Agenda item

Public Question Time

To receive Questions from the Public, in accordance with the Council’s Constitution.


1.         The following public question was received from Mr. James Allen:


            “After going through NHS England news on 29th August 2018, there were three items of interest to be looked at:


1.    Backing from mental health services in Cumbria as NHS England calls for support in GP surgeries

2.    NHS England on why public sector marketing isn’t the private sector’s ‘poor cousin’

3.    NHS England asks GPs to house mental health therapists within practices


I would ask:


1(a)     Will this be looked at by CCG?

1(b)     Will this extend to all areas?

2)         What does this item entail?

3)         Where is the money to come from to put this into practice?”


The following response was provided:


1a).  When will this be looked at by CCG?

Articles 1 and 3 both related to MH practitioners working in closer proximity to primary care – specifically in GP practices and better integration of mental and physical health.  The CCG commissioned an ‘IAPT Plus’ services which is a collaborative between Pennine Care Healthy Minds and Tameside, Oldham and Glossop (TOG) Mind to deliver the stepped-care approach to psychological therapies in Oldham.  It was recognised by the CCG that a service redesign was required to ensure that we deliver on the Five Year Forward View for Mental Health (FYFVMH) requirements to increase access to IAPT services and improve patient recovery.  A key element of the IPAPT Plus service is the provision of ‘Step 1’ service run by TOG Mind – this is the delivery of drop-in and active monitoring counselling options for people, based in their GP practice.  The Mind Services are running out of approximately 75% of Oldham practices and also provides an effective gateway for people who need ‘core IAPT’ services at step 2/3 (i.e. clinically led CBT or counselling).   In addition to this, locality transformation funding has also been approved to deliver a ‘Psychological Medicine in Primary Care (PMPC)’ service in Oldham.  This will support integrated physical and mental health care to significantly improve the quality of care for highly distressed, resource-intensive patients with complex physical health problems who ‘fall through gaps’ in existing services.  There are a large group of underserved people in primary care  with persistent physically unexplained symptoms (also known as ‘medically unexplained symptoms’).  This cohort require more long-term intensive support than IAPT provides.  This service will be based in clusters and operate from GP practice, initially in 2 clusters as a pilot scheme, with the intention to scale to all 5 pending evaluation.

Further development of IAPT services is being looked at by the CCG and is on the ‘long list’ of CCG commissioning intentions.  This recognises that there has to be a greater emphasis on supporting the psychological needs of people who have long term physical health conditions such as diabetes, CVD and COPD.  Better integration of mental and physical health across both primary and secondary care is a key priority for the CCG and options across IAPT and other services are being explored.  In Oldham we already have psychology input as part of an integrated MSK pathway and have commenced discussions with gastro leads at the Acute Trust to identify ways MH can support on MDTs, etc., where there may be underlying MH issues that exacerbate conditions such as IBD and can result in repeat investigations.  This will support GP attendances as people will become better equipped to manage their conditions.

On the basis above, Oldham can be confident that either through existing services or planned transformation work, MH therapies within primary care is becoming well established.  There is always more that can be done, however, and this continues to be a priority as we plan for 2019/20.


1b).  Will this extend to all areas?

Yes, the CCG commissions the ‘IAPT Plus’ model to the whole borough.  The PMPC transformation scheme will initially commence in 2 clusters as it is rolled out, however, will expand to 5 if successful and can evidence positive impact.


2)  What does this item entail?

These developments will require either mobilisation and implementationof new services in Oldham (in the case of transformation schemes such as PMPC) or elements of service design (in IAPT Plus where there will need to be a greater focus on integration with physical health and strengthened links with primary care).  Alignment of MH teams to developing clusters is fundamental to ensure that MH services are embedded in primary case where appropriate and this engagement work is underway.


3)  Where is the money to come from to put this into practice?

The CCG will need to consider any additional funding proposals associated with expansion of IAPT as part of the wider commissioning intentions, although the CCG is committed to meet parity of esteem requirements, which require that the CCG increases the proportion of spend on MH year on year at the same level (or greater) than the annual increase in the allocation for programme budgets.  Any FYFVMH investment proposals will be determined first and foremost within this financial envelope, and need to be considered alongside several other MH priorities.


RESOLVED that the question and response be noted.