Community mental health nurses in GP surgeries help patient wellbeing – report

Community mental health nurses based at GP surgeries can significantly improve patient outcomes, a new study shows

Research led by Staffordshire University examined anonymized data of over 1,500 patients at a primary care mental health service in North Staffordshire.

It follows an NHS initiative to move community mental health teams away from the traditional secondary care service model, to work within new multidisciplinary primary care teams based around doctor's practices that serve smaller neighbourhoods.

A crucial factor affecting integration was a shared IT system, which ensured a co-ordinated patient journey through treatment, aided by training sessions for all mental health professionals on the different clinical IT systems, and each other's roles.

Patients in the study were treated over a period of three years by mental health nurses delivering targeted psychological interventions for a range of mental health problems.

The research found that:

• Self-rated scores for mood and anxiety pre-treatment and post-treatment demonstrated that both symptom severity and functioning improved significantly by the end of treatment.
• 92 per cent of the patients remained within the primary care mental health service throughout treatment, reducing the burden on secondary care mental health services.
• 67 per cent of patients in employment returned to work from statutory sick pay and 5 per cent of unemployed patients returned to work by the end of treatment.
• 4 per cent of patients moved off psychotropic medication (accounting for those who also started medication during the study period).

Lead researcher Dr Mark Kenwright said: “The movement of community mental health nurses into services alongside physical healthcare practitioners aims to create a single point of access and assessment for all mental health problems.

“However, there is currently little evidence or guidance on how this integration should be implemented, or on the effectiveness of mental health nurses in these settings.

“This is the first large-scale study to record the impact of community mental health nurses integrated into primary care teams.

“We were surprised by how much improvement patients were making, because different providers and lines of accountability can be a barrier to this in multidisciplinary primary care teams – but that is what this model has achieved.”

The lack of guidance on how to best integrate mental health services is compounded in the UK by a move to ‘practice-based commissioning’ where primary care physicians now commission services for their own practices from a range of different providers.

As a result of this, three different mental health worker roles now compete for provision in primary care; mental health nurses employed directly by GP practices, psychological therapists commissioned through the ‘Improving access to psychological therapies’ programme, and mental health nurses provided by NHS mental health trusts.

“It’s really important that when people have a mental health problem and are in distress, they can see one person and tell their story just once and be booked in with the right person who will deliver the right evidence-based treatment for their problem. It’s surprising how difficult it is to make that work in today’s NHS system.” 

Mark added: “This research importantly shows that you can achieve integration and, that when done effectively, community mental health nurses can deliver vital treatment that moves people towards recovery and significantly improves their wellbeing.”

Read the full study in the ‘International Journal of Nursing Advances’ – Effectiveness of community mental health nurses in an integrated primary care service: An observational cohort study.

Discover more about Staffordshire University’s Nursing (Mental Health) degree course