Fullscope’s GP pilot: SIX MONTHS ON – what are we learning?

What is the pilot?

On 7th June 2021, Fullscope launched their GP pilot delivering quick access to support for children and young people presenting with mild/moderate mental health or wellbeing issues. The original end point was October 2021, but the pilot has been extended to June 2022.

The pilot model provides a resource efficient, ‘single session intervention’ (assessment) with targeted further contact where appropriate. If the model proves effective, this will be a competitively priced, quick access way to provide low level (Tier 1 and 2) interventions that improve outcomes for children and young people.

The pilot covers two Primary Care Networks in Cambridge City of six surgeries and is funded through the Clinical Commissioning Group’s (CCG) Innovation Fund.

 How does it work?

The pilot offers GPs (or Primary Care practitioners such as Social Prescribers) a simple pathway to a single session intervention that explores the difficulties the young person is experiencing and suggests support based on that conversation. This is undertaken with an experienced clinical assessor. 

Single session therapy (or intervention) is a single, goal orientated session that instead of working through a long assessment of history, asks the client what they would like to be able to do or change. It sets one goal (or very few) for which actions are identified between the client and therapist. Up to two additional sessions are available if necessary. The model is very much about empowerment and is being used around the country including some Child and Adolescent Mental Health Services (CAMHS).

What are the aims and desired outcomes?

Aa a pilot, this is very much about learning as well as delivering support:

·       LEARNING: This is very much a learning pilot that, on a small scale, can identify both internal and wider system issues and processes – and find solutions that inform wider system delivery with the aim of improving outcomes for children/ young people. To this end we are able to be agile problem solvers, quickly amending processes to increase efficiency and effectiveness.

·       Support YOUnited as they grow. The countywide YOUnited mental health and wellbeing service for children and young people commenced in July 2021 and is currently taking professional referrals. It sits within the wider Cambridgeshire and Peterborough Foundation Trust NHS (CPFT) Service for children, young people and families.4 Whilst YOUnited are still growing their capacity – we can help with taking lower risk referrals from a selection of surgeries to ease pressure.

There are four key desired outcomes: 

·       A reduction in the percentage of rejected referrals from the CAMHS SPA

·       A reduction in waiting times to initial appointments. 

·       Children and young people feel they are receiving the right support at the right time

·       Primary Care are confident that their patient will be referred or signposted to the most appropriate type of support

Activity over the six months

·       31 referrals have been received – with all surgeries referring (range 1 – 7 per surgery).

·       In most cases, the family/ young person is initially contacted within 3 days of Fullscope receiving the referral.  The single session intervention is completed within an average of 6.6 days from receiving the referral. Where it is longer it is due to difficulties contacting the family.

·       The single session intervention calls take between 40 – 60 minutes by Zoom, Teams or phone.

·       A further ‘light touch’ phone call or email was made with 74% of cases.

·       The average age is 14years, 58% are female, 39% male.

·       61% were currently or had previously received support.

·       32% had previously been referred to CAMHS but did not meet criteria.

·       Anxiety and depression were the symptoms most often presented.

Going forward

Six months can tell us a great deal! And in the true spirit of what a pilot should do – we are pleased to share these findings – both the successful factors – and those we still need to grapple with.  In summary, successful factors and outcomes include:

Speed: The impact of a quick, response from an experienced therapist means families feel listened to and acknowledged, which increases confidence and trust in what is offered.  

Single session: The single session intervention is a cost-effective way of listening, appraising, goal setting and meeting lower-end (mild) mental health and wellbeing needs.

Positive outcomes: These include families/ young people being able to access support or feeling well enough following the session not to need further help.

No need to return to GPs: Half of our cases did not return to their GP following the session and therefore reduced potential GP resources and frustration and waits for the family/ young person.

However, our findings indicate that we need to work to improve the following areas:

Mild – low level moderate need and GP identification: Our model is most effective with milder end needs; we need dialogue with GPs to help them quickly identify level of need in the short time they have with the patient.

Understanding pathways: Ourselves, together with all partner members need to have a clear understanding of referral pathways, to avoid frustrating families further with inaccuracies and delays in referrals. This is particularly the case for support for neurodevelopmental support and Early Help.

Direct YOUnited pathway: We would like to be able to refer direct to YOUnited any child/ young person that is appropriate, rather than them having to go back to the GP for a referral. 

Increasing referrals: We need to keep finding ways to promote our project to GPs.

Clear information and goal setting: We need to always give clear, succinct information to families/ young people – to stop them feeling overwhelmed and confused. Setting small goals can encourage and empower reluctant families/ young people to take steps to improve their mental health and wellbeing; it provides a helpful way to then check progress.

Setting expectations: We all need to be committed to informing and educating the children/ young people in our county about the ‘normality’ of many emotions and their own capacity, with parental support, to manage and grow positively through experiences. This is long term work and needs partnership with education providers.

We’re amending our process and structure wherever we can to incorporate these findings so we can improve outcomes for children and young people.