The Getting It Right First Time (GIRFT) programme is about to begin pilot visits in its adult crisis and acute mental health workstream, meeting the teams in England’s mental health trusts for the first time.

Dr Ian Davidson, GIRFT’s clinical lead for adult crisis and acute mental health and a consultant general adult psychiatrist at Cheshire and Wirral Partnership NHS Trust, will be heading out on ‘deep dive’ visits over the next few months, discussing the issues facing the specialty, sharing good practice and identifying ways to improve patient care.

Pilot visits are scheduled to:

• Rotherham, Doncaster and South Humber NHS Foundation Trust – 9th December 2019
• East London NHS Foundation Trust – 19th December 2019
• Lancashire and South Cumbria NHS Foundation Trust – 13th January 2020

Visits to the 53 other mental health trusts will begin from mid-January 2020 onwards.

GIRFT aims to improve the quality of care within the NHS in England by reducing unwarranted variations. By tackling variation and sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies. Importantly, the programme is led by frontline clinicians who are expert in the areas they are reviewing.

Mental health is one of 40+ specialties being reviewed by the GIRFT programme, including surgical, medical and cross-cutting clinical services. There are three elements to the GIRFT mental workstream – adult crisis and acute, children and adolescent mental health and rehabilitation services. Visits for the CAMHS and rehab workstreams are also expected to begin in early 2020.

Until now, GIRFT’s ‘deep dive’ review visits have all taken place with acute provider teams.

Dr Davidson said: “This is a first for the GIRFT programme, meeting with teams in mental health trusts, and we are looking forward to getting started. We know there is a lot of good work going on across the country and we will be looking to build on that.

“Working with providers, we want to identify what assists them and what hinders them in delivering and improving services to their local communities. We will be working closely with trust teams to identify where they fit into the national picture, discuss any barriers to improvement and share their good practice with other trusts nationally.”

Two key themes of the GIRFT review of adult crisis and acute mental health services will be:

Timely and appropriate access

In line with the aims of the NHS Long Term Plan, the GIRFT crisis and acute workstream will look at improving access to mental health services, with a view to preventing some mental health crises, as well as identifying sustainable, better responses to those which aren’t preventable.

National campaigns to reduce the stigma of mental health issues in recent years have encouraged more people to seek to access to care and treatment. This has increased demand on services, with higher rates of antidepressant medication in primary care, increased use of social prescribing and greater numbers of people accessing talking therapies through the Improving Access to Psychological Therapies (IAPT) programme.

However, patients with psychoses or where primary care interventions haven’t worked need timely access to secondary care (core community services), and others need more intensive treatment, such as the use of an inpatient acute bed.

Dr Davidson said: “Crises caused by mental health conditions are rare, but crises due to conditions not being addressed in a timely manner are common. If people can’t access and get timely treatment from community services they are likely to develop more severe mental health conditions, which may need inpatient care and treatment.

“The ideal system is one in which we can quickly respond to people to ensure they get access to the right type of service for them at that time. If access to services is timely and appropriate and there are timely, appropriate interventions available, crises will be rare.”

Making use of data

Data quality issues are significant in mental health reporting. There is a need to measure outcomes consistently and to analyse, report and share them to enable trusts to reduce unwarranted variation.

GIRFT is extracting information from available national data sources to share with trusts, to help them benchmark within the national picture. The programme will also share trusts’ successful solutions to the challenges, and identify major areas of interest where robust data is not accessible.

Dr Davidson said: “Although mental health providers collect huge amounts of information that could underpin decision making, our information systems, infrastructure and equipment are generally well behind those in physical healthcare. The reality of prioritising frontline clinical staff means there is less informatics support or skilled analytical support, and limited data flows back to managers or frontline clinicians to help them best deploy available resources. 

“We have worked closely with other GIRFT workstreams and the NHS England and NHS Improvement teams to share findings, and to make best use of all the knowledge and information across all such bodies.

“After sharing their data with the trust teams, we will then work out the key learning points for them. Our regional GIRFT hubs will then support them to make improvements and share good practice from other trusts.”