Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
REVIEW (Open Access)

Systems levers for commissioning primary mental healthcare: a rapid review

Carla Meurk A B E , Meredith Harris A B , Eryn Wright A B , Nicola Reavley C , Roman Scheurer A B , Bridget Bassilios C , Caroline Salom B D and Jane Pirkis C
+ Author Affiliations
- Author Affiliations

A The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia.

B Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld 4108, Australia.

C The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia.

D Institute for Social Sciences Research, The University of Queensland, Long Pocket Precinct, 80 Meiers Road, Indooroopilly, Qld 4068, Australia.

E Corresponding author. Email: c.meurk@uq.edu.au

Australian Journal of Primary Health 24(1) 29-53 https://doi.org/10.1071/PY17030
Submitted: 8 March 2017  Accepted: 23 September 2017   Published: 17 January 2018

Journal compilation © La Trobe University 2018 Open Access CC BY-NC-ND

Abstract

Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. A rapid review of academic and grey literature published between 2006 and 2016 was undertaken to describe the use of systems levers in commissioning primary care services. Fifty-six documents met the inclusion criteria, including twelve specific to primary mental healthcare. Twenty-six levers were identified. Referral management, contracts and tendering processes, and health information systems were identified as useful levers for implementing stepped care approaches. Location, enrolment, capitation and health information systems were identified as useful in implementing a healthcare homes approach. Other levers were relevant to overall health system functioning. Further work is needed to develop a robust evidence-base for systems levers. PHNs can facilitate this by documenting and evaluating the levers that they deploy, and making their findings available to researchers and other commissioning bodies.


References

Addicott R (2014) Commissioning and contracting for integrated care. The King’s Fund, London, UK.

Ashcroft R, Silviera J, Rush B, McKenzie K (2014) Incentives and disincentives for the treatment of depression and anxiety: a scoping review. Canadian Journal of Psychiatry – Revue canadienne de psychiatrie 59, 385–392.
Incentives and disincentives for the treatment of depression and anxiety: a scoping review.CrossRef |

Ashman I, Willcocks S (2014) Engaging with clinical commissioning: the attitudes of general practitioners in East Lancashire. Quality in Primary Care 22, 91–99.

Ashton T (2015) Measuring health system performance: a new approach to accountability and quality improvement in New Zealand. Health Policy 119, 999–1004.
Measuring health system performance: a new approach to accountability and quality improvement in New Zealand.CrossRef |

Australian Government Department of Health (2015a) Needs assessment guide, December 2015. Commonwealth of Australia, Canberra, ACT, Australia.

Australian Government Department of Health (2015b) Australian Government response to contributing lives, thriving communities – review of mental health programmes and services. Commonwealth of Australia, Canberra, ACT, Australia.

Australian Government Department of Health (2016) Primary health networks: grant programme guidelines V1.2. Commonwealth of Australia, Canberra, ACT, Australia.

Australian Healthcare and Hospital Association (2015a) Mental Health: AHHA Primary Health Network discussion paper series: paper two. Australian Healthcare & Hospitals Association, Canberra, ACT, Australia)

Australian Healthcare and Hospital Association (2015b) Primary Health Network critical success factors: AHHA Primary Health Network discussion paper series: paper one. Australian Healthcare & Hospitals Association, Canberra, ACT, Australia.

Ball SL, Greenhalgh J, Roland M (2016) Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness? BMC Family Practice 17, 37
Referral management centres as a means of reducing outpatients attendances: how do they work and what influences successful implementation and perceived effectiveness?CrossRef |

Bassilios B, Nicholas A, Reifels L, Machlin A, Ftanou M, King K, Fletcher J, Blashki G, Burgess P, Pirkis J (2013) Evaluating the Access to Allied Psychological Services (ATAPS) program: consolidated 10-year report. Centre for Health Policy, Programs and Economics, The University of Melbourne: Melbourne, Vic., Australia.

Box G (2009) Patient participation groups: the national picture. Quality in Primary Care 17, 291–297.

