Mental Health Nursing in General Practice + Primary Care

I’ve been a mental health nurse for almost 20 years and up until five years ago I had always worked within mental health secondary care. I had experiences in inpatient, crisis and home treatment teams, and a specialist perinatal team. 

During my time with the perinatal service, I came across many ‘amber’ patients (those who didn’t meet the criteria for secondary care but who were experiencing mental health difficulties). I thought, this should be done in primary care; I could do that.  

I started Googling! Is this role out there? I came across an article written by a GP praising the work of the mental health nurse they had in place (Kilmartin, 2018). It seemed to be the choice of the individual surgery whether to include this specialised role in the General Practice team. I found my way into primary care by forwarding the article to someone I knew who worked in a surgery. The surgery was interested to follow up and we met for an informal interview – the rest is history!  

A Mental Health Nurse in General Practice  

Being a mental health nurse in general practice is a fantastic role. I feel so privileged to be able to meet patients who are, maybe for the first time, seeking support for their mental health. I offer patients 30-minute face-to-face appointments and 10-minute phone calls – sometimes longer appointments are needed and this is accommodated.  

I see adults experiencing a full range of mental health issues such as anxiety, depression, stress (often work related) and burnout; psychosis and mania; suicidal ideation and trauma; and queries regarding neurodiversity, just to name a few. No day is the same or boring! I’m a prescriber so I can initiate medication and deprescribe.  I’m not a therapist but use therapeutic approaches. I don’t hold a caseload of patients and neither do I restrict the number of appointments patients can have. 

Those I have met before know they can book back in with me any time they need to. I find patients tend to only see me when necessary. I can book up to four weeks in advance (my colleagues can also book patients in to see me) and will help out with the duty calls if I can. I also work closely with the GPs to manage more complex patients. 

The MDT 

Within the surgery, I have helped set up a mental health multi-disciplinary team (MDT) where we can discuss patients anyone is concerned about. I have a monthly meeting with our local substance misuse service and also provide supervision to our Social Prescribing Link Workers.  

When I first started this role, I created a Facebook group called Mental Health Practitioners in General Practice, UK. The aim was to build a community of practice. It is an isolating role, often involving working alone and rarely seeing colleagues. I knew I needed supervision and wanted to find others doing the same thing. Today there are over 1000 members in this group; not just nurses and many are in Additional Roles Reimbursement Scheme (ARRS) roles. A few group members have met every month or so over the last 18 months to share good practice and support one another.  

As I have already mentioned, I love my role. Patient feedback is rewarding; they feel valued and listened to. I hope I have reduced referrals to secondary care and avoided antidepressants where they haven’t been needed. I in no way devalue the work our GPs do, and I am very lucky to work with such a fantastic bunch. Unfortunately, GPs are overworked, and they are restricted by the time available in the working day. Time is hard to come by in primary care.  

Do I recommend mental health nurses in a GP surgery? Yes! We have nurses who specialise in diabetes, wound care, and cardiovascular so why not mental health? I know of a few surgeries who have now made the decision to directly employ a mental health practitioner. Some trusts in the UK even have mental health practitioners as an ARRS role. This is great and long may it last.  

Professional Nurse Advocate  

A year ago, I trained to become a Professional Nurse Advocate (PNA) and am now seconded one day a week to implement this throughout primary care in the county. This is not an easy task, but it is so vital and valuable to nurses, I really want it to work!  

As well as looking after our patients, we need to look after our staff. Making sure appointment times are manageable and remembering we are human beings and not machines – we can only tolerate so much before we burnout. We need to talk to our colleagues; work relationships are vital to good staff wellbeing… but now, I digress; that’s for another blog! 

Georgie Callard QN, NMP,
Mental Health Practitioner and Lead PNA for Primary Care, Northamptonshire  

Reference: 

Kilmartin, S (2018). How our mental health nurse reduced GP workload and cut prescription costs. Found at: https://www.pulsetoday.co.uk/resource/clinical-areas/prescribing/how-our-mental-health-nurse-reduced-gp-workload-and-cut-prescription-costs/