The role of secondary care and primary care in service provision for people with severe mental illness: A multi-site cross-sectional observational study
The government's ‘Five Year Forward View’ strategy aims to promote mental health care in physical health care settings, in particular primary care, yet the data for describing mental health service use across primary, secondary and acute care services is limited. Summative service use data from NHS records systems is unreliable and it is not possible to accurately describe mental health service delivery and use for groups such those with a severe mental illness. Collecting such data in a robust, accurate and reliable way is complex and can only be achieved through time consuming manual data extraction from patient healthcare records.
Multi-site, retrospective cross-sectional epidemiological review of primary and secondary care notes conducted in three locations in England. Patient records of individuals with a severe mental illness were selected for the study from five community mental health teams and thirty four practices for a two year period (2012-2014). Care pathway and service use data were manually extracted from both electronic patient secondary mental health care and primary care medical records (n= 297). Data were collected by research assistants and NIHR clinical studies officers and research support officers (between October 2014 and June 2016) using a data extraction tool developed in an earlier study (PARNTERS1).
The average age of the 297 patients included was 47.4 years and 56.2% were male. The majority had were in care cluster 11: ongoing/recurrent psychosis (low symptom) (41.1%) or care cluster 12: ongoing/ recurrent psychosis (high disability) (24.6% ) as their most recent cluster. There were differences in team make up between the three sites. Two of the sites had two consultant psychiatrists within each of their teams, whereas the third only had one. Psychologists were in two of the sites. Numbers of CPNs and Support Workers varied between zero, four and eleven and one, two and eleven respectively and these differences were reflected in who patients contacts. Consistently the majority of care was received from secondary care. Of the 24,692 contacts recorded, 81.57% were those recorded in secondary care. Patients were seen every 44.2 (median) days in primary care (IQR27.0-80.1) compared to every 10.2 days in secondary care (5.7-19.3). We also extracted physical health checks recorded in either setting - blood pressure (86.5%); BMI (79.5%); Cholesterol (65.0%) and HbA1c (38.7%) .
This study highlights results that were not visible in the previous ‘sister’ study (PARTNERS1) which showed that type, content and detail of secondary care contact were vastly under recorded in primary care. Although there is an improvement in physical health monitoring, this study highlights significant challenges for the government's Five Year Forward View strategy, and has clear implications for health service commissioning, including the promotion of collaborative care in primary care.