It is estimated that the total population in York is 198,000 and Selby 83,500 (2011 Census).
On the basis of intensive consultation and staff and service user involvement, the locality has developed a whole system of care. All specialist elements required by the Mental Health National Service Framework are in place, with some local tailoring to meet the challenges of rurality. The service is an integrated health and social care enterprise (with North Yorkshire Social Services).
The whole systems model includes:
• 2 multi-Disciplinary Community Mental Health Teams, North East and South West, which includes nurses, occupational therapists, psychologists, social workers and community support workers with consultant psychiatrist input.
• An Assertive Outreach and Rehabilitation and Recovery Team.
• An Access to Wellbeing Service.
• An Early Intervention in Psychosis Service.
• A 24 hour Crisis Assessment Service and a seven day Home Based Treatment Service. Both have dedicated consultant time.
• A Liaison Service based at York District Hospital.
• A Community Perinatal Service.
• An Approved Mental health professional rota to ensure the need for Mental Health Act assessments can be met during working hours and out of hours.
• There is a newly modified unit for Male and Female Inpatients. Each ward can accommodate 12 patients. The S136 suite and Crisis Assessment Service are attached to this estate.
• Good quality service user and independent sector led community support, housing and inclusion services.
• We aim to provide compassionate care to patients; carers and families that takes account of the patient’s needs and aspirations beyond their mental illness. Our aim is to work collaboratively with patients, sharing responsibility for their care and providing informed choice about treatment options.
• The clinical directorate includes a Locality Manager for Community Services who works closely with the Locality Manager for Acute Services and the Associate Clinical Director. They are all accountable to the Quality Assurance Group which is chaired by the Clinical Director and Head of Services and meets once a month.
Vale of York Clinical Commissioning Group commission a comprehensive range of secondary care mental health services in Selby and York. There are specialist commissioning arrangements for forensic services and tier 4 CAMHS services via NHS England.
Local working arrangements
The post has been created from reconfiguration of services and financial input to the Access to Wellbeing team. The 6PA part of the post is located in the South West Community Mental Health team, (CMHT) based in Selby at Worsley Court. The 4PA part of the job is located with the Access to Well-being Team, (AWT) based at Huntington House in York.
The South West CMHT provides expert secondary mental health care to adults over the age of 18 who live in the Selby and surrounding area. The locality has recently moved from GP allocated services to post code allocated services and there are further plans to align our services with the Primary Care Home model. The other half of the city is covered by the North East CMHT based in York at Huntington House. Our colleagues in the older persons CMHTs provide care for older adults (typically over 70, although the age boundary is flexible depending on need).
The team is multi-disciplinary, utilising the expertise of doctors, nurses, occupational therapists, psychologists, social workers and support workers. There is access to the dietetics team, physical health team and pharmacy.
The whole team consists of
• 1 wte Band 7 Team manager
• 1 wte Band 7 Advanced Nurse Practitioner
• 0.8 wte band 7 CBT therapist
• 9 wte Band 6 Care Co-ordinators (CPNs and OT)
• 8 wte Band 5 Care Co-ordinators (CPNs and OT)
• 3 wte Band 4 Associate Practitioners
• 3 wte Band 3 Support workers
• 0.4 wte Band 8b psychotherapist
• 0.2 wte Band 8a clinical psychologist
• 0.4 wte Band 8b clinical psychologist
• 0.8 wte Band 8c Consultant clinical psychologist
• 0.5 carers support worker
• One clinical pharmacist is attached to the team
• Three junior doctors (one per consultant) – either Psychiatry trainees, GP trainees, or F2 trainees.
• Four administrative staff
• Three consultant psychiatrists
In line with practice across TEWV, the CMHT is divided for clinical purposes into four smaller sub-teams (or ‘cells’): A leadership cell (consultant psychiatrists, team manager, clinical lead, consultant clinical psychologist), and three clinical cells each comprising 8-10 staff members. Research shows that the optimum size of clinical team is 6-12 members, and we have found that working in cells fosters a mutually supportive and clinically responsive atmosphere.
The Access to Wellbeing team acts as a gatekeeping service to secondary mental health services as well as providing short term primary care interventions. It operates extended hours to 6pm.
The team works in a multi-disciplinary manner and consists of:
• Band 7 Team manager.
• 1 Non-medical prescriber
• 8.5 band 6 clinical lead practitioners which consist of nurses and O.T’s
• 3 band 5 clinicians who will be doing groups and brief interventions.
• 2.7 admin/clerical staff.
• Pharmacist (Part time).
The team currently receive around 17 referrals a day. In the last month the team have received 23 requests from GP’s for medication advice, with 5 awaiting outpatient appointments. It would be anticipated that the post holder would assess or review up to 2 patients per day when at the Access team. They would also participate in the huddle at the end of the day to review DNA’s or provide support to the team for any clinical queries.