Better support for complex needs improves lives and saves money, new report

Improving mental health care for people with complex needs can reduce pressures on GPs and hospitals as well as dramatically improving people’s lives, according to a report published today by Centre for Mental Health.

Managing patients with complex needs reviews an innovative service that helps GPs in the City of London and Hackney to support people who fall through the gaps in existing service provision. The report finds that it improves health at the same time as reducing costs in both primary and secondary care services.

The Primary Care Psychotherapy Consultation Service (PCPCS) is run by the Tavistock & Portman NHS Foundation Trust. It supports people with medically unexplained symptoms, people with personality disorders and people with chronic mental health problems. Many of the people it helps have two or more problems at the same time and many also have poor physical health.

The service offers training and support to GPs and a range of psychological therapies to patients. It has been found to improve the mental health of 75% of its patients and to help more than half to recover significantly.

The report finds that the service also cuts costs. It helps to reduce the number of GP consultations, A&E visits, outpatient appointments and hospital admissions among its patients. And the report finds that the service costs just £10,900 per ‘quality adjusted life year’ (QALY) it improves. That is less than half of the threshold for cost-effectiveness in the NHS.

In a foreword to the report, Dr Geraldine Strathdee, National Clinical Director for Mental Health, said: “This kind of innovation should be the hallmark of a twenty-first century NHS. Instigated by GPs, and based on clear evidence of unmet need, the PCPCS offers new hope to people we have not served well.

“I hope that this report will inspire family doctors and clinical commissioning groups across the country. By combining local innovation with learning from the experiences of others, the NHS can offer better care despite the tough financial climate. This is a challenge we cannot, and must not, ignore.”

Hackney CCG mental health lead Dr Rhiannon England said: “The PCPCS represents a genuine partnership between local GPs and a highly respected mental health service provider. By learning from each other’s experience, we have been able to develop a service that helps people who otherwise get poor quality care and whose health has suffered for far too long. And by working in primary care the PCPCS has quickly gained the trust of family doctors and made high quality psychological support available close to people’s homes.”

PCPCS lead Brian Rock said: “The PCPCS offers a distinctive new approach to meeting the needs of people other services have not been able to help. We provide a range of different therapies, tailored to each person’s needs, and we help GPs to support people more effectively by joining them in consultations and by offering training. Local GPs have told us that they really benefit from the service: that the PCPCS offers new hope to patients who have previously not been well served. We are delighted that the Centre has found that we also offer good value for money in straitened times for the NHS.”

Centre for Mental Health chief executive Sean Duggan said: “People with complex mental and physical health problems too often get inadequate care from the NHS. Our report has found that by offering flexible support, based in and around GP surgeries, the NHS can make dramatic improvements in people’s lives and save GPs and hospitals money and time.”