Specialist mental health pharmacist clinics in primary care: a service evaluation supporting integrated neighbourhood working

Primary care continues to experience increasing demand for mental health support, alongside long waiting times for community mental health teams (CMHTs). In response, integrated care boards (ICBs) are developing neighbourhood multidisciplinary teams to improve access, continuity and collaboration across primary and secondary care services^​1​.

Pharmacists with specialist mental health expertise and independent prescribing capability may offer a practical solution to bridge this gap, particularly for patients whose needs sit between traditional primary and secondary care thresholds^​2,3​.

Following the retirement of a long-standing consultant psychiatrist and increasing pressure on a local CMHT service, a specialist mental health pharmacist clinic was established within a GP practice in the same locality to support patients with complex mental health needs.

Alongside this role, the pharmacist is the lead pharmacist for non-medical prescribing in an NHS trust, with clinical and leadership responsibilities, and provides a pharmacist-led clinic within a CMHT in collaboration with the consultant psychiatrist. This dual working across primary and secondary care enabled clinical continuity, supported shared decision-making and facilitated safe boundary-spanning practice.

Service description

The clinic was delivered by a credentialed specialist mental health pharmacist practising as an independent prescriber. Referrals were received from GPs and reception staff using established triage protocols. Patients included those with depression, anxiety disorders, bipolar affective disorder and schizophrenia.

The pharmacist provided mental health reviews, initiated and optimised psychotropic medicines, and followed up patients in line with quality and outcomes framework (QOF) guidance^​4​. Prescribing also included medications typically initiated in secondary care under local ‘amber’ and ‘yellow’ guidance, enabling treatment to be delivered safely within primary care and reducing onward referrals.

Physical health monitoring — including blood pressure, weight and blood tests — was also undertaken in line with NICE guidance^​5​.

Methodology

A service evaluation was conducted over two months using anonymised paper questionnaires for patients and an online survey for clinicians. The questionnaires explored communication, access, satisfaction, perceived outcomes and impact on workload, using a combination of Likert-scale and free-text responses.

Findings

A total of 35 patients responded, all of whom reported that they would recommend the clinic. Patients consistently highlighted clear communication, feeling listened to and improved mental health outcomes. Many described the service as timely, accessible and reassuring, particularly when compared with long waits for secondary care services. Representative comments included “she was a lifeline at a time when my mental health needed help and support” and “I didn’t feel rushed — I felt listened to”.

In total, 6 GPs and 1 physicians’ associate participated. All agreed that the clinic reduced referrals to secondary care and improved medication management. Clinicians described the service as providing “secondary-care-level support within primary care” and valued the pharmacist’s specialist expertise and prescribing capability.

Discussion

This service evaluation demonstrates that specialist mental health pharmacist clinics within primary care are both feasible and highly valued^​6​. However, this model was only possible because of pre-existing professional relationships, specialist experience in secondary care and independent prescribing competence.

From the author’s experience, existing funding arrangements did not permit the formal integration of primary and secondary care roles. Nevertheless, the evaluation highlights a clear opportunity for ICBs to commission enhanced pharmacist roles that deliberately span care boundaries, supporting neighbourhood mental health models while reducing pressure on CMHTs.

Conclusion

This service evaluation highlights the potential for specialist mental health pharmacists to work effectively between primary and secondary care. As ICBs continue to develop neighbourhood teams, there are exciting opportunities to formalise and scale such boundary-spanning roles to improve access, integration and patient outcomes.

Azra Sumar (views are author’s own), lead pharmacist for non-medical prescribing in mental health, Leicestershire Partnership NHS Trust; locum clinical pharmacist (primary care), Market Harborough Medical Centre, Leicestershire (at the time of the service evaluation). Credentialed by the College of Mental Health Pharmacy