Dr Adrian James, Chair, Westminster Parliamentary
If the NHS was thought to be unwell (was it? Maybe a little
unfit?), where is the biopsychosocial model, applied to
addressing care and treatment, reflected in the Act?
Structural or biological approaches are
included in the creation of Clinical Commissioning Groups, run
primarily by GPs who will commission 60% of all NHS care, with the
NHS Commissioning Board commissioning the rest, including primary
care and most specialist mental health services including all
Psychological approaches are focused on a need
to facilitate competition and choice. A new ‘Monitor’ has been
created which becomes the economic regulator for the NHS and will
act to prevent anticompetitive practices. Amendments include
commitments to promote integration alongside competition but there
is no doubt that there will be more opportunities for third and
private sector providers.
Social approaches include how we gather as
clinicians to address population and individual patient need.
Following the report of the Future Forum, Clinical Networks
(individual speciality) and Clinical Senates (across
specialties) will be created and much work will now be done in
collaboration with the local authority where Public Health will be
based and Health and Wellbeing Boards coordinated, resulting in the
all important Joint Strategic Needs Assessments.
What implications will there be for psychiatry?
General Practitioners will lead the majority of
commissioning of mental health services. Specialist Commissioners
will regroup under the aegis of the NHS Commissioning Board. The
considerable turbulence that occurs in such widespread change is
likely to see a degree of service development blight until new
mechanisms are properly established. Competition will exert a huge
effect, albeit that some areas of mental health such as addiction
services and Secure Services have been subject to this at a high
level for some time. Local authorities will have a much greater say
at looking at health in broader terms rather than a focus on
services (a potentially very welcome change for mental health).
- Hug a GP… Engage with
Clinical Commissioning Groups to ensure that mental health is the
main priority. Consider putting yourself forward as a secondary
care clinician on the Clinical Commissioning Group.
- Buy a toga and get down to
the senate... Explore with your mental health movers and
shakers across all stakeholder groups the feelings behind the
creation of a regional Clinical Network for Mental Health. The
nature of the Networks has yet to be fully determined. It is likely
that there will be a Mental Health Clinical Network in all regions,
led by a clinician. Why not take the lead in its creation?
Additionally link with the emerging local Clinical Senates that
provide an opportunity to engage across medical disciplines.
- The X Factor… Provide the
best quality service you can within your current sphere of work and
ensure that all care episodes are recovery and service user focused
and arranged around clear goals and outcomes.
- Ask the audience... Work
with local Service User Bodies to ensure that they have a strong
voice within National and Local Healthwatch.
- Wash your hands... And meet
with your local Public Health Lead and ensure that public mental
health has the prominence that it needs and deserves
- Visit you
local...authority... Link in with the Chair of the local
Health and Wellbeing Board. Much of what determines good mental
health is influenced as much, if not more, by local authorities
than health services. They will provide the opportunity to engage
with this. It is particularly important that there is input to the
Joint Strategic Needs Assessments.