A psychological treatment service, rolled out across the South Nottinghamshire Integrated Care Partnership in 2019, is offering hope to people with high levels of complex persistent physical symptoms
Primary Care Psychological Medicine (PCPM) is an innovative service delivered by mental health liaison professionals and allied health professionals providing patients holistic care for persistent physical symptoms where:
- their presentations are too complex for Increasing Access to Psychological Therapy (IAPT) providers
- the physical nature of their main presenting symptoms and complex diagnoses make them unsuitable for core mental health services
- the lack of a medical explanation for their symptoms makes it difficult for physical health specialists to provide effective interventions
PCPM also forms part of the assessment and rehabilitation pathway for post-COVID service. This fulfils the specific NICE guidelines on rehabilitation services that should be available to people with post-COVID syndrome
Before the service was introduced, patients were being seen by various specialities in their individual silos without any overarching assessment or treatment plan that combined their whole presentation, from both a mental and physical health perspective.
Persistent physical symptoms can be painful, life-limiting, disabling, distressing and increase dependency on others, and can mean multiple GP appointments, outpatient visits and even visits to an emergency department. The PCPM service provides active management of the patient in the community, working in a person-centred way to help patients understand the connection between their physical and mental health, provide treatment, promote self-management and deliver a better experience and outcome for the patient.
And the results speak for themselves. PCPM patient Jane, who has struggled with multiple physical and mental health issues over a number of years, has been receiving care from the whole multidisciplinary team, says: “It’s a unique service. The team saved my life. I feel like a jigsaw and the pieces are being slotted in by each member of the team and slowly, one day hopefully soon, this jigsaw will be finished.”
As well as improving patient health and wellbeing, as seen in Jane’s story – https://www.youtube.com/watch?v=eEpJqdkinGg&t=1s, Patient Reported Outcome Measures (PROMs) have been used to understand the impact of the service and support the patient in assessing their own symptoms and progress. In all domains of the PROMs, statistically significant improvements have been seen and sustained after discharge, and this has continued despite Covid. The project has also had a dramatic impact on Emergency Department and inpatient activity in this group of patients:
- Inpatient activity reduced by 72.7%
- Emergency Department and Urgent Care Centre activity reduced by 74%
- Outpatient Department activity reduced by 51.3%
Project lead Dr Chris Schofield, Consultant Liasion Psychiatrist at Nottinghamshire Healthcare NHS Foundation Trust, says: “The ‘whole team’ approach in integrating mental and physical health and primary and secondary services is effective and this service has delivered impressive results, including improved patient outcomes and reduced primary and secondary care attendance.
“It perfectly fits the new ways of working emerging from the Primary Care Networks, in line with ICS aspirations. Overall, it’s a great example of integrated care, bringing together primary, hospital and community care, and helping us deliver a more holistic approach with patient need at the centre.”