Children and young people diagnosed with attention deficit hyperactivity disorder (ADHD) and related conditions, who need regular monitoring of their height, weight, blood pressure and pulse, can now have this done at a local pharmacy rather than having to attend a main clinic, which could be many miles from their home. In addition to carrying out the physical measurements, staff at community pharmacies are also able to support families with any medication related queries, such as how to administer the medication, potential side effects and possible interactions with other medications. Called ‘Bringing child and adolescent mental health services (CAMHS) closer to home’, the project was initiated by the New Forest team at Hampshire Child and Adolescent Mental Health Services (CAMHS), which is run by Sussex Partnership NHS Foundation Trust
Highly Commended in CYPMH Category - #MHAwards18
Co-Production
From start: Yes
During process: Yes
In evaluation: Yes
Evaluation
Peer: No
Academic: No
PP Collaborative: Yes
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Dr Subha Muthalagu - Consultant Child and Adolescent Psychiatrist
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Children and young people diagnosed with attention deficit hyperactivity disorder (ADHD) and related conditions, who need regular monitoring of their height, weight, blood pressure and pulse, can now have this done at a local pharmacy rather than having to attend a main clinic, which could be many miles from their home. In addition to carrying out the physical measurements, staff at community pharmacies are also able to support families with any medication related queries, such as how to administer the medication, potential side effects and possible interactions with other medications. Called ‘Bringing child and adolescent mental health services (CAMHS) closer to home’, the project was initiated by the New Forest team at Hampshire Child and Adolescent Mental Health Services (CAMHS), which is run by Sussex Partnership NHS Foundation Trust. It was launched following an increase in the clinic waiting list, delays to monitoring young people’s progress and an increasing number of missed appointments, with feedback from families that they often found it difficult to get to the clinics.
We asked parents why they were struggling to bring their children to their monitoring appointments and the overwhelming response was that it was inconvenient to get to a clinic during the working day. Distance was an issue, and they often had to miss work and take their child out of school, which isn’t always possible and is far from ideal for the family. Our clinics could not always be responsive to their needs and fit in all of the appointments due to limited resources. We realised that something needed to be done to improve access to appointments and improve the quality of the service we were giving to families. As there is no medical need for the checks to be done at one of our main clinics we looked at what other options there were. Working with colleagues at local community pharmacies we provided training to support them in carrying out the necessary physical monitoring, and families were asked if they’d like to choose a pharmacy and convenient time for their appointment. The one year pilot project in the New Forest ran at 15 pharmacies, and more than 130 families took part.
What makes your service stand out from others? Please provide an example of this.
As far as we are aware, this particular approach has not been tried in other areas. It was piloted in the New Forest and 130 families took up the option of an appointment at their local pharmacy. We saw increased numbers of children and young people engaging with medication monitoring, and receiving improved quality of care closer to home. Of those eligible, 90% continued to be actively involved in the project. The audit outcomes for the service improved too, with audit relating to medication monitoring and review improving dramatically. We’ve seen a significant reduction in clinic waiting times and it’s freed up clinical time and resources for CAMHS staff to concentrate on young people who need specialist mental health support at their appointments rather than routine monitoring, which other healthcare colleagues are better placed to provide. It also reduces stress for young people and families, bring appointments closer to home and removing the anxiety around attending a CAMHS clinic by replacing it with the more familiar environment of a community pharmacy. The families are happy with the service and it is now embedded locally as part of our offer to families. We now hope to roll this initiative out across other areas of Hampshire and Sussex, to offer the same level of flexibility to families no matter where they live in the county.
How do you ensure an effective, safe, compassionate and sustainable workforce?
We estimate that the project has feed up around 40% of our resources within the New Forest CAMHS team, enabling our staff to concentrate on providing specialist help at appointments rather than regular monitoring, which other healthcare colleagues are better placed to provide. We have worked closely with our colleagues in community pharmacies to give them the skills they need to competently, and confidently, complete this monitoring. We continue to make ourselves available to these colleagues should they have any questions about the process and have developed a good working relationship with the local pharmacies, strengthening our community connections. Families also benefit because they are able to access advice on medication and other areas of healthcare at the same time.
How do you work with the wider system?
We worked closely with colleagues in pharmacies to give them the skills they needed to carry out the required monitoring. This was done in consultation with them as we developed the pilot, and they were actively invited to share their ideas and views as to how it may work. The same approach was taken with young people and their families. We are sharing our experience and knowledge with other teams across the Trust, in both adult and children’s services and we now hope to roll this initiative out across other areas of Hampshire and Sussex, to offer the same level of flexibility to families no matter where they live in the area we serve. We are also talking to other Trusts across the country, sharing our best practice.
Do you use co-production approaches?
Key to the success of this project was working together as a team with all our stakeholders, which included the young people and their families, our commissioners and local pharmacy colleagues. We involved service users from the beginning, and they helped to co-design the service. We also carried out a mini-pilot prior to starting the project. This meant we went into the project already with overwhelming support and reflecting on the learning and improving the care model with stakeholder feedback. Families like the choice and flexibility that this care model offers and are keen for the service to continue in the future’.
Do you share your work with others?
We share our work internally within the Trust through newsletters and our own staff Positive Practice Awards, which are modelled on those run by the Mental Health Collaborative. The team have also presented the results of the pilot within the Trust and we are working with colleagues in both adult and children’s service to look at rolling the initiative out across the whole area that we serve, giving all service users equal access to such appointments. We have shared our project with NHS England South East and hope that a case study will shortly be published to share the project more widely within the health system.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
We have freed up clinical within the team by 40%, allowing staff to concentrate on the areas of greater need rather than holding monitoring appointments, which can be done by other healthcare professionals rather than mental health specialist. We monitor attendance at appointments, and have seen a significant decrease in the number of missed appointments. The audit outcomes for the service improved too, with audit relating to medication monitoring and review improving dramatically.
Has your service been evaluated (by peer or academic review)?
Not that I’m aware of at this stage.
How will you ensure that your service continues to deliver good mental health care?
The pharmacy project is now embedded within the pathway for New Forest CAMHS following the positive evaluation of medication monitoring, appointment attendance and general satisfaction from families. We continue to work closely with colleagues at pharmacies across the area to ensure they have the skills and resources they need to continue the project. There is commitment from Sussex Partnership to continue the arrangement, and we are talking with colleagues from other services across the Trust to look at the possibility of rolling it out further. Our commissioners are also pleased with the impact it has had on our service and the clinical time that has been freed up.
How many people do you see?
132 families initially took part in the pilot and 90% are still engaged with the project.
How do people access the service?
Open to anyone attending the ADHD clinic at New Forest CAMHS. They are offered the option of monitoring appointments at a selected local pharmacy or to continue attending the main CAMHS clinic.
How long do people wait to start receiving care?
Appointments begin as soon as the family express a wish to take up a pharmacy appointment.
How do you ensure you provide timely access?
Appointments are available at 15 pharmacies across the area, ensuring demand is spread and convenient appointments can be offered.
Webpage for service
www.hampshirecamhs.nhs.uk
Hours the service operates *
Monday to Friday, 9am – 5pm
Population details
Brief description of population (e.g. urban, age, socioeconomic status):
The New Forest is close to the urban centre of Southampton but is rural in nature, with populations dispersed across the National Park area.
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
West Hampshire CCG
Provided by (e.g. name of NHS trust) or your organisation: *
