How a nurse-led community mental health hub is improving patient care and access

Mental health nurses from a first-of-its-kind community mental health hub have spoken about the success of the programme in Hampshire and Isle of Wight. The collaborative service has helped patients access nurse-led mental health services, reducing referrals to secondary care. The team now hopes to see this programme expanded elsewhere. This article comes as part of Nursing in Practice’s How Nurses Count campaign, which aims to champion nursing expertise and innovation.

‘The feedback we’ve had from patients is that it is continually really outstanding care during a very difficult time for mental health services,’ says clinical lead of the enhanced primary care mental health service, Dr Dan O’Neill.

‘Patients can call any one of the 12 practices across the Isle of Wight, whichever surgery it is, and get booked in with the mental health access coordinators for initial signposting, explaining the options, educating the patient and empowering the patient to have an awareness and make a decision themselves about where the best entry point is.

‘Then they can actually get through to the service, going through to the nurses, who then deliver outstanding care.’

The enhanced primary care mental health service consists of nine GP practices across two primary care networks (PCNs) in Hampshire and Isle of Wight.

A third PCN with three GP practices follows a similar model and works collaboratively with the service but the mental health nurses are employed through the individual practices.

The service consists of four mental health nurses, eight mental health access coordinators, a team manager for the coordinators, and an operations manager.

It operates as an integrated mental health hub, providing patients across the Isle of Wight with an accessible, wraparound, community based mental health service, regardless of the GP practice they are registered with.

Over the last 12-month period, there were 13,000 contacts, such as phone calls or appointments, from the mental health access coordinators, of which 4,500 were new patients.

Dr O’Neill says the idea for a collaborative mental health hub was first proposed by advanced mental health practitioner Jackie Napper in November 2018.

The pilot started began in Tower House Surgery in Ryde initially before expanding to deliver the service across three GP practices in Ryde before it merged with the six others across two PCNs.

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From April this year, the enhanced primary care mental health service was officially commissioned.

Dr O’Neill says the idea came from Ms Napper who had approached him concerned about the number of patients seeking secondary mental health care.

She said if patients had intervention at an earlier stage, the need for secondary care would be less, he explains.

‘She asked about any possibility of looking at having a specialist mental health nurse working within the practice,’ says Dr O’Neill.

‘It sounded like a fantastic idea. One of the things I’d recognised is how difficult mental health care was in primary care, and how the way that primary care is set up, it’s just not designed to deliver good quality mental health care.

‘The issues that Jackie was raising, it resonated with me, so we looked at developing a system that provided a much higher level of mental health specialist care for our patients, which it did.

‘The feedback from the GPs was fantastic. Feedback we had from the patients was fantastic. It really was revolutionary.’

Dr O’Neill explains that there have been additional benefits to the new system as well as helping patients, such as reducing the workload from GPs and an 80% reduction in referrals to secondary care.

Due to the success of the pilot, Dr O’Neill took the initiative to the local integrated care board (ICB) to get funding to roll out the programme in other areas.

‘Initially, practices wanted to do it themselves and everyone was quite keen to have their own nurse and so forth,’ says Dr O’Neill.

‘But the ICB said we had to be careful we don’t just employ loads of mental health nurses and then they were being used in a way that wasn’t really delivering the efficiencies that we had identified within our way of working.

‘So we tried to create a more aligned approach and we created this kind of first contact practitioner type model where Jackie would see people in the first instance instead of the GPs, and the outcomes were really positive and other practices on the island started employing nurses and we were seeing the work align together.

‘There were subtle differences, but we were working in an aligned model. We were learning from each other. They were learning from what Jackie had done.’

He adds: ‘There were the obvious issues with resilience and cover and availability, and it not working in certain places.

‘So we started to work much more aligned with each other. We created more of a hub model; we merged the PCNs together.’

Dr O’Neill, who is also the director of One Wight Health, said it ‘wasn’t easy’ to get funding for the combined hub but said the ICB was ‘very supportive’ of the service.

‘It was recognised that the mental health provision on the island really wasn’t up to scratch and that there were some real issues,’ he says.

‘The ICB recognised that there was probably a shortage of specialist mental health and so getting the pilot started was good.’

Another scheme the hub is operating is focused on recruitment, with Dr O’Neill acknowledging that recruiting on the Isle of Wight is ‘difficult’.

In this scheme, mental health access coordinators can be put forward to complete an apprenticeship to become a mental health nurse.

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The feedback from patients to the hub has been positive, with Ms Napper noting that patients describe feeling ‘very grateful and heard’.

‘Patients feel that we’re taking it seriously, that they feel like we’re listening to them, whereas GPs don’t have the time to spend with someone and secondary care don’t have the time or resources,’ she says.

‘We get people better and it’s amazing to see their journey when they first come to us and they’re really anxious and nervous or have had a bad experience and we gently guide them in.

‘We get people better, and the feeling of someone walking in and smiling when you’ve seen them at the absolute depth of despair is it’s the thing that keeps us going.’

Advanced mental health practitioner Sarah Hatton, who works at the hub, adds: ‘It’s a massive privilege to be invited into someone’s life in their darkest time.

‘Sometimes you are the only person they’ve ever told something to, and that trust that is given to you, and it is an absolute privilege, and we’ve never taken it for granted. That’s what keeps us going.’

Ms Hatton also adds that the hub had been beneficial for herself and other mental health nurses as it has brought her together with other like-minded professionals in what is usually an isolated role.

‘There is a perception that primary care is quite easy and it’s a little bit of, “Put your feet up and have a cup of tea with the patient”.

‘It is absolutely nothing like that. When you’re on your own in a practice, you are quite isolated and I have found that, whilst the GPs are very supportive, this has helped bring together very like-minded people.

‘You need to be with your own, if you like. So when Jackie and I sat down and thought about how might this look coming together, it has definitely enhanced our own wellbeing in this job, and I think that’s really important.’

The team says they believe the model ‘should be everywhere’ and have even had other PCNs within their ICB contact them to enquire about the hub.

Dr O’Neill says: ‘The model can move everywhere. I think the island has some advantages from the point of view of the geography, but that is not essential.

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‘I think you can have this in any area.’

‘Speak to a practice manager,’ he adds, when asked how other nurses and GPs could start a similar hub. ‘Say you’ve read about this service and it’s something that’s been positive from a GP perspective but also delivered really high-quality care.’

Ms Hatton concludes: ‘We’re just ultimately very proud of it – I’d like to shout out about this service. You know that everyone’s worked so hard to get it where it is.’

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Nursing in Practice’s How Nurses Count campaign aims not only to encourage nurses across primary and community care to share best practice and learn from one another, but also to ensure that their collective voice is recognised at the highest levels.

Please get in touch with editor Megan Ford ([email protected]) or senior reporter Gee Harland ([email protected]), to be involved in our campaign and share how you count.