NHS Foundation Trust Local Education Provider sitewww.cnwl.nhs.uk/postgraduate-medical-education/cnwl-as-local-education-provider/

Centre for Mental Health Information and resources www.centreformentalhealth.org.uk

East London NHS Foundation Trust Teaching and Training Resource sitenhs-primarycare.staging.winonaesolutions.net

Oxleas NHS Foundation Trust GP Continuing Professional Development and Resources site oxleas.nhs.uk/gps-referrers/gp-continuing-professional-dev/

South London and Maudsley NHS Foundation Trust Education and Training siteslam.nhs.uk/about-us/education-and-training

The Tavistock and Portman NHS Foundation Trust Courses / Webinars sitetavistockandportman.uk/training/courses

UCLPartners AHSN Integrated Mental Health programme www.uclpartners.com/our-work/academic-health-science-network/integrated-mental-health

http://www.beh-mht.nhs.uk/gps-and-referrers/primary-care-academy.htm

http://www.cnwl.nhs.uk/postgraduate-medical-education/cnwl-as-local-education-provider/

http://www.centreformentalhealth.org.uk

http://nhs-primarycare.staging.winonaesolutions.net/

http://oxleas.nhs.uk/gps-referrers/gp-continuing-professional-dev/

http://slam.nhs.uk/about-us/education-and-training

http://www.candi.nhs.uk/health-professionals/resources/psychologically-informed-consultation-and-training-pict/training

http://tavistockandportman.uk/training/courses

http://www.uclpartners.com/our-work/academic-health-science-network/integrated-mental-health


21


22

Appendix 1 | Primary care workforce education and training curriculum checklist

A. Communication

Education and training componentsSuggested curriculum

Tier 1 Tier 2 Tier 3 Tier 4A1 Communicating with relatives/carers of patients with mental health

problems P P P P

A2 Demonstrating empathy, connecting with patients, building rapport P P P P

A3 Providing an opportunity for patients to share emotional and psychological issues within consultations P P

A4 Using relaxation techniques P P

A5 Motivational interviewing P P

A6 Communicating with a patient under the influence of alcohol or drugs P P

A7 Communicating with specialist mental health services P P

A8 Communicating with the multidisciplinary team (MDT) (eg social workers, addiction counsellors, CPNs, clinical psychologists) P P

A9 Communicating with out of hours psychiatric services and crisis management P P

A10 Knowing how to access the current contact details for specialist services (eg on call psychiatry, IAPT, CAMHS, Alcohol and Drug team, Adult and Older Adult services)

P P

A11 Engaging with patient participation groups and service users about the mental health services provided by your practice P P

A12 Recovery-based care planning with patients who have mental health problems P P P

Note: The level of knowledge/detail required to meet each education and training component may vary according to individual roles.


23


B. Wellbeing and prevention of mental health problems


Tier 1 Tier 2 Tier 3 Tier 4B1 Your knowledge of the factors that affect wellbeing P P P P

B2 Strategies for maintaining “good” mental health and wellbeing for patients P P P P

B3 Strategies for maintaining “good” mental health and wellbeing for yourself P P P P

B4 Being able to recognise when an appointment is needed and being able to negotiate this both with the patient and within the system P P

B5 Being able to signpost patients to sources of self-help P P

B6 Being able to signpost patients to voluntary organisations and other third sector agencies P P

B7 Your awareness of the mental health needs of carers P P

B8 Your awareness and understanding of stigma, social exclusion and difficulties in access to health services for people with mental health problems

P P P P

B9 Your awareness of the link between unemployment and mental health problems and where to signpost these patients for help and support P P

B10 Your awareness of risk factors for and recognition of early signs of commonly presenting mental health problems P P P

B11a Suicide awareness training (in addition to B11b) P P P P

B11b Identifying where patients are at significant risk (eg suicide risk) P P P

B12 Your ability to assess for common mental health problems in people with other long term conditions P P

B13 Knowing the demographics of your practice population and locality in order to actively promote equality and diversity in your work P P P P



24


C. Screening and diagnosis of mental health problems


Tier 1 Tier 2 Tier 3 Tier 4C1 Identifying patients within routine consultations who may have

undiagnosed mental health problemsP P

C2 Awareness of gambling addictions P P

C3 Medically unexplained symptoms P P

C4 Knowing how to access and use validated tools for identifying harmful use of alcohol

P P

C5 Awareness of substance misuse and addictive behaviours P P

C6 Awareness of anxiety and depression P P

C7 Awareness of domestic violence and abuse P P

C8 Awareness of anger management P P

C9 Knowing how to access and use validated tools for screening for anxiety and depression

