Mental Health Practitioners (MHPs) contribute to the NHS Long Term Plan ambition to develop new and integrated models of primary and community mental health care, offering patients access to specialist support and providing guidance to other clinicians working in the general practice multidisciplinary team (MDT). Practices can employ them as jointly funded ARRS MHPs – in collaboration with Avon & Wiltshire Mental Health Partnership (AWP), through the Additional Roles Reimbursement Scheme (ARRS) – or as independently employed MHPs (IEMHPs) — please note that the method of employment can impact their core functions.

Through the Additional Roles Reimbursement Scheme (ARRS), MHPs can be jointly employed and funded by a PCN and local community mental health service provider (in BNSSG’s case, Avon & Wiltshire Mental Health Partnership (AWP)). A local service agreement will confirm this arrangement. This jointly funded ARRS MHP role can be taken on by any registered clinician working at Band 5 or above, such as:

• Community Mental Health Nurses
• Social Workers
• Mental Health Occupational Therapists

Main functions of the jointly funded ARRS role:

• No exclusion criteria other than under 18 years old and dementia
• Combined consultation, advice, triage and liaison function, supported by the local community mental health provider
• Working with patients to support shared decision-making about self-management; facilitate onward access to treatment services; provide brief psychological interventions, where qualified to do so and where appropriate and work closely with the PCN MDT to help address wider patient needs
• Operating without the need for formal referral from GPs
• Being supported through the local community mental health services provider by robust clinical governance structures to maintain quality and safety, including supervision

For more information please see Network Contract DES

Practices may choose to employ their own MHPs to allow greater freedom in adapting the role to better fit practice and patient population needs. However, the general concept of the IEMHP role will remain much the same:

• Combined triage, consultation, advice, and liaison function
• Working with patients to support shared decision making around self-management, and to facilitate onward access to treatment services
• Provide brief psychological interventions where qualified to do so and where appropriate
• Prescribing and reviewing medication where indicated, and if appropriately qualified to do so
• Support with QoF
• Exclusion criteria dependent on practice and individual practitioners

It is recommended that MHPs have 2– 5 years‘ experience working in mental health before joining the primary care sector, due to the level of autonomy associated with the role.

Additionally, due to the nature of the role and career progression, it is recommended that Band 6+ or equivalent roles – ideally a Mental Health Nurse – are employed in this capacity.

For more information on the Network contract DES see here

For more information on working for the NHS in Mental Health see here

NHS England Mental Health Nursing and Nurse Associates see here

Mental Health Practitioners (MHPs) can offer a wide range of benefits to patients, practices, and primary care networks (PCNs), though they can differ depending on whether MHP(s) are employed through the Additional Roles Reimbursement Scheme (ARRS) or independently.

Individuals can undertake a self-assessment on their own skills against this core capabilities framework and they can identify to their employer and supervisor where they think they are at with regards to their knowledge, skills and behaviour Mental-Health-Core-Capabilities-Framework-Final-30-April-2024-PDF-1.pdf. It is based on the Mental Health Nursing – Competence and Career Framework and you can then understand what the skill gaps are and develop a PDP for each individual.

Benefits for patients:

• MHPs can help with reducing waiting times
• They can help to prevent referral into secondary care
• They provide an integrated pathway for patients
• They provide access to specialist mental health support
• Patients typically report positive experiences with MHPs
• Integrated pathways for patients
• Access to specialist mental health support
• Reduced waiting times
• Prevention of referral into secondary care
• Positive patient experience

Benefits for PCNs:

• MHPs can integrate into and work as part of the multidisciplinary team, in line with the community mental health framework
• They can teach other clinicians new skills around managing mental health
• They provide a bridge between primary care and specialist mental health providers
• Through MHPs, PCNs can draw on a range of mental health service providers
• When employed through ARRS, PCNs don’t need to be involved in the recruitment process for MHPs
• They’re employed through an innovative model of shared employment
• No formal referral process is required

Benefits for patients:

• Access to specialist mental health support
• Patients typically report positive experiences with MHPs
• Patients can have longer appointments for assessing and formulating a treatment plan
• Reduced waiting times

