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

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.

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. Further details can be found below.

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. You can see the benefits of each model under What are the benefits?

To employ an MHP through ARRS, there are certain criteria that must be met. For instance, as stated the Network Contract Directed Enhanced Service (DES) contract specification 2023 / 2024:

• “B14.2. Where a PCN engages one or more Mental Health Practitioners under the Additional Roles Reimbursement Scheme, the PCN must ensure that each Mental Health Practitioner provides the following functions depending on local context, supervision and appropriate clinical governance:
• a. mental health advice, support, consultation, and liaison across the wider local health and social care system, including acting as a first point of contact in primary care for patients whose care needs are not suitable for Talking Therapies services;
• b. facilitation of onward access to mental and physical health, well-being, and biopsychosocial interventions;
• c. provision of brief psychological interventions, where qualified to do so and where appropriate;
• d. work closely with other PCN-based roles to help address the potential range of biopsychosocial needs of patients with mental health problems. This will include the PCN’s MDT, including, for example, PCN clinical pharmacists for medication reviews, and social prescribing link workers for access to community-based support; and
• e. may operate without the need for formal referral from GPs, including accepting some direct bookings where appropriate, subject to agreement on volumes and the mechanism of booking between the PCN and the provider.”
• “B14.3. A PCN must ensure that the postholder is supported through the local community mental health services provider (or by the employer of the postholder, where the local community mental health services provider has subcontracted the service to another organisation) by robust clinical governance structures to maintain quality and safety, including supervision where appropriate.”

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

Provided by Avon & WiltshireMental 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 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?

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.

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.