Breton M, Levesque J-F, Pineault R, Hogg W (2011) Primary care reform: can Quebec’s family medicine group model benefit from the experience of Ontario’s family health teams? Healthcare Policy 7, e122–e135.

Breton M, Maillet L, Haggerty J, Vedel I (2014) Mandated Local Health Networks across the province of Quebec: a better collaboration with primary care working in the communities? London Journal of Primary Care 6, 71–78.
Mandated Local Health Networks across the province of Quebec: a better collaboration with primary care working in the communities?CrossRef |

Buetow S (2008) Pay-for-performance in New Zealand primary health care. Journal of Health Organization and Management 22, 36–47.
Pay-for-performance in New Zealand primary health care.CrossRef |

Bywood P, Brown L, Raven M (2015) Improving the integration of mental health services in primary health care at the macro level. PHCRIS Policy Issue Review. Primary Health Care Research and Information Service, Adelaide, SA, Australia.

Campbell SM, McDonald R, Lester H (2008) The experience of pay for performance in English family practice: a qualitative study. Annals of Family Medicine 6, 228–234.
The experience of pay for performance in English family practice: a qualitative study.CrossRef |

Cartwright N, Hardie J (2012) ‘Evidence-Based Policy: a Practical Guide to Doing it Better.’ (Oxford University Press: New York, NY, USA)

Chambers N, Sheaff R, Mahon A, Byng R, Mannion R, Charles N, Exworthy M, Llewellyn S (2013) The practice of commissioning healthcare from a private provider: learning from an in-depth case study. BMC Health Services Research 13, S4
The practice of commissioning healthcare from a private provider: learning from an in-depth case study.CrossRef |

Chan T, Cohen A, de Lusignan S (2010) Using routine data to conduct small area health needs assessment through observing trends in demographics, recording of common mental health problems (CMHPs) and sickness certificates: longitudinal analysis of a northern and London locality. Informatics in Primary Care 18, 273–282.

Checkland K, Coleman A, Harrison S, Hiroeh U (2009) ‘We can’t get anything done because...’: making sense of ‘barriers’ to Practice-based Commissioning. Journal of Health Services Research & Policy 14, 20–26.
‘We can’t get anything done because...’: making sense of ‘barriers’ to Practice-based Commissioning.CrossRef |

Checkland K, Allen P, Coleman A, Segar J, McDermott I, Harrison S, Petsoulas C, Peckham S (2013) Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS. BMJ Open 3, e003769
Accountable to whom, for what? An exploration of the early development of Clinical Commissioning Groups in the English NHS.CrossRef |

Cummins S, Curtis S, Diez-Roux AV, Macintyre S (2007) Understanding and representing ‘place’ in health research: a relational approach. Social Science & Medicine 65, 1825–1838.
Understanding and representing ‘place’ in health research: a relational approach.CrossRef |

Dawda P, True A, Wells L (2016) Commissioning: perspectives from the ground. Australian Journal of Primary Health 22, 5–8.
Commissioning: perspectives from the ground.CrossRef |

Department of Health (2016) Fifth National Mental Health Plan: draft for consultation. Available at http://www.health.gov.au/internet/main/publishing.nsf/content/8F54F3C4F313E0B1CA258052000ED5C5/$File/Fifth%20National%20Mental%20Health%20Plan.pdf [Verified 27 August 2017]

Douglas KA, Rayner FK, Yen LE, Wells RW, Glasgow NJ, Humphreys JS (2009) Australia’s primary health care workforce–research informing policy. The Medical Journal of Australia 191, 81–84.

Edwards K, Lunn J, Baass B (2015) Beyondblue NewAccess: demonstration independent evaluation. Summary of findings – reporting to August 2015. Ernst & Young: Melbourne, Vic., Australia.

