Research into practice – reflections from a primary care event
by Vanessa Pinfold
Today I attended a learning and development event for primary care practitioners – GPs, practice nurses, information specialists. It was called HEAT – very appropriate considering the soaring temperatures brought by brilliant sunshine by lunchtime – and involved every GP practice from across one CCG (Clinical Commissioning Group). The topic was mental health. You might have been hard pushed at lunch to recognise this as only one of the nine stands was promoting mental health directly, but leaving that aside it was great to see so many people who have such important roles to play in promoting wellbeing all thinking about mental health for an afternoon.
The opening session particularly addressed local practitioners about current changes in mental health – both local and national agendas including how funding is allocated and services join up. With the new mental health task force working away to create a 5 year forward view of the future it will be interesting to see how issues raised in local meetings such as HEAT can find their way to the task force because crucial concerns are being raised particularly about collaborative provision of solutions for people with mental health problems. How to remove the barriers between teams or system elements so that better care is provided? Can research help with some answers? I hope so. The importance of research linked to practice was mentioned several times.
Firstly, I was there because the McPin Foundation have been working in this CCG to co-produce a new model of care for people with long term mental health needs. We have been attempting to take a piece of research, and do more than write about it, by modelling a new way of working around wellbeing mapping. The good news is the Wellbeing Network was mentioned in the opening slides at the event – the CCG are on course to set up a pilot programme. And it will be evaluated and learning shared.
Secondly, the issue of medication and evidence was raised. This is topical because there is a Maudsley Debate tonight at Kings College London on “This house believes that the long term use of psychiatric medications is causing more harm than good”. An article in the Guardian newspaper on use of psychiatric drugs provides a viewpoint from Peter Gøtzsche who argues that many prescriptions cause long term damage and thus should be stopped with people being supported in other ways, but other experts strongly disagree. GPs were reminded, there is still disagreement over the evidence base for medication in mental health. It was also stressed that medication management and discharge planning needs the service user centre stage. I reflected that more work is needed to better understand the role of primary care in shared decision making. I think some of the GPs present feel they are left out of the conversation entirely, particularly on discharge planning.
We heard from a perinatal consultant who runs a service for women with mental health problems. She spoke about how the service helps women make decisions over medication use, and supports them while pregnancy and up to 3 months post birth. We know from research how vital this service is – having spoken to women with psychosis who felt they did not get the support they needed while pregnant. But the leaflet advertising this service said on the front – funded until July 2015. It made me think research evidence could help keep this service going – making the vital case for this specialism.
I left the event struggling with the McPin Foundation banner, report and leaflets into the brilliant sunshine feeling a mixture of emotions. Collaborative working has a long way to go – but it is beginning. No one has enough time to learn, reflect, plan in the NHS – there are so many pressures that an afternoon event like HEAT is precious. The importance of placing the service user centre position in all our work was emphasised – but so people experience this? Things do need to change. As one GP said visiting our stand – we do a lot of mental health work, and we are very capable of doing this as long as we can extra help for people when needed. The concern is GPs locally and across the country can’t.
By Vanessa Pinfold