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Three past and one current evaluations of CMHF implementation in Somerset, Herts and West Essex, East London and Buckinghamshire (current). The descriptions below related to starting point plan – all sites made changes during and after evaluations.
The sites where we carried out PARTNERS 3 research were in Leeds, York & Frimley and West Berks. We also drew from past experience working in emerging primary care mental health systems.
Somerset
Somerset
Somerset is a large county with a population of around 600,000 spread across a mixture of urban and rural settings. The county was one of the 12 early implementer sites for the Community Mental Health Framework. Different groups that offer services to people with mental health difficulties came together to make positive changes to the way mental health services were offered. Together, these services are referred to as the Open Mental Health alliance.
The open mental health alliance in Somerset
This alliance is made up of statutory and voluntary sector services working together to break down barriers between primary care, secondary care, social care and voluntary sector partners. They aim to ensure that people with mental health difficulties obtain ‘the right care at the right time’. A strategic level, top-down cultural-change approach to creating this transformation was designed collaboratively by the Open Mental Health steering group to develop an ecosystem of care where the changing culture allows for easy access and flexible approaches to the needs of people living in Somerset. The steering group is made up of Health Somerset NHS Foundation Trust (the ‘Trust’), the voluntary sector (VCSEs), primary care (via primary care networks), social care, Somerset Clinical Commissioning Group (CCG) and experts by experience.
Cultural changes in Somerset
The evaluation in Somerset focussed upon the Mendip locality of Somerset. It looked at how cultural change was evident and how it might be transforming the way services were being offered.
Hertfordshire and West Essex
Hertfordshire and West Essex
In July 2022, Hertfordshire and West Essex became one of 18 Integrated Care Systems (ICSs) in England. It delivers health and social care to just over 1.5 million people across 13 district and borough council areas, an area with a wide range of communities living in both rural and urban settings.
Mental health support is provided through Essex Partnership University Foundation trust (EPUT), Hertfordshire Community NHS Trust (HCT), Central London Community Healthcare NHS Trust (CLCH) and Hertfordshire Partnership University NHS Foundation Trust (HPUFT).
The evaluation was focused in two PCNs within areas covered by HPUFT and EPUT (Attenborough and Epping Forest North respectively). Attenborough was selected in Hertfordshire as it was the first area within the county to pilot the implementation of the Enhanced Primary Mental Health Service (EPMHS). This decision was made because there were existing relationships with clinical partners in primary care willing to support these developments. Epping Forest was chosen within West Essex due to its spread of demographics, including rural and urban areas. Further development of enhanced primary care mental health services has taken place in other PCNs across the Hertfordshire ICS, but Attenborough was the most well developed. In Herts, we expanded the focus to examine how the main gateway to mental health services, the cross Herts Single Point of Access (SPA), functioned to affect access.
Figure 3: Map of Herts and West Essex ICS
From About our area – Hertfordshire and West Essex Integrated Care System
The illustration below demonstrates the work in West Essex and is an example of the areas that were considered in the evaluation which was carried out.
East London
East London
East London was an early implementer site for the CMHF. The change process in East London builds on previous work to innovate and better meet the needs of local populations across the boroughs of Newham, Tower Hamlets, and City and Hackney. The original transformation plan in 2019 was co-produced with local stakeholders from all key sectors – primary care, VCSE, East London Foundation NHS Trust and Local Authorities (see ELFT video). The focus was on a blended offer of care – “delivering what really matters to people who need mental health support”. The aims and objectives of the transformation are described in the diagram below:
The East London framework. Image from an East London board presentation
The Evaluation in East London focussed on the work within Neighbourhood teams in 3 localities exploring the impact which they might have upon dissolving boundaries across the mental health system as a whole.
The relationship of a neighbourhood mental health team to extended teams as well as community and specialist services. Diagram from East London.
Buckinghamshire
Buckinghamshire
The Oxfordshire and Buckinghamshire bid for transformation funding through the community mental health framework was submitted in early 2021 and serves an estimated population of 553,100. The trusts aim to plug the gap in mental health support by introducing a number of new services and provisions in primary care between 2021 and 2024. This is alongside ensuring that current offers within the secondary mental health care system will work to promote models of care that are seamless and which adhere to the ‘no wrong door’ principle. Local developments have focussed upon the presence of new services, or ‘hubs’, that sit within the primary care system at local level. Here the staff described in the infographic below work together to offer services to people requiring support.
Buckinghamshire mental health services sharing a no wrong door approach. Image from Buckinghamshire NHS Trust.
The evaluation in Buckinghamshire is exploring the impact of implementing hubs across the county across primary and secondary care services as well as VCSE providers. It aims to understand how statutory services can work alongside VCSE partners to deliver meaningful interventions and develop a robust system of support for local people in need.
Partners Collaborators
Partners Collaborators
During the implementation of the PARTNERS approach to working with people with psychosis in primary care, we worked with practitioners from Leeds and York partnership Trust and their VCSE partners to develop an offer specific to the group of people who traditionally have not been served well in Primary care services as they tend to receive little intervention whilst they are stable. The principles of the PARTNERS approach are to support a motivational goal focussed approach, to encourage engagement amongst this group and promote a better quality of life for them.
This implementation was replicated in West Berkshire and Frimley (as part of Surrey and Borders Partnership Trust) where VCSE and Mental Health Practitioners were trained to offer this approach in their local areas. This was embedded in the newly emerging local developments of the community mental health services.
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