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The Royal College of Psychiatrists Improving the lives of people with mental illness

Mental health payment systems - have your say

Monday, 3 March 2014

The College is organising a mental health tariff programme 'stock-take day' on 19 March. I am therefore using this blog to ask all members to feed back to me their views on the opportunities and challenges presented by the current payment by activities work.

This topic sits in the top three things members always want to discuss with me, so I am really keen to hear from you. You can send your thoughts in via our Policy Unit.

I am grateful for the continued listening to us and work of Dr Geraldine Strathdee, NHS England's National Clinical Director for Mental Health , and the ongoing efforts of the Payment by Results (PbR) group  at the College which produced this helpful College position statement in January.

It is really important that your views and ways forward are fed into this day in March.  I want to hear views and ideas that reflect all the work that we undertake as psychiatrists, leading teams across specialities, settings and lifespan.

We all know we were invited late to the PbR party. I know many of you are finding what you are now expected to do in reporting your activities time consuming, cumbersome, and not reflecting what you actually do, but we have to work with whatever is the extant system and influence it for the better. I have personally tried to stress that, for many of us, we are  de facto not working with a  neat circumscribed single acute episode of mono morbidity mental disorder but complex, real world, multi morbidity, long term conditions (including in childhood). I believe ‘year of care’ would better reflect the work we actually do and capture the changes in outcomes across the domains of a patient’s life over time. 

And there is also the myriad of other work we all carry out to ensure we have a well-trained next generation of psychiatrists, a well informed public and a system where safeguarding and quality improvement are at the fore of everyone's thinking and practice.

So if you have been invited to this stock-take day please try and attend.  If not, feed in your views so our lead College members can attend on your behalf and be well informed about  both continued problems and your suggested solutions. 

This is all taking place in the very negative context of the Monitor’s ‘tariff deflator’ - a  decision which will and is already resulting in money being taken from mental health and community care to fund the implementation of the Francis report in acute trusts. This is in the further unhelpful context of messages put out by NHS England that can be and are, out on the ground in the land of CCG pressures, interpreted six ways to Christmas, but not in favour of mental health. This is a fundamentally flawed decision that ignores the fact we have ‘parity’ enshrined in legislation.  I am working hard with the mental health charities and the NHS Confederation Mental Health Network to achieve a meeting with those who have been party to this decision across Monitor and in particular NHS England.

I will keep you informed but if there is not a significant shift in the current response, this is a matter of such fundamental importance to mental health I will  be asking you to lobby your MPs.  This is a real betrayal of what we were promised about parity which  mental health professionals, patients and carers thought would, after so many years, make us equal partners in health. Neither I nor the President Elect will  give up on this.

I know how busy everyone is and the pressure you are under, but to influence the direction of services we believe will best serve our patients we have to be and remain  involved, so make sure you have your say.


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Re: Mental health payment syst
Hi Sue, I remain concerned about Mental health trusts not getting paid for referrals from Primary Care (sometimes designated urgent) which fall in to the lower clusters (1-4). These referrals take a 2 hour work through period on our electronic (PARIS / RIO) minimum data set, and often needs a Consultant review to discharge back to Primary Care. As it is likely we will be paid for only 4 all age care pathways, psychosis, affective, organic and LD, this triaging effort is likely to make us loss making, unless there is a separate funding for triaging based on the degree of urgency.
Re: Mental health payment syst
I am seeing consequences of cutbacks in mental health funding .I work in the prison sector (as a consultant psychiatrist)and have noticed a large increase in the number of people with mental illness seemingly ending up in prison. There was a very interesting article on this topic in last Saturday's Guardain newspaper .
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