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Finding Friends to Play With:: 

Finding Friends to Play With: Enhancing the practice nurse role in mental health care through collaboration & integrated networks

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273 GPs in practice – 195 EFT 76 practices – 23 solo Recognized area of workforce shortage 140 practice nurses National Performance Indicators for Mental Health – est. 31,500 people would benefit from mental health care planning; 1 GP for every 162 people Who are we?

Where are we?: 

Where are we? Melbourne’s south-east extremity 2 Local Govt. areas Population approx. 300,000, with 80,000 seasonal fluctuation 1 large central business area Smaller communities in a semi-rural locality on Melbourne's fringe Where are we?

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Majority of social services located in Frankston Co-located satellite services operating to the south 1 hospital network – Peninsula Health 2 Community Health Services Child & Adolescent Mental Health Service provided via satellite service from Southern Health Area Health Services

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Robust Practice Nurse program Provide education, networking, peer support activities Forum to articulate needs for further education & professional development Common themes 18 months ago; up-skilling in area of mental heath, dual diagnosis, service access, family support Practice Nurses direct learning needs.

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Identified clear & under utilised role for the PN in supporting GPs in the care of presenting patients with mental health issues PNs could be skilled in identifying & working with patients with a mental health issue Capacity to support & reinforce psycho-education Reinforce medication regime A new game begins!

Disclaimer!: 

Disclaimer! At no time has it been intended that the up-skilled PN would assume the role of a Mental Health Nurse Aim to increase the scope of practice of participating nurses to support and enhance the capacity of the GP team PN not Mental Health Nurse

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Internal collaboration – PN & MH programs Proposed that two programs link to include PNs in the established mental health CPD program and clinical attachments SIMPLE lets go! The hunt for playing partners begins!

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Level of clinical content Closed forum of clinical case discussions Clinical attachments funded for GPs only At this time… Better Access to Mental Health Care initiative was introduced to general practice Responsibility of GPs, private psychiatrist and allied psychological health providers Barriers

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New climate under COAG Mental Health initiative has increased the burden on GPs as demands for “better access” services grow Issues of workforce shortage already exist Would appear somewhat unrealistic to sustain requirements of the GP to undertake the required work, monitoring and follow up COAG: Mental Heath Initiative

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No authorisation for PN in supporting GP in the treatment of patients with mental health issues under COAG: Better Access to Mental Health Care Initiative Enthusiasm squashed when told “we can’t play together on this one – Sorry!” Ok – so no Medicare funded mandated players here Program Collaboration

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Peninsula Health - Primary Mental Health Team approached for advice and ideas Enthusiastic discussions lead to an initial proposal Funding required 2006-07 NiGP Initiative funding proposal due for submission I took my ball but didn’t go home.

Objectives: 

Increase PN skill in mental health assessment & referral pathways Advance & enhance the skills of PNs along our Chronic Disease model NiGP Initiative Program Proposal Objectives

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Engage Primary Mental Health Team to develop an education program for PNs Conduct a needs assessment of PN requirements Development of patient education resources Develop a clinical pathway for patients requiring referral NiGP Program Proposal Strategies & Activities

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PHPS: Nurse Education & Quality Improvement Program (NEQIP) Existing nurse “Orientation to Mental Health” program Fruitful relationship developed 2 areas of action identified New Player Introduction

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Why does NEQIP want to be involved? Assess to an existing nurse education program meant; Quality control mechanism Efficient use of time & resources Cost savings NEQIP Support

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Release of nurses for 5 days prohibitive Marketing of an untested program Cost Upfront Hidden costs Barriers to introducing program

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Re-write of program by NEQIP in consultation with Program Officer Review of time commitment Ensure quality and content retained Relevance to General Practice pivotal Implement initial pilot with an evaluation process clear from the beginning Strategies to Address Barriers

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Flyer to Practice Nurses Accompanying letter to Principle GP & PM highlighting; the course outline practice & nurse commitment anticipated outcomes & benefits to participating PN, GPs, Staff & patients Marketing Plan

Tier 1: 

Follow initial group of nurses through the “Introduction to Mental Health for Nurses in General Practice” Support application of learning and knowledge into practice Keep the team together for a full season! Ready to Field a Team Tier 1

Tier 2: 

Tier 2 Enhance service integration & collaboration PN peer support Clinical support Clinical attachment options Network linkages Process protocol development Resources Coaching & Skills Development

Tier 3: 

Tier 3 Ongoing PN learning options available Ongoing delivery of a comprehensive model of education Linkages and referral pathways entrenched into clinical practice Identified and validated role of the PN in care of patients with mental health issues Sustainability

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NiGP funding report and evaluation against proposed plan Participant feedback of sessions Impact evaluation; participants GPs from participating practices Evaluation: Tier 1

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Train the trainer model could facilitate greater access of course to PNs Quality of overall program would be compromised Need for further consultation to facilitate ongoing program delivery via NEQIP NiGP Initiative Report

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Content & delivery engaged its audience 100% attendance all sessions Engaging and interactive dialogue Course outline applicable to the workplace Overall ratings consistently high for content and delivery Participant Feedback

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Understanding & capacity to utilise Mental State Examination tool Capacity to assess need and refer to area mental health services (AMHS) Improved networking with AMHS Improved patient support Better understanding of patient problems,, thoughts & actions Overall Impact of Training

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PNs participating GP Practice & staff Patients Impact on key Stakeholders

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Improved networking and referral to AMHS Easier work flow within the practice due to nurses application of new knowledge Confidence in patient interactions Patients appear more receptive to nurses and practice team in general results in improved health outcomes all round GP Perspective

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Maintain 4 x ½ days Delivery across an intensive weekend may assist potential non-attendance Comprehensive course outline, but greater opportunity for discussion and information exchange would be welcomed “…too much information to fit in – consider education handouts either prior to (pre-reading) or good electronic references” Program Timing & Structure

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Future opportunities for clinical attachment highly regarded to facilitate an extension of the learning experience Area mental Health Service, acute & community Peninsula Drug & Alcohol Services Pharmacotherapy Clinic Specific General Practices Reflections on Next Steps

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Model still in early phase of development Quality patient care cannot be achieved by isolated education program delivery Quality Improvement – PDSA essential for program success Networks & partnerships essential Reproducibility?? Not quite there yet Advocate for a formalised role for the PN Conclusion

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PNs have a clear role in other clinical disciplines, example CDM A role that supports the activities of a GP PN MBS Item 10997 Check Monitor Inform / reinforce Collate data PNs in a Different Playing Field

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Strong team in place with definite runs on the board Networks and partnerships have been key to early progression & program development Current team happy to progress further Coaches and Administrators returning for a new season Did we find enough friends to play with?