P P

C10 Awareness of cognitive decline and dementia P P

C11 Knowing how to access and use validated tools for screening for memory problems

P P

C12 Awareness of maternal and perinatal mental health P P

C13 Awareness of the mental health of veterans P P

C14 Knowing how to access and use validated tools for screening for postnatal depression

P P

C15 Your awareness of eating disorders P P

C16 Knowing how to access and use validated tools for screening for eating disorders

P P

C17 Awareness of autistic spectrum disorders P P

C18 Creating a differential diagnosis for common mental health problems and developing a framework for further investigation

P



25


D. Management of people with common mental health problems


Tier 1 Tier 2 Tier 3 Tier 4D1 Having a basic understanding of the management in general practice

of common mental health problems in adults P P P

D2 Having a basic understanding of the management in general practice of common mental health problems in the older adult P P P

D3 Having a basic understanding of the management in general practice of common mental health problems in children and young people P P P P

D4 Dealing with the uncertainty associated with frequent attenders, drug seekers, self-harm and chronic suicidality P P

D5 Caring for the physical health of patients with mental health problems P P

D6 Being aware of the guidance available for mental health conditions (eg SIGN, NICE, NSF) P P

D7 Carrying out brief intervention for alcohol excess P

D8 Carrying out non pharmacological treatments for mental health conditions including psychological therapies (eg brief CBT) P

D9 Being aware of the commonly prescribed therapies for mental health conditions and knowing the guidelines on how often these are monitored

P P

D10 Undertaking monitoring of commonly prescribed therapies for mental health conditions P

D11 Managing aggressive or violent patients (eg de-escalation) P P

D12 Managing panic and referral on if appropriate P P

D13 Managing self-harm and referral on if appropriate P P

D14 Managing threatened or attempted suicide P P

D15 Managing the seriously depressed patient P P

D16 Initial detection / management of acute psychosis and referral on if appropriate P P

D17 Supporting patients through recovery P P

D18 Recovery-based care planning with patients who have mental health problems P P P

D19 Managing challenging behaviour P P



26


E. Referral and liaison


Tier 1 Tier 2 Tier 3 Tier 4E1 Being familiar with the Mental Capacity Act 2005 and have an

understanding of the legal aspects of consent to treatment and capacity

P P

E2 Knowing when and who to refer on to for mental health problems in adults P P

E3 Knowing when and who to refer on to for mental health problems in children and young people P P

E4 Knowing when and who to refer on to for mental health problems in older adults P P

E5 Knowing when and who to refer on to for mental health problems in the antenatal and postnatal period P P

E6 Referring on for community detoxification/rehabilitation P P

E7 Knowing when and who to refer on to for acute psychosis P P

E8 Learning from Significant Event Analysis and Reflection for Mental Health issues P


http://www.legislation.gov.uk/ukpga/2005/9/contents


27


28

Appendix 2 | Education and training in London - Tier 1Education and training components relevant to everyone who may, as part of their day-to-day work, come into contact with ta merson with a mental health illness (eg, GP reception staff, home care staff)

Curriculum checklist

Group Nature of training

Specific courses and contacts Commitment Further contact details*

C3 All staff – can be tailored to appeal to target audience

General update

Depression awareness delivered by the Charlie Waller Memorial Trust (CWMT) | Link

Training can be tailored to meet your specific requirements

B1-B3,B8, B11

Receptionists General update

Awareness training 3 hours Barnet CCG - Charlotte Benjamin, [email protected] CCG - Rebecca Olowookere, [email protected] CCG - Muhammed Akunjee, [email protected]

D3, E3 General staff General update

CAMHs training pilot - whole practice training delivered by Young Minds (partnership led by Newham GP Confederation with UCLP, Anna Freud Centre, Young Minds)

2 hr (+evaluation) City and Hackney CCG – Rhiannon England [email protected]

D3, E3 General staff – non clinical - social workers, care managers, care coordinators, support staff

General update

CAMHS training for non-clinical staff Edward Diggines – [email protected]

Planned for Sept 15 – Feb 166 sessions – 20 participants per sessionCost: £18,000 (£15,000 venue trainer & refreshments, £1,000 publicity and £2,000 administration costs)

Barking & Dagenham CCG – Dr Raj Kumar – [email protected] Havering CCG – Dr Ranjan Adur - [email protected] Redbridge CCG – Dr Chidi Okorie - [email protected]

A10, B1-B11b, B13, C9, C15, D3, D4, D6, D13

General staff Awareness raising

Child and adolescent mental health awareness training in primary care | Link- Module 1: Whole GP practice mental health awareness training- Module 2: Self harm awareness in children and adolescents- Module 3: Eating disorders awareness in children and adolescentsBreaking down the barriers - UCLPartners Contact Ronke Adejolu, programme manager

1-2 hoursTraining format: Presentations, case-based studies and scenarios, videos, classroom training, group based discussions and activity

* This column provides contact details of leads or individuals who have been involved in the training specified. The column provides an opportunity to contact these individuals if you would like to share materials or understand how the education and training was set up. It is not an exhaustive list of leads who have undertaken the training.

