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

Health & Social Care Act 2012

Dr Adrian James, Chair, Westminster Parliamentary Liaison Committee

Dr Adrian James, Chair, Westminster Parliamentary Liaison CommitteeIf 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 Secure Services.


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?

Health & Social Care Act 2012General 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.



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