Service evaluation of primary care mental health support services in north Wales

AimsBringing specialist psychiatrist into PCMHTUndertaking initial assessments for people Referred by G.P'sWorking According to the principle of “Prescribing Interventions”Decrease number of assessments carried out within secondary CareMethodCounty of Wrexham is situated between the lower Dee Valley and the Welsh mountains. It is the largest town in North Wales (140,000)Since 2013, the total new patient referrals to be seen by Wrexham county consultant psychiatrists has consistently risenThis issue has been dealt with in different ways across North Wales and indeed the whole of WalesFollowing a review of services in Wrexham during 2017, it was identified that there was an opportunity to pilot a new model which would allocate a designated Consultant to the local Primary Care Mental Health Team (PCMHT)The Consultant would work entirely within Part 1 of the Mental Health Measure and would offer specialist opinions to Tier 1 ServicesResultPCMHT team members are maintaining open cases for a significant amount of time rather than the 8–10 sessions that was originally predicted during the implementation of the Mental Health MeasuresIn order to sustain the service, the minimum number of direct clinical patient contact sessions to be offered by the psychiatrist was up to 4 a week.During the review period, total number of clinics offered were 51 and a total of 139 patients were offered appointmentsConsultants in secondary care covering the same area received exactly 100 less referrals in the first 6 months of the pilotMain source of referrals to the Tier 1 Consultant came from G.P.'s and the local PCMHT itselfConclusionPilot demonstrated that bringing specialist consultant psychiatrist dedicated to the PCMHT improved the care offered to patients referred by G.P'sScope of PCMHT needs to extend in order to absorb mild to moderate mental illness and thus avoid patients going into secondary careThis model should be supported, and further resources should be inputted into PCMHTWe should move from a categorical diagnostic referral system to a needs-based intervention where only the most complex cases requiring lengthy interventions shall progress to secondary careRisk should not be classed as criteria to move patients into secondary care and PCMHT should be able to absorb moderately risky cases