Costs, links and contact details correct at the time of publication.

http://www.cwmt.org.uk/training/the-training-we-offer/

mailto:[email protected]








http://uclpartners.com/what-we-do/clinical-themes/mental-health/breaking-down-the-barriers/%23strategic


29




Specific courses and contacts

Commitment Further contact details*

D3 General staff Awareness raising

Child and adolescent learning disabilities awareness in primary care | LinkBreaking down the barriers - UCLPartners; Contact Ronke Adejolu, programme manager

B1-B3, B8, B11, D1

General practice staff

Awareness raising

Mental health and personality disorder awareness sessions (practice staff)

½ day session – 1/yr Camden CCG – Alex Warner [email protected]

B1-B3, B8, B11

General practice staff

Awareness raising

Team around the practice – newly commissioned from Tavistock and MIND tailored to practice needs

1-2 hours Camden CCG – Alex Warner – [email protected]

B1-B3, B8, B11

General staff and wider public

Awareness raising

Awareness raising – delivered by MIND

2 hours Hammersmith and Fulham – Dr Beverly McDonald – [email protected]

B1-B3, B8, B11


Awareness raising

Awareness raising 2 hours Kingston CCG – Phil Moore – [email protected]

B1-B3, B8, B11


Awareness raising

Awareness raisingDr Philip Summers – [email protected]

2 hours Richmond CCG/Richmond wellbeing service – Dr Stavroula Lees –[email protected]

B1-3, B5-8, C6, C9, D14, D16


MH first aid standard certificate

MHFA - [email protected] or 020 7250 8062

2 days (£300)

B1-3, B5-8, C6, C9, D14, D16

General staff including local authority, housing associations, community teams/groups

MH first aid standard certificate

Mental Health First Aid Training – delivered by the Charlie Waller Memorial Trust (CWMT) | Link

2 days - CWMT training is usually delivered free of charge. Organisations that can afford training are encouraged to make a donation to cover costs, or to raise funds on CWMT’s behalf. Training usually takes place at the host organisation’s premises



http://uclpartners.com/what-we-do/clinical-themes/mental-health/breaking-down-the-barriers/%23strategic








http://mhfaengland.org/first-aid-courses/first-aid-standard/




30





B1-3, B5-8 General staff and wider public

MH first aid ‘lite’ certificate

Link to [email protected] or 020 7250 8062

3 hours (£75) City and Hackney CCG – Rhiannon England, [email protected] CCG – Alex Warner, [email protected]

B1-B3 General staff General information

Staying mentally well, delivered by Charlie Waller Memorial Trust (CWMT)Strategies that can enhance and promote positive mental healthLink

½ day explore evidence-based strategies for self-care1 day builds on half day including case studies

B7, D15 General staff General information

Psychosis and schizophrenia - caregiving issuesKing’s College LondonLink

Online e-learning, 2 week course, 3 to 4 hours per week

B11 General staff Suicide prevention Suicide mitigation programme - Dr Alys Cole-KingLink

1 day (£2,500) for up to 12 people

B11, D14 General staff Suicide prevention Suicide response training – part 1 or part [email protected]

2 hr / ½ day session~£2,000-£3,000 (depending on whether for 12-24 people) for one module or 1 day ~£2,000-£4,000 for up to 12 people

B11 General staff and wider public

Suicide prevention Suicide awarenessLink [email protected]

2 hr/1/2 day session~£2,000-£3,000 (depending on whether its 12-24 people)

B1-B13 Healthcare support workers

General update Mental health awareness - healthcare support workers – (City University)

Study day City and Hackney CCG – Rhiannon England - [email protected]



http://mhfaengland.org/first-aid-courses/first-aid-lite/





http://www.futurelearn.com/courses/caring-psychosis-schizophrenia%20%20

http://www.connectingwithpeople.org/courses%20%20%20

http://www.connectingwithpeople.org/courses


http://www.connectingwithpeople.org/courses%20




31





D2, E4 Healthcare support workers

General update

Mental health and older people - healthcare support workers - London South Bank University

Workshop City and Hackney CCG – Rhiannon England - [email protected]

B1-B13 Healthcare support workers

General update

Mental health awareness - healthcare support workers - London South Bank University


B1-B3, B8, B11,C10

Healthcare support workers, care home staff, support workers, day care assistants

