Time is running out on NHS England’s plans to upgrade mental health services.
In 2019, the NHS published its ‘Mental Health Implementation Plan 2019/20 — 2023/24’. The plan aimed to build on previous five-year plans for improving mental health care, ensuring “that the NHS provides high quality, evidence-based mental health services to an additional 2 million people” by 2023/2024.
The plan was backed by £2.3bn of ringfenced funding for integrated care systems to meet specified targets for improving care across nine mental health services, including children and young people’s mental health, adult common mental illnesses and adult severe mental illnesses (SMI) community care.
Central to these plans were the 27,460 additional staff, who would be required by March 2024. This included 260 pharmacists, who were expected to take up positions in new integrated primary and community care teams for people with SMI, such as psychosis and bipolar mood disorder.
However, training figures shared exclusively with The Pharmaceutical Journal from the University of Bradford suggest recruitment is significantly below target. Only 39 out of 70 places were filled on the university’s ‘Specialist mental health pharmacy training pathway’ in 2023/2024. The course is funded by the NHS and was designed in response to the implementation plan’s targets to develop the mental health pharmacist workforce.
With less than three months of funding left before the clock runs out on the plan, the reasons behind the low uptake are concerning.
Diane Webb, assistant professor at the University of Bradford’s School of Pharmacy and Medical Sciences, suggested NHS trusts are still creating the community mental health pharmacist roles. Karen Shuker, president of the College of Mental Health Pharmacy, noted that the funding for pharmacists in community mental health teams was not ringfenced, meaning that integrated care systems may have directed their share of the £2.3bn fund to other mental health priorities.
This would be a significant mistake. The value of pharmacist input into mental health care is well documented. An article published in the Irish Journal of Psychological Medicine in November 2023 highlighted the value of specialist mental health pharmacists in managing those with SMI in particular, describing them as “best placed to provide leadership for medicines optimisation”, improving adherence and providing information.
A systematic review of 37 studies published in 2022 concluded that pharmacist-led interventions improve clinical outcomes for patients with SMI. “Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals,” the authors said.
Research published in the BMJ in 2019 found that primary care pharmacists with patients with SMI were able to clarify discharge information, review high-dose and multiple antipsychotic prescribing, correct errors and investigate adherence issues.
Pharmacists are a valuable asset to mental health teams and NHS mental health services cannot afford to leave any stone unturned in their effort to improve access to care. A report published by the House of Commons Committee of Public Accounts in July 2023 found that despite efforts to increase the workforce, as part of plans to improve services, the workforce grew by just 22% between 2016/2017 and 2021/2022, while the number of referrals grew by 44% in that time.
Community mental health services — where pharmacists were expected to be recruited — now have an estimated waiting list of 1.2 million people, which continues to grow. Data from the NHS Benchmarking Network, published by the Centre for Mental Health on 10 January 2024, revealed an 11% growth in the number of referrals to adult community mental health services in 2023, compared with the previous year, with 625,000 people referred.
Decreasing these waiting times is particularly vital for those with SMI. NHS England’s previous improvement plan for mental health services, ‘The five year forward view for mental health’, noted that people with SMI are likely to die up to 20 years earlier than average, and are three times more likely to attend A&E with an urgent physical health need and almost five times more likely to be admitted as an emergency.
Pharmacists could make an invaluable contribution to the care of this patient group. Funding for their positions on integrated primary and community care teams must be ringfenced, and vacancies opened and recruited into before time runs out.
A report by the Royal Pharmaceutical Society, published in 2018, described pharmacists as “the greatest untapped potential” in primary- and community-based mental health care. If recent training numbers are any indication, this will remain detrimentally true. PJ