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West London NHS Trust > Coronavirus guidance for GPs and referrers

Coronavirus guidance for GPs and referrers

Due to the significant stress placed upon mental health services at the current time, we are having to change the way some of our mental health services are accessed and delivered.

Please read more about the changes below.

Changes we’ve made to Primary Care Mental Health Services (PCMHS)

  • We are currently operating both primary and secondary care mental health services across the boroughs. Where possible services are being delivered by telephone or video, however, face to face reviews are offered where necessary.
  • The enhanced multi-disciplinary duty services in each borough are open from 9am to 5pm to ensure patients have access to support outside of appointment times. 
  • Primary care consultants are available to give advice to GPs within each borough (the details have been shared with all GP practices) or can be contacted via the SPA.
  • Referrals for new patients should be sent via the SPA or primary care as before.

 

How will referrals be dealt with?

  • New referrals will be screened by the SPA, as usual but in order to free staff capacity, there will be an increased focus on urgent referrals.  This means the threshold for non-urgent referrals, will need to take into account whether patients are likely to deteriorate over the short-to-medium term.
  •  Each referral will be considered on a case by case basis.
  • If it is determined there is no immediate need to undertake a new assessment within the next few months, this referral will not be processed at the current time.
  • Feedback will be provided to the GP with suggestions for management.
  • If the GP wishes to speak with a clinician, the SPA will enable them to speak with a senior practitioner.
  • If the senior practitioner cannot resolve the issues, the call will be forwarded to a senior psychiatrist (consultant or registrar).
  • Patients who do meet an enhanced threshold for follow-up by secondary care services, will have their care transferred in the usual way.

Perinatal Mental Health Service

There are no changes to this service and it continues to receive referrals in the usual way.

Early Intervention in Psychosis (EIP)

  • This will remain separate from the community mental health service at this point to ensure an expert and enriched service to this group of patients.
  •  The three borough-based services may merge to a tri-borough service, depending on staffing pressures, in due course.
  • Referrals of suspected First Episode Psychosis should be made via SPA in the usual way.

Cognitive impairment and Dementia Services

  • The CIDS has temporarily ceased all Dementia assessments, and have stopped all face-to-face patient contact.
  • The CIDS team is not accepting referrals at the current time, however for urgent queries that require immediate advice, GPs are asked to call Ealing CIDS on 020 84832647
    or the Hounslow and H&F combined team on 020 84832525
  • For patients known to the CIDS team, a reduced service is still operating which includes, monitoring and advice on medication and treatment, via our duty system.

Essential community mental health services

The following services will continue to run:

Clozapine service

  •  Clozapine clinics in each borough will continue.
  • There is no data at present which suggests clozapine patients should discontinue their clozapine if infected with Covid-19 (unless the severity of illness dictates stopping on medical grounds). Please be assured that patients on Clozapine will be rag-rated red, and we will be keeping in regular contact with those patients directly.

The clinics continue as normal with enhanced hand hygiene vigilance. Clinics will try to minimise time spent in communal waiting areas, e.g. patients will asked to wait in their car, to be called by staff.

Administration of depot anti-psychotic medication

  •  Those patients receiving Depot medication in their GP surgery will continue to do so.
  • Medication administered by the team will continue to be given in patient’s home or at the team base as indicated.
  •  Work is underway to streamline treatments by using a smaller number of depot medications and by decreasing the frequency of injections where clinically safe to do so.
  •  All home visits follow Trust guidance regarding Covid protocols.

Essential home visits

  • Wherever possible patients will be first offered telephone or video consultations however there will be a number of patients for whom face-to face-contact remain essential. These will be informed by a detailed multi-disciplinary rag-rating of all caseloads.

Facilitating early discharge from inpatient services

  • A multi-disciplinary team has been mobilised to help identify more quickly, the patients for fast-track discharge from acute in-patient services.

Approved Mental Health Practitioner (AMHP) service

  •  Each Borough has an established AMHP service which continues to receive referrals in the usual way.

Other statutory Local Authority services

All Local Authority social work teams will be focused on high priority work. All contacts will be completed via other means than face-to-face, which may include telephone or video conferencing, or where there are safeguarding concerns or statutory duties to be met.

Duty (urgent and emergency) services in each borough

  • The enhanced duty services in each Borough are open from 9am to 5pm. These services now also cover those patients previously seen by Primary Care Mental Health Service.
  • The teams are being enhanced with staff from all disciplines to enable a timely response. Where possible this will be delivered by telephone or videolink, however, face-to-face reviews will be offered where absolutely necessary.

Caring for people at the highest risk during Covid-19

  •  In line with government recommendations we are reviewing our process for those patients who are at the highest risk of severe morbidity and mortality from Coronavirus (COVID-19).
  • We are committed at this time to take specific care in reviewing the needs of any patients who meet the criteria within the guidance.

 

Mental health services for Children and Adolescents (CAMHS)

The duty services in each borough CAMHS continue to function uninterrupted. Each specialist CAMHS service has a core team on site daily to prioritise and manage new referrals.

We are requesting that referrals to CAMHS are focussed on higher levels of need and emerging mental illness.

All Trust CAMHS services are able to receive and process referrals through the usual mechanisms at present but cases will increasingly be prioritised on severity of need.

At present most clinical patient contact is through indirect mechanisms such as Skype, other video means or phone call but where essential, CAMHS attendance remains an option.

Tier 2 services continue to offer treatment through remote access but have stopped direct contact with service users for now.

The CAMHS Alliance crisis team supports specialist services with cases that have escalated needs and also support early discharge from tier 4 units to allow flow-through and capacity to be maintained.

We are developing emergency access sites away from A&E to contribute to relieving the burden on acute sector emergency services.

There is a weekly London-wide CAMHS update, led by NHSE, to support co-ordination of services and newly developed pathways during the crisis period.