Primary care support for common mental health conditions
‘Primary care is in a unique position to deliver mental health care, being most people’s first port of call-in times of health care need or the development of symptoms. It is the only part of our health service that offers ‘cradle to grave’ family orientated, person-centred care, often seeing and supporting patients through significant life events such as pregnancy and bereavement.’ – Royal College of General Practitioners (Royal College of General Practitioners, 2017)
- It is estimated that 1 in 4 people using primary care services will require treatment for a mental health condition at some point in their life (Care Quality Commission, 2015).
- 90% of adults with mental health conditions (excluding those with serious and enduring mental illness) are supported in primary care (Independent Mental Health Taskforce, 2016).
- It has been estimated that 30 – 40% of people seeing their GP have a mental health component to their consultation (Mind, 2018; Royal College of General Practitioners, 2017).
- 12% of GP patients in Cambridgeshire and Peterborough report having a long-term mental health condition (NHS England, 2023a).
What support is provided?
- At the initial stages of the stepped care model, healthcare professionals in primary care should be alert to the symptoms of common mental health conditions and have a good understanding of the best practice protocols they can put in place and the onward referral routes available (Public Health England, 2019).
- Onward referral options include social prescribing (add link) to community resources such as community support groups (such as CPSL Mind), volunteering opportunities, physical activity programmes and befriending services. This is likely to increase confidence, build social networks and develop self-efficacy (Public Health England, 2019).
- Medication should not routinely be prescribed at the lower steps for recent onset mild common mental health conditions (Public Health England, 2019). NICE guidelines are clear about when they should be prescribed (NICE, 2022).
Appointments
In May 2023, there were around 429,000 appointments in general practice in Cambridgeshire and Peterborough ICS (NHS Digital, 2023a) (note that these appointments were made for any reason, not specifically mental health).
- Around half of these appointments took place within 48 hours of being booked and almost 70% within a week of booking (NHS Digital, 2023a).
- This data does not capture the full picture as some people may find it difficult to book a GP appointment initially, and not end up making an appointment. People with poor mental health may face additional barriers to accessing appointments.
- It is also important to be aware that many people want to book ahead for GP appointments (Paddison, 2023).
Figure 32: Waiting time between booking and getting an appointment in general practice in Cambridgeshire and Peterborough ICS, May 2023. Image source: NHS Digital
68% of general practice appointments in May 2023 were delivered face-to-face, which is similar to the national average. Almost a quarter were on the telephone.
Figure 33: General practice appointment mode in Cambridgeshire and Peterborough ICS, May 2023. Image source: NHS Digital
The majority of appointments in May 2023 were with ‘other practice staff’ (56%) and general practitioners (39%), with the rest of appointments being carried out by ‘unknown’ healthcare professionals (NHS Digital, 2023a).
Experience of general practice
GP Patient Survey is sent to adult patients (aged 16+) registered with GP practices in England. In 2023, the response rate in Cambridgeshire and Peterborough was 34% (10,993 responses). Several questions in this survey relate to mental health.
In 2023, 69% of local respondents described their overall experience at their GP practice as good. This is similar to the national average (71%), which has also declined in recent years. There is substantial variation between primary care networks (PCNs) in Cambridgeshire and Peterborough, from 87% to 43% reporting that their overall experience was good.
Figure 34: Responses to the question ‘overall, how would you describe your experience of your GP practice?’ in the GP Patient Survey, Cambridgeshire and Peterborough ICS, 2020 – 2023. Image source: GP Patient Survey
The vast majority of local people (81%) reported that healthcare professionals recognised and/or understood their mental health needs at their last appointment. This has remained consistent over recent years and is similar to the national average (81%). The range within PCNs is from 90% to 66%.
Figure 35: Responses to the question ‘During your last general practice appointment, did you feel that the healthcare professional recognised and/or understood any mental health needs that you might have had?’ in the GP Patient Survey, Cambridgeshire and Peterborough ICS, 2020 – 2023. Image source: GP Patient Survey
On average, 83% of all GP patients in Cambridgeshire and Peterborough felt that healthcare professionals were good at treating them with care and concern at their last general practice appointment. This was slightly lower (76%) amongst patients who reported having a long-term mental health condition.
Additional resources
References
Full list of references is included at the end of this chapter.