General update

Care certificate – includes awareness of mental health, dementia and learning disability (Skills for Health, HEE and Skills for Care) [email protected]

E-learning

C10 Healthcare support workers

General update

Caring for patients with dementia for healthcare support workers

2 hours Barnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

C10 Healthcare support workers and receptionists

General update

Dementia awareness ½ day Barnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

C10 Healthcare support workers and receptionists

General update

Dementia champions ½ day Barnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

B1-B10, C12, C14, D1-D3

Practice admin staff, commissioners, GPs, nurses

General update

Mental health for life - LinkMental health basic awareness with: Parents and infants; children and young people; working age adults; older people; employers; schools; councils; health and emergency services

E-learning


















http://mentalhealthforlife.org/


32

Appendix 2 | Education and training in London - Tier 2Education and training components relevant to everyone who may, as part of their day-to-day work, come into contact with ta merson with a mental health illness, and who support service development/improvement (eg, practice managers, commissioners)




A1-A11B1-B13C1-C18D1-D19E1-E8

GPs, CPNs, practice nurses, commissioners, practice managers, pharmacists, social workers, and registrars (although not marketed as such)

University accredited diploma level

Advanced diploma in primary care mental health (Staffordshire University) Ian Walton and Lisa Hill - [email protected]

6 half days3 essays1 viva£1,600 – Diploma and academic support

Kingston CCG – Dr Phil [email protected]

Sutton CCG – Dr Chris Keers [email protected]

Hammersmith and Fulham – Dr Beverly [email protected]

Lambeth CCG –Dr Rajive Mitra [email protected]

A1-A11B1-B13C1-C18D1-D17E1-E8

GPs, CPNs, practice nurses, commissioners, practice managers, pharmacists, social workers, registrars (although not marketed as such)

University accredited CPD

The course in primary care mental health can be done without essays and viva (Staffordshire University) Ian Walton and Lisa Hill - [email protected]

9 mth courseRun over 2 academic terms – Entry points: Jan / Apr / Sept£900 – CPD£300 - Module

Kingston CCG – Phil Moore [email protected]











33

Appendix 2 | Education and training in London - Tier 2Education and training components relevant to everyone who may, as part of their day-to-day work, come into contact with ta merson with a mental health illness, and who support service development/improvement (eg, practice managers, commissioners)




D3 Commissioners, practice managers, pharmacists, nurses, dentistsGPs

Children and young people’s mental health and wellbeing. MindEd resources - Comprehensive source of rapid access learning on children and young people’s mental health and well-being for any adult with any role, voluntary or paid, that carries a responsibility for a child or young person. It shows the links to physical health issues.Covers:- Normal psychological development- Detecting problems and first help- Providing care in the right way- Collaborative working- Therapy techniques – including IAPT- Cultural and legal issuesLink

E-learning modulesSessions ~30 minutes

A12, D18 Commissioners, GPs, practice nurses

Awareness-raising session facilitated by service user trainers

Recovery-based care planning with patients who have mental health problems (National Survivor User Network)

[email protected]@gmail.com [email protected]

A 2 hour workshop (for the full session) - Link£500 (two trainers)A 40 minute workshop (short version) - Link£250 (two trainers)Good practice principles from mental health patients for recovery-based GP appraoches - Link




https://www.minded.org.uk/mod/page/view.php%3Fid%3D1590

[email protected]

[email protected]

[email protected]

http://www.londonscn.nhs.uk/wp-content/uploads/2016/08/mh-nsun-pri-care-training-062016.pdf

http://www.londonscn.nhs.uk/wp-content/uploads/2016/08/mh-nsun-pri-care-training-short-062016.pdf

http://www.londonscn.nhs.uk/wp-content/uploads/2016/08/mh-pri-care-gould.pdf



34

Appendix 2 | Education and training in London - Tier 3Further education and training components for clinical staff who are not mental health specialists, but who have responsibilities for making decisions about patient care, or who provide other support to people with a mental health illness (eg, practice nurses, nurse practitioners or social workers)Curriculum checklist



A1- A11B1-B13C1-C18D1-D19E1-E8





Kingston CCG – Dr Phil Moore – [email protected] Sutton CCG – Dr Chris Keers – [email protected] Hammersmith and Fulham – Dr Beverly McDonald – [email protected] CCG –Dr Rajive Mitra [email protected]

A1- A11B1-B13C1-C18D1-D17E1-E8

GPs, CPNs, practice nurses, commissioners, practice managers, pharmacists, social workers, registrars (although not marketed as such)


The course in primary care mental health can be done without essays and vivaIan Walton and Lisa Hill - [email protected]