Benefits for PCNs:

• MHPs can integrate into and work as part of the multidisciplinary team, in line with the community mental health framework
• They can teach other clinicians new skills around managing mental health
• They can help to free up GPs’ time
• When employed independently, PCNs have full control over the recruitment process
• PCNs can, consequently, develop the role according to their particular patient population and practice needs

Mental Health Practitioners (MHPs) can either be employed independently at a practice surgery, in which case the practice will fully fund and oversee the recruitment process; otherwise, they can be employed as a jointly funded ARRS role in collaboration with Avon & Wiltshire Mental Health Partnership (AWP) through the Additional Roles Reimbursement Scheme (ARRS).

Employed through either model, MHPs are a valuable addition to any MDT.

To employ an MHP through ARRS, there are certain criteria that must be met. Please see Network Contract DES for further information

The Avon & Wiltshire Mental Health Partnership (AWP) suggests that MHPs should have the following personal characteristics:

• Ability to diplomatically challenge inaccurate assumptions and perceptions
• Comprehensive experience in educating and training the mainstream workforce, particularly non-specialist mental health workers
• Effective active listening skills, enabling the reframing and testing of understanding
• Effective verbal communication skills, which can be put to use with people at all levels (even when an assertive approach is needed)
• Effective written communication skills, with experience of compiling and sorting notes and reports, establishing statistical data, and analysing information
• In-depth working knowledge of secondary specialist mental health services, the wider health and social care community, and the third sector
• Possesses a detailed understanding of the relevant legal frameworks / legislation, including CPA process, the
• Mental Health Act, the Mental Capacity Act, and safeguarding
• Substantial experience in assessing risk and producing risk management strategies
• Well-versed with Microsoft Office, and willing to embrace new technology and processes
• Well-versed with national drivers and policies, and with legislation affecting patients and service users

Please note: the above information is drawn from AWP‘s job description for a Band 6 mental health practitioner — it should, therefore, not be considered an exhaustive list, for all situations.

For further information, please consult NHS Health Careers‘ guidance on required personal characteristics and skills by clicking here.

It is recommended that MHPs have significant post-qualification experience of working in mental health field prior to join the primary care sector. Available job descriptions suggest between 2 – 5 years‘ of experience, on account of the level of autonomy associated with the MHP role in primary care.

The Avon & Wiltshire Mental Health Partnership (AWP) suggests that MHPs should have the following training and educational qualifications:

• A professional qualification in mental health, equivalent to a registered RMN (mental health nurse), registered social worker, or registered therapist.
• In-depth working knowledge of secondary specialist mental health services and the wider health and social care community, as well as the third sector.
• Comprehensive experience in educating and training the mainstream workforce, particularly non-specialist mental health workers.
• Substantial experience with assessing risk and producing risk management strategies.
• Current registration with a professional body (ideally the Nursing and Midwifery Council (NMC), and a commitment to CPD.

Individuals can undertake a self-assessment on their own knowledge, skills and behaviour against this core capabilities framework  Mental-Health-Core-Capabilities-Framework-Final-30-April-2024-PDF-1.pdf. It is based on the Mental Health Nursing – Competence and Career Framework and you can then understand what the skill gaps are and develop a PDP for each individual.

Provided by Avon & Wiltshire Mental Health Partnership (AWP), this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

Produced by Amy Chrzanowski, our previous Mental Health Profession Lead, this job description offers a role summary, lists the role’s duties, and provides a template person specification.

To read it, please click here.

Below is a set of sample interview questions:

• “What skills can you bring to this role?”
• “How would you assess a patient’s needs?”
• “How would you risk assess and safety plan with a patient who is experiencing thoughts of self-harm and suicide?”
• “Appointment times are shorter in primary care: how do you envisage you will adapt to this?”
• “What challenges do you think you may encounter coming from secondary care into primary care?”
• How do you look after your own wellbeing?

