PRISM – PRImary Service for Mental health

1. PRISM – PRImary Service for Mental health

2. Why? • The gap between what GP can offer and secondary care threshold is getting bigger. • IAPT can’t solve everything • Secondary Care is inundated – Limited capacity to deliver interventions • People are dying – poor physical health monitoring and sitting on waiting lists

3. The idea

4. Characteristics of PRISM • Population based service – see and intervene philosophy • Prism to support GPs. It is not a separate service to refer into – “request for service”, not referral to PRISM • Informal conversations to provide GPs with advice and support • Joint Prioritisation – upskilling GPs • GP remains responsible clinician • Integration with third sector services and social care – reduced story telling

5. PRISM refers onto relevant ream/pathway to support individual in secondary care Supported discharge with Recovery Coaches The Patient Journey Rapid re-access to secondary care if required GP monitors patient, offers support & medication GP seeks advice from PRISM to support patients Patient sees PRISM team in GP surgery for support and brief interventions PRISM directly books into 3rd sector recovery services for interventions GP monitors patient Step patient down to PRISM for ongoing monitoring PRISM Peer worker supports access to community resources

6. What will this mean for the System? • The final state of PRISM will see the vast majority of patients assessed and treated in “primary care” • True delivery of parity of esteem – quick access • Patients will be put in the right part of the system at the right time – reduction of re-referrals • Reduction in healthcare utilisation – GPs, A&E etc. • Better use of health and social care investment • Capacity released in specialist services • Offering complete pathways

7. What will this mean for the patient? • Support will be available at every stage of MH journey • Early intervention will reduce crisis and escalation of need • Better experience of the system – not being bounced around • Direct booking into IAPT and 3rd sector – reduced need for story telling • Stable SMI patients with enhanced MH needs will have improved physical health outcomes

8. What does this mean for secondary care? • Demand reduced so ability to deliver interventions as opposed to hold risk • A truly integrated physical/mental health approach • Easier to discharge patients when there is adequate support with the GP to support the discharge

9. The core PRISM team • Mental health specialist – band 6 + 7 • Consultant psychiatrist support (for advice) • Peer support worker – recovery focus • Physical health care worker – SMI, screening and intervention • Management and Admin • Exploring pharmacist role

10. Early outcomes • There is a small subset of data available from GP surgeries with PRISM. Initial feedback and data shows: • Time to assessment dropped from 17.76 days in Sept 2016 to 12.96 days in Nov 2017.

11. Early outcomes • Positive GP feedback on consultant involvement and pilot of case discussions • Reduction in referrals to secondary care. Chart shows referrals on to secondary care from PRISM where GP surgery now has PRISM service compared to baseline data from 2016.

12. The Plan • Phase 1 – delivery underway • Align mental health staff to and base within practices • Clinical records on GP systems • Rolled out to 90 of 106 surgeries – full roll out by end Dec 17 • Phase 2/3 • Consultants aligned. • Step-down patients managed in GP practices collaboratively. • Physical health role/medication monitoring. • Integration of Recovery service (jointly commissioned LA and CCG) • Integration with social care • Review of secondary care treatment pathways/model

13. Future aspirations • A primary care wellbeing pathway! • To include: • PRISM – mental and physical health • Other relevant community mental health services e.g. PD, perinatal, EIP • Psychological wellbeing service • LA services – including drug/alcohol services • Third sector/community services

14. Reflection Tips so far….. • Delivery • Engagement – to deliver in Primary care, PC have to be on board. This is not another place to dump MH referrals otherwise you continue to get same problem • Regular comms – Hit Squad for problems • Operational • Culture change – LANGUAGE (PRISM dictionary), PRISM principles • Pragmatic approach – one size does not fit all, need to allow for local variance in operations. Not allow process to clog the system

15. Reflection Tips cont. • Commissioning and Contracting • Culture Change – do the KPIs work for/against the vision? • Impact can be measure elsewhere in the system i.e. secondary care waiting times, don’t get fixated on FPEs and waiting times for PRISM • Relational versus formal contract management • Know your contracts and use them to hold your solutions together • Explore your currencies to support your payment models

16. PRISM Project Team • Kaeron Dodson – PRISM Programme Manager • Liz Lingley – Project Manager • Ree Wood – PRISM Service Manager • Caroline Meiser-Steadman – Associate Clinical Director • Pamela Peters – Consultant Psychiatrist supporting PRISM • Simon Mitchell – Consultant Psychiatrist supporting PRISM • Emma Tiffin CCG Adult Clinical Mental Health Lead • Adele McCormack – CCG Commissioning Manager • More information can be found by visiting- • http://nww.intranet.cpft.nhs.uk/adults/Pages/Prism.aspx

17. Questions? • We are always happy to be contacted! • PRISMmailbox@cpft.nhs.uk • CAPCCGMHLDComissioning@nhs.net