Mental Health Pathways Event

1. Mental Health Pathways Event CNWL Services in Westminster: Primary Care Plus, the Single Point of Access Service and Adults Community Services Nicola Hazle & Jo Emmanuel Borough Directors

2. The Local System in Westminster

3. Primary Care Services • Two teams covering the borough – PCLN team part of Time to Talk and PCP • Both part of wider primary care mental health systems working in GP practices • Good links with IAPT and other psychological therapy services in the borough • PCP currently being reviewed by CCG as part of wider primary care pathway review • Referral via GP and/or self referral (IAPT)

4. CNWL Single Point of Access Service • The Single Point of Access launched in November 2015 and is based at CNWL Trust HQ in Euston • Referrals via – Telephone: 0800 0234 650 (former UAL number) Email: cnw-tr.SPA@nhs.net • Is a multidisciplinary team of admin, nurses, social workers, occupational therapists & a consultant • Provides access to North West London adult services through a single centralised entry point, replacing existing local referral points into adult mental health services in Brent, Harrow, Hillingdon, Kensington Chelsea and Westminster. • Available 24 hours a day 7 days a week 365 days a year for information, support and advice

5. What does the Single Point of Access do? • Processes referrals and telephone-triages calls from patients, carers, GPs, police, LAS, housing departments and other providers • Refers to teams within CNWL: • (i) Emergency and Urgent Referrals are handed to the RR/HTTs • (ii) Routine +/ Routine for assessment by the CMHTs are booked directly into available appointments • (iii) Refers Routine to PCLN/PCP where appropriate • Signposts to appropriate services and other statutory or third sector providers • Can be contacted by GPs to discuss potential referrals or shared care arrangements, and for medicines and other psychiatric advice. • Integrates current functions of Urgent Advice Line

6. Urgent / Emergency Signposting, Support and Advice Routine / Routine + Single Point of Access Access via one telephone number / Email address Initial Contact and triage by multi-disciplinary team Consultant, Nurses, Social Workers Occupational Therapists Blue Light Ambulance / Police Directory of Services / Access to DoSTo contain details of specific clinical services provided by any commissioned service in the area and non-statutory and 3rd sector support Borough Service Identified Appointment booked with integrated multi-disciplinary community team Signposted information Signposted information (where applicable) 24 hour Home Treatment / Crisis Resolution (Rapid Response Referrals ‘held’ with SPA whilst awaiting additional information / ongoing telephone support Short term crisis support / intervention Admission to inpatient ward

7. Rapid Response Home Treatment Team Service • In delivering the Crisis Care Concordat investment was also put into developing 27/7 Rapid Response Home Treatment Teams • All Emergency (4 hr) and Urgent (24 hr) referrals should be made by telephone to the SPA (with referral form to follow) and if triaged for this level of response will be handed to the local RR/HTT team • Model enables team to assess in the community – at GP practice, person’s home or another community setting – to reduce A&E attendances. • Person may be taken on for crisis/RR support for short period or onto the HTT caseload and then may be referred on to relevant secondary or primary care service.

8. Westminster Community Services Redesign Externally a response to: • Crisis care concordat Feb 2014, North West London Like Minded Strategy, Care Act compliance • Shifting Settings of Care agenda/Investment into primary care In the Trust a response to: • Provide a local care pathway that integrates with the Trust SPA and RR/HTT and PCP/ PCLN services • Need to address flow through community services and the whole system – has been subsequent changes to the inpatient model of care • Provide extended hours by our community services • Ensure a skill mix review of teams and services

9. Pathway Emergency/ Urgent/ Routine+ Routine Emergency/Urgent Urgent/ Routine+

10. Operational Model Principles • Strong clinical leadership • Medical, health and social care lead • Robust governance • Supports clinical supervision • Team approach to caseloads • Works to strengths of profession/skills • Discipline-led discrete interventions • Work to a zoning model • Intensity of support based on acuity • Facilitate patient flow and journey • Robust discharge planning • Support independence in managing mental health • Strong links to community • Extended hours • Revised skill mix • Link to primary care hubs/villages

11. Transition to date • Community teams reorganised from 25 January where transfer of caseloads is still underway • Centralised AMHP service started 02 February • Migration of caseloads on the record systems will take 3-4 weeks • Extensive recruitment is on-going • Implementation of new inpatient model has started from 15 February • Daily white board meetings • Single Consultant led wards which will be aligned to the Hubs