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Mental health therapists in primary care

Psychological support

In August 2018, NHS England developed guidance on the co-location of mental health therapists in primary care in collaboration with the BMA’s General Practitioners Committee and the Royal College of GPs. This guidance has come from the NHS England GP Forward View, with a commitment to introduce around 3,000 additional mental health therapists into general practices by 2021.

The guidance looks at how GPs, practice managers and commissioners can integrate mental health therapists into the primary care pathway. It also covers some of the organisational and financial issues that need to be considered.

Context of the guidance

The majority of people with mental health problems are initially supported in primary care as GPs are the first port of call when patients need to access mental health services within the NHS. This impacts significantly on GP workload and highlights the need for a significant increase in mental health therapists directly linked to practices, which will make it easier for patients to access care.

The role of the mental health therapist in the primary care team

Mental health therapists will be full members of the primary healthcare team receiving not only self-referrals from patients but also from all members of the GP team, including GPs, clinical pharmacists, practice nurses and health care assistants. They will be expected to attend practice meetings, provide specialist advice and liaise with clinicians across other mental health, social care, and physical health services on behalf of the patient and practice.

How mental health therapists are best co-located within general practice will be determined by a range of factors including accessibility for patients, the size and location of practices and the space available to accommodate them. Opportunities may arise for co-locating within single practices or within a primary care network serving a number of smaller practices.

Premises costs

GP contractors receive reimbursement of premises costs from the NHS under their contract. This provides for rent business rates, water and clinical waste which are typically reimbursed in full. All other premises running costs fall to the GP practice to fund as business costs. IAPT (improving access to psychological therapies) teams do not currently fall within the model of core primary care services and so there is no contractual obligation on NHS England or CCGs (clinical commissioning groups) to support the premises costs for these services; instead, provision for premises costs should be included within the contract price or tariff.

Further information can be found in Appendix 1.3. Accommodation approved for GMS

The BMA’s position

This initiative is very welcome, but practices must ensure they are satisfied that recurrent new funding to support this workforce expansion is in place before signing any service level agreements. There are potential co-location cost implications if unchecked, e.g. facilities / equipment costs etc. Such costs, and any necessary practice reimbursement arrangements, must be factored into the IAPT contract tariff price that the local commissioner has agreed.

You should also explore whether sufficient therapists are being trained locally or regionally to avoid simply taking these skilled professionals from existing overstretched IAPT services.

Read the guidance in full.