1. Enhanced Primary Mental Health Service & Service Redesign Health Service Strategic Commissioning Topic Group – 5 th September 2007 NHS Hertfordshire Partnership NHS Foundation Trust

2. Enhanced Primary Mental Health Service (EPMHS) Partnership between Joint Commissioning Team, Primary Care Trusts & HPFT - formal contract Partnership between Joint Commissioning Team, Primary Care Trusts & HPFT - formal contract Part of integrated, whole system & stepped care approach to the care and treatment of mental ill health Part of integrated, whole system & stepped care approach to the care and treatment of mental ill health Aid to understanding of mental ill health & facilitation of social inclusion & recovery Aid to understanding of mental ill health & facilitation of social inclusion & recovery Multi-disciplinary service to adults of working age with mild-moderate mental ill health Multi-disciplinary service to adults of working age with mild-moderate mental ill health

3. Enhanced Primary Mental Health Service EPMHS does form part of the modernisation of mental health services agenda EPMHS does form part of the modernisation of mental health services agenda EPMHS does not replace primary care counselling services EPMHS does not replace primary care counselling services EPMHS does not replace secondary care community mental health services EPMHS does not replace secondary care community mental health services Secondary mental health services will focus primarily on those with most complex needs Secondary mental health services will focus primarily on those with most complex needs

4. Enhanced Primary Mental Health Service – What does it deliver? Signposting Signposting Triage Assessment Triage Assessment Guided/Self Help Guided/Self Help High volume, low intensity psychological therapies High volume, low intensity psychological therapies Individual/Group work Individual/Group work Short term interventions Short term interventions Social & Vocational Support Social & Vocational Support Primary care professional support & guidance Primary care professional support & guidance

5. Enhanced Primary Mental Health Services – Who delivers it? Graduate Workers Graduate Workers Link Workers Link Workers Support, Time & recovery Workers Support, Time & recovery Workers Input from:- Input from:- Psychologists Psychologists Consultant Psychiatrist Consultant Psychiatrist Others including Vocational Advisers, Occupational Therapists Others including Vocational Advisers, Occupational Therapists

6. Enhanced Primary Mental Health Services – Where ? Within Primary Care Within Primary Care GP Practices GP Practices Alternate, non-stigmatising community or voluntary sector settings eg Letchworth Health Living Centre Alternate, non-stigmatising community or voluntary sector settings eg Letchworth Health Living Centre

7. Enhanced Primary Mental Health Services – Current Position Further development of previous pilots:- Further development of previous pilots:- Watford > WatCom, including Watford & 3 Rivers Watford > WatCom, including Watford & 3 Rivers Letchworth > North Herts to include Hitchin & Royston (under negotiation) Letchworth > North Herts to include Hitchin & Royston (under negotiation) St Albans to extend to include all GP practices St Albans to extend to include all GP practices Stevenage Practice Based Commissioning Pilot includes development of EPMHS Stevenage Practice Based Commissioning Pilot includes development of EPMHS

8. Enhanced Primary Mental Health Services – Next Steps Discussions under way with Hertsmere PBC Discussions under way with Hertsmere PBC Approach from Cheshunt GPs in South East Herts Approach from Cheshunt GPs in South East Herts Hertfordshire’s success as Pathfinder Site for Improved Access to Psychological Therapies Hertfordshire’s success as Pathfinder Site for Improved Access to Psychological Therapies Development of Joint Transition plan between HPFT, Joint Commissioning Team, Practice Based Commissioning Groups for EPMHS development across all areas of Hertfordshire Development of Joint Transition plan between HPFT, Joint Commissioning Team, Practice Based Commissioning Groups for EPMHS development across all areas of Hertfordshire

9. Mental Health Service Redesign Key Principles Recovery Approach Recovery Approach Whole system & Strengths Based Whole system & Strengths Based Needs-led service with focus on outcomes Needs-led service with focus on outcomes Evidence-based/best practice Evidence-based/best practice Timely/flexible access to required service Timely/flexible access to required service Clarity of function & roles Clarity of function & roles Standardised Assessment Framework Standardised Assessment Framework New Ways of Working & New Roles New Ways of Working & New Roles Equity of resources Equity of resources Partnership Working Partnership Working

10. Mental Health Service Redesign Elements for Consideration Enhanced Primary Care Service development Enhanced Primary Care Service development Consequent Redesign of Secondary Service within CMHTs Consequent Redesign of Secondary Service within CMHTs Location of Referral & Assessment function Location of Referral & Assessment function Relationships with other community mental health services including:- Relationships with other community mental health services including:- Assertive Outreach Service Assertive Outreach Service Community & Home Support Services Community & Home Support Services Residential Rehabilitation Services including Group Home provision Residential Rehabilitation Services including Group Home provision Day Services Day Services Crisis Assessment & Treatment Service Crisis Assessment & Treatment Service A&E A&E

11. Mental Health Service Redesign Process HPFT Redesign Steering Group including Service User & Carer representatives; HPFT Redesign Steering Group including Service User & Carer representatives; Countywide & Sector stakeholder workshops Countywide & Sector stakeholder workshops Development of Proposals with input:- Development of Proposals with input:- JCT JCT HPFT Executive HPFT Executive ACS Management Board ACS Management Board Staff-side Change Management Group Staff-side Change Management Group Consultation & Response Consultation & Response Implementation Implementation