Commissioning neuropsychiatry services: barriers and lessons

Abstract

Aims and methodPrevious studies have shown variations in commissioning of neuropsychiatry services and this makes access to neuropsychiatric services a post-code lottery. In this survey, we approached all mental health and neuropsychiatric service commissioners within London to map current funding and commissioning arrangements, and explored perceived barriers to neuropsychiatric service commissioning.Results83% of commissioners within London responded. There was significant variability between neuropsychiatric services commissioned through the mental health stream. Contracting arrangements were variable. Lack of earmarked fund for neuropsychiatry and disjointed funding stream for such services were identified by commissioners as a barrier, as was the critical mass of neuropsychiatric cases.Clinical implicationsNeuropsychiatric service development continues to be hindered by lack of clear commissioning process. Strategic drive is needed to promote more equitable neuropsychiatric services. National or regional commissioning covering a large population will provide a better model for neuropsychiatric services to be commissioned.

Provision of neuropsychiatry services: variability and unmet need

“…Most neuropsychiatry service models from outside the UK refer to a liaison consultation model. 10 , 19 In the UK, the College's Faculty of Neuropsychiatry working group proposed a hub-and-spoke model, with the hub closely allied to the neurosciences centre but the spokes working closely with services in the community. 6 Currently, there is no evidence that this model has yet been adopted consistently in London.…”

“…The participants' responses might be affected owing to a lack of coherent understanding around caseness in neuropsychiatry. We have proposed a clearer definition of what constitutes a neuropsychiatric condition in Box 2 in the accompanying paper, 10 and have defined the threshold criteria for when a referral should be made to a neuropsychiatric service for such conditions in Box 1 in this paper. In our opinion, a combination of a clear definition of neuropsychiatric condition and the threshold criteria will help resolve the issue of caseness.…”

“…The reasons for such variability need to be explored and minimised. Barriers to commissioning and provision 10 need to be explored and removed. A hub-and-spoke model of neuropsychiatry provision closely allied with neurosciences centres 6 should be adopted widely to bring consistency of pathways.…”

“…We have defined neuropsychiatric conditions under four broad categories in the accompanying paper. 10 Not all patients in those categories would require specialist neuropsychiatric input. Neuropsychiatry services would see patients that are complex and beyond the service provision capacity of either neurology services or mental health services alone.…”

“…Neuropsychiatry services would see patients that are complex and beyond the service provision capacity of either neurology services or mental health services alone. Patients accessing neuropsychiatry services should have problems that fall within one of the four categories that define neuropsychiatric conditions 10 and should meet at least one of the criteria described in Box 1 .…”