Reflections on how best to integrate a Mental Health Practitioner (MHP) into General Practice

Peter McNelly is a seasoned Mental Health Nurse, with over 50 years’ experience, and in the last 5 years has worked in 8 different GP Practices, in Northern Ireland and England.

What’s happened?

The use of other professionals working within GP Practices to support GPs with workloads was an initiative by the government in 2019.  Different schemes have been enacted, as health is devolved within the four countries of the UK.¹ Each of the four countries in the United Kingdom have different methods/models to help achieve these goals. Even within each country there is wide variation on which professionals are needed in a Practice² and what they might do.^3,4

In England most of these new professionals are employed between Primary Care Networks (PCN) and Trusts, and few if any directly by a Partner/GP Practice. Such arrangements can lead to a lack of ownership for these professional staff.

The PCNs and Trusts often have an arm’s length engagement with these staff with multiple reporting lines that are often unsatisfactory⁵ and confusion about to whom these professionals are accountable. Lack of team ‘ownership’ has been a source of dissatisfaction, with high turnover of these staff working in GP Practices.^6,7

So what?

There are several actions that Trusts, PCNs and individual GPs/partners can do that would improve the integration of these professionals about to set out on their primary care careers. An example of such an approach could be with Mental Health Practitioners (MHP) who in the main fall under the Additional Roles Reimbursement Scheme (ARRS), and therefore employed jointly by a Trust and PCN and not a GP practice.

Primary stakeholders (that is partners/GPs) who might have a MHP in their surgery, should have a clear desire to have the MHP working in the practice, and not find someone who has been seconded into their practice by a Trust/PCN, with little meaningful conversation with the partners/GPs.

I have worked at several GP Practices in which even a year on, some GPs thought I was a CPN (Community Psychiatric Nurse), Counsellor, Therapist, CBT Therapist (Cognitive Behavioural Therapist), (I have been all these in past jobs). I am aware that a title carries meaning (As junior doctors’ rebranding as resident doctors demonstrates).

Clearly in some GP Practices no robust thought has been given to having an MHP, or their role and scope of practice. Those GPs who have requested and take ‘ownership’ of the MHP, are best placed to integrate them into the practice team.

Joint employment between a Trust and PCN for MHPs requires supportive and protected time for induction into these organisations, whilst the MHP moves to working in the GP Practice.Induction into the GP Practice and integration, (the clinical employment base for the MHP), will again require appropriate training, including tuition in the use of electronic patient notes, be that Vision, EMIS  or SystemOne (the author has used all three in various GP Practices). Providing protected time along with ownership and desire to “integrate” the MHP working in the GP Practice as a member of the Practice Team, will provide a solid base to meet such an objective, and pragmatism springs to mind in this context. Acknowledgement of different learning styles can be most helpful to maximise any induction process.

Staff who are required to work in 3 or 4 different surgeries may find it almost impossible to integrate and may never meet some members of the practice team (including GPs) and go on to develop a role like that of the window cleaner who attends in an ad hoc way.

I say the above having worked in both small and large practices in Northern Ireland and England, and from being in a single practice to working across three practices, within the same week. I am pleased to report that I now work in just one medium sized GP Practice now, and genuinely feel part of the practice. One of the partners participated in my interview and appointment.

What now? My recommendations

• Some actions should ensure better integration of MHPs into GP Practice than has been the case to date.  These are as follows: –
• MHPs should whenever possible work in just one practice. Those working across multiple practices or sites to do so should ensure they meet all the various members of the practice, GPs, and the like, for example, by alternating their working days week to week.
• In the first few months of employment, the MHP should be actively discouraged from working from home, as integration will be easier and quicker for them if they are in the practice.
• GPs and practice partners should have a clear understanding and desire to want a MHP as part of their service, and be involved in the appointment of the MHP, at which point they can match the role the MHP will play, with the skills/experience/knowledge the MHP applicant has to offer. Not all MHP will wish to practice as GPs and practice partners may want them to!
• Practice mangers who work alongside the GPs/partners are key in the process and have a major influence on how well the integration of the MHP is achieved as they will have sapiential authority to manager the MHP on a day-to-day week to week basis, to ensure the smooth and safe running of the practice.
• The office the MHP works out of, should suit their role, it does not need an examination couch (the days of Sigmund Freud are long gone), it needs to be comfortable for patient and MHP alike, as consults may be 30 minutes or longer.
• If the NHS is to meet its goal of good primary care, then it needs to be funded appropriately, and to  integrate ARRS staff into primary care, on the same footing as other Practice Staff,  be they doctors, receptionists, advanced nurse practitioners, clinical pharmacists, practice manger, physiotherapists, secretaries, phlebotomists, healthcare assistants, paramedics, physician associates, practice nurses and the like.

Deputy editor’s note: see also Peter McNelly’s other observations on the MHP in primary care on BJGP Life

• https://bjgplife.com/reflections-on-multi-disciplinary-teams-working-in-and-alongside-general-practitioners-in-northern-ireland/
• https://bjgplife.com/an-introduction-to-the-mental-health-practitioner-in-general-practice/
• https://bjgplife.com/obstacles-to-the-effective-introduction-of-mental-health-practitioners-into-the-gp-surgery/
• https://bjgplife.com/mhp/

 References:

1. https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/ [accessed 27/10/24]
2. https://www.england.nhs.uk/long-read/additional-roles-a-quick-reference-summary/ [accessed 27/10/24]
3. https://www.bma.org.uk/advice-and-support/gp-practices/employment-advice/employing-clinical-pharmacists-in-gp-practices [accessed 27/10/24]
4. https://www.thcprimarycare.co.uk/post/an-introduction-to-the-primary-care-network-mental-health-practitioner [accessed 27/10/24]
5. https://www.england.nhs.uk/publication/example-induction-checklist-template-for-multidisciplinary-team-staff-in-general-practice/  [accessed 27/10/24]
6. McNelly P, Reflections on multi-disciplinary teams working in general practice in Northern Ireland BJGP Life 17 November 2021. https://bjgplife.com/reflections-on-multi-disciplinary-teams-working-in-and-alongside-general-practitioners-in-northern-ireland/  [accessed 27/10/24]
7. PCN ARRS Funding Scheme Available 2024/25.  https://clinicalrx.co.uk/nhs/  [accessed 27/10/24]

Featured photo by Tim Marshall on Unsplash.