9 month courseRun over 2 academic terms – Entry points: Jan / Apr / Sept£900 – CPD£300 - Module

Kingston CCG – Phil Moore – [email protected]

B11 GPs and nurses General updates for GPs and ractice nurses

MH curriculum – Managing risk and preventing suicide, Prescribing and recovery (ELFT)

2hrs per module – lecture/onlinePart of GP contract

City and Hackney CCG – Rhiannon England - [email protected]




35



Specific courses and contacts

Commitment Further contact details*

As appropriate

GPs and nurses General updates for GPs and nurses

All areas 1 hr/monthly Hounslow CCG – Dr Annabel Crowe – [email protected]

GPs and nurses General updates for GPs and nurses

- All areas - Managing the impact of primary care mental health on service utilisation- Bipolar

2hrs / 2-3 times per year Richmond CCG/Richmond wellbeing service – Dr Stavroula Lees –[email protected] Philip Summers – [email protected]

C12, C14, E5 GPs and nurses General updates for GPs and nurses

Perinatal mental health masterclass

1 hour Free - funding for pilot from Health Education North Central East London (HENCEL)

Barnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere - [email protected] CCG - Muhammed Akunjee - [email protected]

C12, C14, E5 GPs and nurses General updates for GPs and nurses

Introduction to perinatal mental health training

1 day - delivered by perinatal champions within borough

[email protected]

C12, C14, E5 GPs, GP registrars and nurses and social workers

General updates for GPs and nurses

Perinatal – multi agency simulation training course Dr Catherine Wilson, Fellow in Medical Education/[email protected]

1 day Barnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere - [email protected] CCG - Muhammed Akunjee - [email protected]
















36




A2-A5, A7, A8, B1-B5, B7, B8, B10-B12, C1, C4, C5, C9, C12, C14, C15, C17, D1, D4-D10, E2

Nurse practitioners and practice nurses

Course in mental health for nurses

Mental health and wellbeing training for practice nurses 5 face-to-face modules (module 1, Basic mental health awareness, is compulsory), 5 e-learning modules (hosted by BMJ learning, see next row)Mental health and wellbeing training for practice nurses is provided by the Charlie Waller Memorial Trust (CWMT) - LinkArticle: Mental health nurses can incraese capability and capacity in primary care by educating practice nurses: An evaluation of an education programme in England - Link

Sheila Hardy [email protected]

3 hrs per module(10 months)

Camden CCG – Alex Warner – [email protected] CCG – Phil Moore – [email protected] and Hackney CCG – Rhiannon England - [email protected]

D9, D10

C1, C4, E6


Suitable for GPs, too

BMJ e-learning - Specific mental health conditions: a guide for practice nurses - Link- Care planning - Link- Your patient’s journey - Link- Medication for mental health problems in primary care: a guide for practice nurses (part one) - Link- Medication for mental health problems in primary care: a guide for practice nurses (part two) - Link

- Managing alcohol and drug misuse in primary care - a guide for practice nurse - Link



http://www.londonscn.nhs.uk/wp-content/uploads/2016/08/mh-pri-care-cwmt-practice-nurses.pdf

http://onlinelibrary.wiley.com/doi/10.1111/jpm.12208/full







http://learning.bmj.com/learning/module-intro/mental-health-practice-nurses.html%3Flocale%3Den_GB%26moduleId%3D10051835

http://learning.bmj.com/learning/module-intro/care-planning---a-guide-for-practice-nurses-.html%3Flocale%3Den_GB%26moduleId%3D10051489

http://learning.bmj.com/learning/module-intro/.html%3FmoduleId%3D10051204

http://learning.bmj.com/learning/module-intro/medication-mental-health-practice-nurses.html%3Flocale%3Den_GB%26moduleId%3D10050771

http://learning.bmj.com/learning/module-intro/medication-mental-health-practice-nurses.html%3Flocale%3Den_GB%26moduleId%3D10050783

http://learning.bmj.com/learning/module-intro/managing-alcohol-and-drug-misuse-in-primary-care---a-guide-for-practice-nurses-.html%3Flocale%3Den_GB%26moduleId%3D10050427


37




As appropriate


Depot administration


B1-B3, B8, B11


Awareness raising Mental health awareness - City University ½ day study City and Hackney CCG – Rhiannon England - [email protected]

C10, C11 Nurse practitioners and practice nurses

General updates for nurses

Dementia awareness - City University (practice nurses)

½ day study City and Hackney CCG – Rhiannon England - [email protected]

B1, B3 Nurse practitioners and practice nurses


Mindfulness for healthcare professionals - City University (practice nurses)

2 days City and Hackney CCG – Rhiannon England - [email protected]

