GP Led Commissioning of Mental Health Services

Dr Alan Cohen FRCGP Director of Primary Care

GP led commissioning

A little background

• GP fund-holding – Counselling was the most common service purchased by practices – Pilot of purchasing of mental health services • PCGs – Commissioned some mental health services

So far…

• We know that – Mental health services will be commissioned • We don’t know – Which services – What happens about joint commissioning?

• So what are the threats and opportunities?

– Where does the evidence take us?

Opportunities

• Long Term Conditions • Medically Unexplained Symptoms

Diabetes Risk Profiling

• Depression is 2 – 3 times as common in people with diabetes • Associated with – Increased health care consumption – Increased self perceived symptom load • NOT associated with improved glycaemic control?

Diabetes Potential Efficiency Savings

• Cost of treating co-morbid diabetes and depression is 250% • Cost of all treatment is 400% • Proportion of NHS hospital expenditure on diabetes is 10% of total spend

Ischaemic Heart Disease Risk Profiling

• Depression is 2 – 3 times as common in people with ischaemic heart disease • The best predictor of death following MI is the presence of depression • QOF indicator

Ischaemic Heart Disease Potential efficiency Savings

• 40% of admissions can be prevented by providing psychological treatments • 50% of revascularisation procedures (CABG and PTCA) can be prevented by providing psychological treatments

Anxiety Risk Profiling

• Anxiety occurs in 25% of people with COPD • People with COPD make up the largest group of “frequent flyers” • A fear of becoming of short of breath, or actually becoming short of breath?

Other conditions to be considered for this model of care

• Neurology • Gynaecology • Gastroenterology • ENT • Pain clinics • A&E

Chesterfield

Chesterfield Results

25 patients -2 cohorts 6 x PCI saved 3 x CABG saved 1 Angiogram All improved with programme

Savings

• £43,888 in procedures ( not including a transplant ) • £40,221 on hospital activity • Total £84,109

After Cost

• 25 Patients £52,250 • Overall saving = £31,859 • £1,274 per patient

Hillingdon

Hillingdon

Hillingdon

• Cost of admissions (6 month period) – Intervention – Control £71,799 £128,344

Opportunities

• Improved care for people with long term conditions • More cost effective – savings: – OPD – In-patient care – GP attendance – GP prescribing • People prefer talking therapies

Medically Unexplained Symptoms Sub-threshold (£ Million) Severe MUS (£ Million) Total Cost (£ Million)

Primary Care Out-patient In-patient A & E Total Non NHS Consultations Prescriptions Referral Follow-up Bed days Attendance 740 285 41 267 693 32 96 36 42 27 610 23 837 321 83 294 1,303 54 2,892 14,583

Opportunities

• For GP commissioners – Cost effective – Reduced consultation rate – Increased skills • For MH Trusts – Commissioned liaison psychiatry services • For Acute Trusts – Better use of in-patient services

Threats

• GP commissioning – Knowledge – Expertise – Time • MH Trusts – CMHTs?

– In-patient services?

– Other services?

Questions?

Thank You

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