1. Mental Health Pathways Event Nicola Hazle & Jo Emmanuel
CNWL Services in Westminster: Primary Care Plus, the Single Point of Access Service and Adults Community Services
Nicola Hazle & Jo Emmanuel
Borough Directors

2. The Local System in Westminster

3. Primary Care Services
Two teams covering the borough – PCLN team part of Time to Talk and PCP
Both part of wider primary care mental health systems working in GP practices
Good links with IAPT and other psychological therapy services in the borough
PCP currently being reviewed by CCG as part of wider primary care pathway review
Referral via GP and/or self referral (IAPT)

4. CNWL Single Point of Access Service
The Single Point of Access launched in November 2015 and is based at CNWL Trust HQ in Euston
Referrals via – Telephone: (former UAL number)
Is a multidisciplinary team of admin, nurses, social workers, occupational therapists & a consultant
Provides access to North West London adult services through a single centralised entry point, replacing existing local referral points into adult mental health services in Brent, Harrow, Hillingdon, Kensington Chelsea and Westminster.
Available 24 hours a day 7 days a week 365 days a year for information, support and advice

5. What does the Single Point of Access do?
Processes referrals and telephone-triages calls from patients, carers, GPs, police, LAS, housing departments and other providers
Refers to teams within CNWL:
(i) Emergency and Urgent Referrals are handed to the RR/HTTs
(ii) Routine +/ Routine for assessment by the CMHTs are booked directly into available appointments
(iii) Refers Routine to PCLN/PCP where appropriate
Signposts to appropriate services and other statutory or third sector providers
Can be contacted by GPs to discuss potential referrals or shared care arrangements, and for medicines and other psychiatric advice.
Integrates current functions of Urgent Advice Line

6. Signposting, Support and Advice Borough Service Identified
Urgent / Emergency
Routine / Routine +
Single Point of Access Access via one telephone number / address
Initial Contact and triage by multi-disciplinary team Consultant, Nurses, Social Workers Occupational Therapists
Blue Light Ambulance / Police
Directory of Services / Access to DoS To contain details of specific clinical services provided by any commissioned service in the area and
non-statutory and 3rd sector support
Borough Service Identified
Appointment booked with integrated multi-disciplinary community team
Signposted information
Signposted information (where applicable)
24 hour Home Treatment /
Crisis Resolution (Rapid Response
Referrals ‘held’ with SPA whilst awaiting additional information / ongoing telephone support
Short term crisis support / intervention
Admission to inpatient ward

7. Rapid Response Home Treatment Team Service
In delivering the Crisis Care Concordat investment was also put into developing 27/7 Rapid Response Home Treatment Teams
All Emergency (4 hr) and Urgent (24 hr) referrals should be made by telephone to the SPA (with referral form to follow) and if triaged for this level of response will be handed to the local RR/HTT team
Model enables team to assess in the community – at GP practice, person’s home or another community setting – to reduce A&E attendances.
Person may be taken on for crisis/RR support for short period or onto the HTT caseload and then may be referred on to relevant secondary or primary care service.

8. Westminster Community Services Redesign
Externally a response to:
Crisis care concordat Feb 2014, North West London Like Minded Strategy, Care Act compliance
Shifting Settings of Care agenda/Investment into primary care
In the Trust a response to:
Provide a local care pathway that integrates with the Trust SPA and RR/HTT and PCP/ PCLN services
Need to address flow through community services and the whole system – has been subsequent changes to the inpatient model of care
Provide extended hours by our community services
Ensure a skill mix review of teams and services

9. Pathway Referrer SPA PCP/ PCLN North CMHT North Hub (QPP)
Emergency/ Urgent/ Routine+
Routine
SPA
PCP/ PCLN
Emergency/Urgent
Home Treatment Rapid Response Team
Urgent/ Routine+
North CMHT
North Hub (QPP)
North East Hub
South CMHT
Central Hub
South Hub
Centralised AMHP service
Psychological Therapies Hub
Westminster Rehab Team
KCW Dual Diagnosis Team

10. Operational Model Principles
Strong clinical leadership
Medical, health and social care lead
Robust governance
Supports clinical supervision
Team approach to caseloads
Works to strengths of profession/skills
Discipline-led discrete interventions
Work to a zoning model
Intensity of support based on acuity
Facilitate patient flow and journey
Robust discharge planning
Support independence in managing mental health
Strong links to community
Extended hours
Revised skill mix
Link to primary care hubs/villages
Zone 1
High intensity support for people with the most complex needs / new
Daily team review
Zone 2
Active intervention with clear timelines
Zone 3
Preparation for supported discharge to primary care
PSW/groups
Step-down to community

11. Transition to date
Community teams reorganised from 25 January where transfer of caseloads is still underway
Centralised AMHP service started 02 February
Migration of caseloads on the record systems will take 3-4 weeks
Extensive recruitment is on-going
Implementation of new inpatient model has started from 15 February
Daily white board meetings
Single Consultant led wards which will be aligned to the Hubs