What is being done?
In South Gloucestershire, the Avon and Wiltshire Partnership NHS Trust provide a primary care liaison service for older people. The service supports primary care professionals who are concerned about the mental wellbeing of their patients by providing advice and guidance with the overall aim of people getting access to the right care at the right time in a way which suits them.

New role and function
The service is Nurse led, with 5 whole time equivalents on the team. Recruitment to the team took some time as it was felt to important to get the right skills and approach for the team, because it is distinct from traditional older people’s mental health services in the following ways:

• Nurses don’t carry a case load, but rather support primary care to better manage someone, through informal education, advice and support. The GP retains clinical responsibility.
• A formal referral doesn’t need to be made to the PC Liaison Service – a phone call and discussion about a person’s needs is frequently all that is necessary to get the involvement of the PC Liaison Service, who may then see the person directly, or provide routes to other support and services.
• They are not strict on their referral criteria (e.g. not age restricted) meaning that they can better manage demand on inpatient services through either supporting person to remain in secondary care, arranging referral to the Community Mental Health Team for those who are presenting with severe and enduring mental health condition.
• In addition, they are in the best position to determine what support the older person does need and to make the connections for them, rather than the person being referred back to primary care and waiting to see their GP again.
• Support is tailored to the needs of the person, rather than being dependent on them successfully navigating the health system.
• Strong links with local community organisations and groups, so the final support that a person receives is not just medical, but social too; particularly useful for supporting older people who have poor mental health due to social isolation.
• More formal training opportunities are also offered, but the main approach to education is much more opportunistic and natural – learning by seeing and talking, rather than sitting and listening.
• The service is not dementia specific; this was a purposeful decision, based on the likelihood that some of the patients seen aged 50+ who have depression like symptoms may actually have early signs of dementia. If the service only saw people with dementia, the responsibility is on the GP to diagnose correctly and refer, which may mean that people who would benefit from early diagnosis and treatment would not get it, leaving families and patients without the support they need to live well with dementia.

What has been achieved?
Regular evaluations are undertaken which have demonstrated that in the 18 months the service has been running, a third more referrals have been received by the service, so there has been success in case finding and supporting Primary Care to do something for older people who present with a mental health concern.

Despite this increase, as the Service is also the access point for the Community Health Team, referrals on to the CMHT are better managed, which has led to a drop in referrals on the CMHT.

The implications of this are:

• More people are being supported in primary care with their mental health, which can mean cost savings, as well as improved outcomes for patients as their needs are identified early and steps taken to meet those needs before they become chronic.
• The Community Mental Health Team now sees only those people which need their specialist support and intervention.
• There is more capacity in the CMHT to do this.
• Confidence in supporting people with mental health conditions in primary care has grown, which can mean that an older person with a mental health concern who attends their GP is more likely to get the right service, at the right time in a way that suits them.