C7 Nurse practitioners and practice nurses


Domestic violence and abuse awareness - City University (practice nurses)

½ day study City and Hackney CCG – Rhiannon England - [email protected]

B1-B13 Nurse practitioners and practice nurses


Mental health awareness - London South Bank University(practice nurses)




Dementia awareness: Fundamentals of LTC management - London South Bank University(practice nurses)




Dementia and end of life care: Fundamentals of LTC management - London South Bank University(practice nurses)













38

Appendix 2 | Education and training in London - Tier 4Additional education and training components for clinical staff who are often the first point of contact for diagnosing, managing and providing care for people with a mental health illness (eg, GPs, GP registrars and other clinical staff)




A1- A11B1-B13C1-C18D1-D19E1-E8





Kingston CCG – Dr Phil Moore [email protected]

Sutton CCG – Dr Chris Keers [email protected]


C5 GPs University accredited postgraduate certificate

Dementia for practitioners with a special interest - Link

1 year – part time study (2 X 2 face to face lectures/tutorials)~ £3,000

Kingston CCG – Dr Nerida Burnie - [email protected]

A1- A11B1-B13C1-C18D1-D19E1-E8



The course in primary care mental health can be done withouth essays and viva (Staffordshire University) Ian Walton and Lisa Hill - [email protected]

9 mth courseRun over 2 academic terms – Entry points: Jan / Apr / Sep£900 – CPD£300 - Module

Kingston CCG – Dr Phil Moore [email protected]







http://www.brad.ac.uk/study/courses/view/%3Fc%3Ddementia-for-practitioners-with-a-special-interest-pgcert-part-time





39





A10, C1, C4 GPs RCGP certificate Management of alcohol problems in primary care - [email protected] 020 318 7650

£260 RCGP members£260 non members1 dayClassroom basedIncludes 3 and half hour pre e-learning module

C2 GPs RCGP certificate Gambling disorders in general practice - Link

Free to RCGP members£55 to non members90 minsOnline learning

A10, D8 GPs RCGP certificate Improving access to psychological therapies - Link

Free to RCGP members£55 to non members90 minsOnline learning

D3 GPs RCGP certificate Adolescent health - Link £179 RCGP members£223 non members1 day

D2, E4 GPs RCGP certificate Mental health in older people - Link Free to RCGP members£25 to non members2 hours Online learning

B11 GPs RCGP certificate Suicide prevention - Link Free from RCGP1 hourOnline course

C13 GP, GP trainee, GP trainer or educator, physician assistant, retired GP, First5, practice nurse

RCGP accredited Veterans health in general practice - Link Free from RCGP2 hoursOnline course



http://www.rcgp.org.uk/professional-development/substance-misuse-and-associated-health-courses


http://www.rcgp.org.uk/professional-development/online-learning/ole/gambling-disorders-in-general-practice.aspx

http://www.rcgp.org.uk/professional-development/online-learning/ole/improving-access-to-psychological-therapies.aspx

http://www.rcgp.org.uk/professional-development/business-development/one-day-essentials/ode-adolescent-health-3-july-2015.aspx

http://www.rcgp.org.uk/professional-development/online-learning/ole/mental-health-in-older-people.aspx

http://elearning.rcgp.org.uk/course/info.php%3Fpopup%3D0%26id%3D166

http://www.rcgp.org.uk/courses-and-events/online-learning/ole/veterans-health-in-general-practice.aspx


40





E1 GPs CPD Mental Health Act Section 12 refresher training course - Link

£4952 days

D3, E3, C5, C9

GPs General updates for GPs

All areas – recently CAMHS and anxiety ½ day – 1-2/yr Camden CCG – Alex Warner – [email protected]

D3, E3C10, C11

GPs All areas – this yr CAMHS, conduct disorder, dementia 1 hr (Friday lunchtime sessions)

City and Hackney CCG – Rhiannon England [email protected]

C1, C4, C10, C11, D16, E7

B12, C12, C14, D5, D9, D10, E5

GPs All areas – recently drug and alcohol misuse, managing psychosis, serious mental illness, dementia

Mental health with SLAM - Covering psychiatric medications (common side effects and monitoring), a service user’s perspective and referral pathway to forensic psychiatry and management of mentally disordered offenders in Croydon; managing mental health disorders in pregnancy, learning difficulties and long term conditions.Kamran Khan - [email protected] (CCG education lead for Croydon)

Ad hoc – protected GP learning afternoon

Evening lectures

Croydon CCG – Dr Dev Malhotra – [email protected]

Various GPs All areas 3 hours - quarterly Lambeth CCG –Dr Rajive Mitra [email protected]



http://www.educationandtrainingnetwork.co.uk/Topics/Mental-Health-Act-Training/MHA-Section-12-Refresher-Course







