Qualitative evaluation of a complex mental health intervention in general practices serving socioeconomically disadvantaged communities in northern England

Background ‘Deep End’ primary care is a network of general practices serving communities facing extreme socioeconomic disadvantage. In the ‘Deep End’ there are high levels of patient mental ill-health support needs. Previous co-design research with professionals working in Deep End Primary Care has identified key priorities for them around better supporting patients’ mental health and dealing with relentlessly high numbers of patients with multiple and complex needs, against a backdrop of severe challenges in workforce recruitment and retention. MINDED (Mental Health In the Deep End) is a qualitative evaluation aiming to understand the feasibility and acceptability of implementing a complex intervention to embed a GP-based psychology team in ‘Deep End’ primary care within Northern England.Methods Case studies of three models of service delivery in GP practices were explored using qualitative interviews with professional staff in clinical and non-clinical roles. NHS Research Ethics Committee-approved topic guides examined the context of each pilot; phases of recruitment, training, supporting and embedding new staff; and the organisational changes involved in expanding workforce provision. Audio-recorded, online interviews were transcribed verbatim, and then analysed using thematic analysis, including deductive codes derived from topic guides, and iterative codes emerging from data collection.Results The pilot was implemented in six ‘Deep End’ general practices. Thirty semi-structured interviews were conducted with professionals working in these practices (GPs, nurse practitioners, practice managers and support staff, mental health therapists, practitioners, clinical psychologists, pharmacists and social prescribing link workers). The interviews revealed the varying context of each practice, from the number of registered patients, daily administrative tasks and responsibilities (triage and booking systems), and variation in new mental health roles implemented (career stage, experience, expertise). Complexities around recruitment necessitated pursuing a range of funding streams and employment arrangements (general practice direct employment and secondment of mental health specialists from Secondary Care Trusts).The evaluation captured key learning in respect of the hopes, expectations, barriers and bumps to integrating new in-house psychology services in Primary Care. The results are grounded in the data and show that complex interventions evolve and unfold over time, yet this context also elevates the importance of documenting the shifting landscape and demonstrating how pilot studies translates in to practice.Conclusion The complexities uncovered through this research will inform service transformation and act as a guide to other areas wishing to implement similar interventions and address socioeconomic inequalities in health and care