General

– For jointly funded MHP’s – there is a clear induction process in place between AWP & PCN – 1 week induction with AWP (introduction to secondary care teams, RIO/system training, locality & team induction, stat/man training), then 2-week induction with the PCN (allocation of GP Mentor, EMIS training, induction & orientation to PCN, stat/man training, laptop collection & IT set up)

– Considerations for all – Orientation to practice – access codes, layout of surgery, where to find things – stationary etc

– Access to all relevant IT systems and suitably trained up – remedy, Emis, Docman, Accrux

– Awareness of protocols and policies within the practice including risk management and safeguarding.

– For practitioners who are not prescribers, having a clear process for if patients want to access medication

– Having a clear plan for the role, including available appointment types and who can book in. It would be helpful to disseminate this information to the team ahead of the MHP starting and arrange for the MHP to meet with wider team to discuss this. It may be helpful to hold meetings to review this and alter according to practice/MHP need. (* For jointly funded MHPs, this would be clarified prior to start date, alongside AWP, and reviewed on a regular basis recognising the need to tweak things collaboratively)

– Complete stat/man training

– QoF training – SMI, Depression

– Link in with local services in the area that are available to refer to – e.g. CMHT, IAPT, VSCE services

– Having clear expectations between employee/employer/ARRS Management

– 2 weeks shadowing, general working of surgery, training with systems, as well as shadowing other practitioners within surgery (Unless otherwise agreed by AWP)

– If possible, arrange for worker to spend a day shadowing a mental health practitioner already in post

– Allow time to meet with local MH teams to forge relationships and links, including knowing how to access A&G link consultant

– Following induction – start own clinics with blocked slots to allow time to embed to a different way of working

– See example morning clinic templates below for IEMHP’s and Jointly Funded ARRS Workers respectively.

– For jointly funded MHP’s – Recommended for initial appointments 30-40 minutes then 20-30 minutes for follow-up appointments.

– For IEMHP’s – to be agreed between MHP and practice. Recommendation of minimum 30 minutes for urgent/initial assessment/routine appointments. Recommendations for meds/non-meds review minimum 10/15mins accordingly.

– Considerations for all – Set clinics up with a variety of appointment types – face-to-face/videocall/telephone – urgent, routine, follow-up for medication/non-medication

– Longer appointment times are advised if practices would like MHP’s to provide more structured interventions within appointments

– Consider separate clinics for ADHD/SMI/Urgent – should be set up in collaboration with individual practitioners

– Daily admin time – for referrals, letters, fit notes, repeat prescription requests. Discussions with colleagues (internal/external), reviewing notes, docman

– Breaks built into clinics

– Encourage “open door policy” in-between patients

– Allow time for new practitioners to embed into new way of working – appointments blocked off to allow time to adjust to shorter appointments etc

Example clinic for IEMHP to support embedding process:

Example clinic for IEMHP once embedded:

Example clinic for Jointly Funded ARRS Workers:

If employed through the Additional Roles Reimbursement Scheme (ARRS), then MHPs will receive line management and clinical supervision through Avon & Wiltshire Mental Health Partnership (AWP).

• AWP will also offer lunchtime check-ins with peers from across BNSSG, twice a week
• Monthly team meetings will be held by AWP, too
• PCNs should still identify a GP Mentor to work with MHPs, however

For more information on the role of a GP Mentor, please click here.

Click here for an example job description of GP Mentor.

If employed independently, then line management and clinical supervision for MHPs should be provided by a…

• GP (a mental health lead would be ideal)
• Senior Mental Health Practitioner
• Or Nurse Manager

…with the frequency of supervision should be agreed with individual practitioners.

Peer supervision with other MHPs in primary should be encouraged, too, as a means of sharing best practice and supporting retention.

Mental Health Practitioners

Primary Care Careers – Mental Health Practitioner

Understanding the role of Mental Health Practitioners in Primary Care

Recruiting mental health practitioners through the Additional Roles Reimbursement Scheme | NHS Confederation

Programmes – elearning for healthcare (e-lfh.org.uk)

Mental Health | NHS England (NHSE)

New Roles in Mental Health Project Resources.pdf (NHSE)