41





D1 - All areas - Managing the impact of primary care mental health on service utilisation- BipolarDr Philip Summers – [email protected]

2hrs / 2-3x per year Richmond CCG/Richmond wellbeing service – Dr Stavroula Lees –[email protected]/

B1, B3, C6, C9, C12, C14 D15, E5

All areas – staying well at work, depression, perinatal mental health, secondary care psychology, CBT, hoarding, risk assessment

1 session per topic - TBA

Waltham Forest CCG – Dr Paulette Lawrence – [email protected]

A1-A5 Selected areas (eg BATHE technique) 1/2 days (12 months) Kingston CCG – Dr Phil Moore – [email protected]

B1-B3 Selected areas (eg mindfulness and learning disability)

4 hours - monthly Southwark CCG – Dr Nancy Kuchemann – [email protected]

A10, D8 GPs General updates for GPs - CPD

IAPT (mild to moderate) Bromley CCG - [email protected]

C10, C11 GPs General updates for GPs

Dementia 1/2 day Sutton CCG – Dr Chris Keers – [email protected]

C10, C11 GPs General updates for GPs - CPD

Dementia 1/2 day Bromley CCG - [email protected]

B1-B3 GPs General updates for GPs

Mindfulness – delivered by voluntary sector 2 hrs City and Hackney CCG – Rhiannon England - [email protected]

B1-B3 GPs General updates for GPs

Mindfulness 1 hr Waltham Forest CCG – Dr Paulette Lawrence – [email protected]


Alcohol management training in primary care e-learning preparatory module½ day face to face

Camden CCG – Alex Warner – [email protected]


















42






Alcohol – presentation and case studies 90 minutes Waltham Forest CCG – Dr Paulette Lawrence – [email protected]

C3, D4 GPs General updates for GPs

GP management of medically unexplained symptoms (MUS) – Rhiannon England and psychiatrist

3 hours – e-learning



GP management of medically unexplained symptoms (MUS)Dr Phil Summers [email protected]

2 hrs – evening course

Richmond CCG/Richmond Well Being Service – Dr Stavroula Lees [email protected]

Various GPs General updates for GPs

Masterclass on mental health 2 hrs/wk for 6 weeks


A10,D8 GPs General updates for GPs

GPs and mental health services access: Liaison, IAPTs, home treatment team, community recovery team, EIP, secondary care psychology. (speed dating event)

2 hr Waltham Forest CCG – Dr Paulette Lawrence – [email protected]

C6, C9, D15, D16, E7


Psychosis and depression pathways 90 mins – presentations and case studies


C10, C11, D6, E4


Integrated care/dementia/older people 90 mins – presentations and case studies















43





D16, E7 GPs General updates for GPs

Psychosis 90 mins – presentations and case studies


D6, E7 GPs General updates for GPs

Urgent care pathway training 2 x 1/2 days Hammersmith and Fulham – Dr Beverly McDonald – [email protected]

A1-A5 GPs General updates for GPs

Use of the BATHE techniqueIan Walton [email protected]

Tailored to suit requirements Included as part of Hounslow primary care mental health training and development programme

Kingston CCG – Phil Moore – [email protected] Hounslow CCG – Dr Annabel Crowe – [email protected]

D9, D10 GPs General updates for GPs

Primary care mental health training and development programme: Local referral pathways, structure local services, symptoms recognition, needs assessment, managing risk and safety, medication management and safe discharge and recovery

4-6 hrs over 1-2 sessions(Hounslow did 4 hrs in one session)

Hounslow CCG – Dr Annabel Crowe – [email protected]

B11, B11a GPs General updates for GPs

Suicide response training (part 1) - Link 2 hr session£2,000-£3,000 (depending on whether for 12-24 people)

Kingston CCG – Phil Moore – [email protected]

E8 GPs General updates for GPs

Case discussions At least annually Southwark CCG – Dr Nancy Kuchemann [email protected]

C5 GPs General updates for GPs

Supervision group – substance misuse (educational and case management component)

At least annually Southwark CCG – Dr Nancy Kuchemann [email protected]










http://www.connectingwithpeople.org/courses







44





B1-B13, D3, E7


Locality meetings with reps from GP practices – All areas CYP, wellbeing, prevention, integrated care

Monthly Southwark CCG – Dr Nancy Kuchemann [email protected]


Dementia care pathway N/A still to run Southwark CCG – Dr Nancy Kuchemann [email protected]


Dementia awareness (Link) ~20mins -1hr 45 mins (e-learning)

Bexley CCG – Dr Wolfgang Wallet [email protected]


Domestic violence and abuse awarenessBlue Stream Academy (Link)

~20mins -1hr 45 mins (e-learning)

Bexley CCG – Dr Wolfgang Wallet [email protected]

D3 GPs General updates for GPs

Detection of mental health issues during consultations with CYPCharlie Waller Memorial Trust [email protected]

1 day case based approach


Parental mental health and safeguarding [email protected]

1 day – classroom Bexley CCG – Dr Wolfgang Wallet [email protected]


Anger [email protected]

1 hr Bexley CCG – Dr Wolfgang Wallet [email protected] Bromley CCG – Dr Atul Arora [email protected] Greenwich CCG – Dr Vivienne Chair [email protected]







http://medical.bluestreamacademy.com/modules/


http://medical.bluestreamacademy.com/modules/










45




Specific courses and contacts Commitment Further contact details1

B11 GPs General updates for GPs

Assessing risk of [email protected]



Cognitive behavioural therapy: Improving [email protected]



Cognitive behavioural therapy: NICE recommended treatments and managing depression in primary [email protected]


A10, C4, D4, D7


Drug, Alcohol use and mental [email protected]





















46






Managing ADHD and [email protected]



Managing challenging [email protected]


A5 GPs General updates for GPs

Motivational [email protected]


C10, C11, D2, E1


Older people’s mental health: - Dementia- Managing distress and challenging behaviour in dementia- Palliative care of advance dementia- Mental capacity, choice and imposing care- Depression and psychosis in older [email protected]



Personality disorders (adults)[email protected]






























47





C1, C4, C6, C9, D15

GPs General update Managing acute mental health (past sessions include alcohol addiction, depression)

Sutton CCG – Dr Chris Keers – [email protected]

D9 GPs and nurses General updates for GPs and practice nurses

Mental health curriculum – Managing risk and preventing suicide; prescribing and recovery (ELFT)

2hrs per module – lecture/onlinePart of GP contract


Various GPs and nurses General updates for GPs and practice nurses

All areas 1 hr / monthly Hounslow CCG – Dr Annabel Crowe – [email protected]

Various GPs and nurses General updates for GPs and practice nurses

- All areas - Managing the impact of primary care mental health on service utilisation - Bipolar

2hrs/ 2-3 x per year Richmond CCG/Richmond wellbeing service – Dr Stavroula Lees –[email protected] Philip Summers – [email protected]

C12, C14,E5 GPs Perinatal mental health masterclass 1 hour Free - funding for pilot from Health Education North Central East London (HENCEL)

Barnet CCG, Enfield CCG and Haringey CCGBarnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

C12, C14, E5 GPs and nurses Introduction to perinatal mental health training

1 day - delivered by perinatal champions within borough

[email protected]

















48





C12, C14, E5 GPs, GP registrars, nurses and social workers

General updates for GPs and nurses

Perinatal – multi agency simulation training courseDr Catherine Wilson, Fellow in Medical Education/[email protected]

1 dat Barnet, Enfield and HaringeyBarnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

C3, D4 Multiprofessional collaborative learning group

General update

Medically unexplained conditions 2 hours Barnet, Enfield and HaringeyBarnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

B12, D5 Multiprofessional collaborative learning group

General update

Long term conditions in mental health 2 hours Barnet, Enfield and HaringeyBarnet CCG - Charlotte Benjamin [email protected] CCG - Rebecca Olowookere- [email protected] CCG - Muhammed Akunjee - [email protected]

C1-C18, D1-D19

GPs CPD (12) mhGAP OrientationTeaching skills course based on World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) Implementation GuideImproving teaching skills in integration of mental health into primary health care in low and middle income countries. Applicability and transferrable skills for UK Valuable for all grades. LinkDr Peter Hughes [email protected]

2 days; 9.30-4.30 weekend course













http://www.who.int/mental_health/publications/mhGAP_intervention_guide/en



49

June 2016

About the London Clinical Networks

The London Clinical Networks bring together those who use, provide and commission the service to make improvements in outcomes for complex patient pathways using an integrated, whole system approach.

The Clinical Networks work in partnership with commissioners (including local government), supporting their decision making and strategic planning, by working across the boundaries of commissioner, provider and voluntary organisations as a vehicle for improvement for patients, carers and the public. In this way, the networks will:

» Reduce unwarranted variation in services » Encourage innovation in how services are provided now and in

the future » Provide clinical advice and leadership to support their decision

making and strategic planning.

London Clinical Networks | NHS England (London Region) londonscn.nhs.uk | [email protected]


Tooling up and gearing up mental health in primary care up and gearing up mental health in primary...

Documents

Transcript of Tooling up and gearing up mental health in primary care up and gearing up mental health in primary...