Elston J, Stein K (2007) A rapid needs assessment of the provision of Health Technology Assessment in the south-west peninsula. Journal of Public Health 29, 157–164.
A rapid needs assessment of the provision of Health Technology Assessment in the south-west peninsula.CrossRef |

Ferrante JM (2010) Principles of the patient-centered medical home and preventive services delivery. Annals of Family Medicine 8, 108–116.
Principles of the patient-centered medical home and preventive services delivery.CrossRef |

Flodgren G, Pomey M-P, Taber SA, Eccles MP (2011) Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes. Cochrane Database of Systematic Reviews 2011, CD008992

Franx G, Dixon L, Wensing M, Pincus H (2013) Implementation strategies for collaborative primary care-mental health models. Current Opinion in Psychiatry 26, 502–510.
Implementation strategies for collaborative primary care-mental health models.CrossRef |

Gardner K, Powell Davies G, Edwards K, McDonald J, Findlay T, Kearns R, Joshi C, Harris M (2016) A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy. Australian Journal of Primary Health 22, 40–49.
A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy.CrossRef |

Gask L, Rogers A, Campbell S, Sheaff R (2008) Beyond the limits of clinical governance? The case of mental health in English primary care. BMC Health Services Research 8, 63
Beyond the limits of clinical governance? The case of mental health in English primary care.CrossRef |

Goodwin E, Frew EJ (2013) Using programme budgeting and marginal analysis (PBMA) to set priorities: reflections from a qualitative assessment in an English Primary Care Trust. Social Science & Medicine 98, 162–168.
Using programme budgeting and marginal analysis (PBMA) to set priorities: reflections from a qualitative assessment in an English Primary Care Trust.CrossRef |

Grace FC, Meurk C, Head B, Hall W, Carstensen G, Harris M, Whiteford H (2015) An analysis of policy levers used to implement mental health reform in Australian 1992–2012. BMC Health Services Research 15, 479
An analysis of policy levers used to implement mental health reform in Australian 1992–2012.CrossRef |

Grace FC, Meurk CS, Head BW, Hall WD, Harris MG, Whiteford HA (2017) An analysis of policy success and failure in formal evaluations of Australia’s National Mental Health Strategy (1992–2012). BMC Health Services Research 17, 374
An analysis of policy success and failure in formal evaluations of Australia’s National Mental Health Strategy (1992–2012).CrossRef |

Grant S, Ring A, Gabbay M, Guthrie B, McLean G, Mair FS, Watt G, Heaney D, O’Donnell C (2015) Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams. Sociology of Health & Illness 37, 30–51.
Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.CrossRef |

Greenhalgh T, Humphrey C, Hughes J, MacFarlane F, Butler C, Pawson R (2009) How do you modernize a health service? A realist evaluation of whole-scale transformation in London. The Milbank Quarterly 87, 391–416.
How do you modernize a health service? A realist evaluation of whole-scale transformation in London.CrossRef |

Gyani A, Shafran R, Layard R, Clark DM (2011) Enhancing recovery rates in IAPT services: lessons from analysis of the year one data. Improving Access to Psychological Therapies (IAPT), London, UK.

Ham C, Raleigh V, Foot C, Robertson R, Alderwick H (2015) Measuring the performance of local health systems: a review for the Department of Health. The King’s Fund, London, UK.

Harris M, Pirkis J, Burgess P, Olesen S, Bassilios B, Fletcher J, Blashki G, Scott A (2010) Evaluation of the better access to psychiatrists, psychologists and GPs through the Medicare Benefits Schedule initiative: component B: an analysis of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) administrative data. Centre for Health Policy, Programs and Economics, The University of Melbourne, Melbourne, Vic., Australia.

Health Care Homes Implementation Advisory Group (2016) Terms of reference: Health Care Homes Implementation Advisory Group. (Commonwealth of Australia, Department of Health) Available at http://www.health.gov.au/internet/main/publishing.nsf/content/primary-tor-health-care-homes [Verified 7 June 2017]

Hilferty F, Cassells R, Muir K, Duncan A, Christensen D, Mitrou F, Gao G, Mavisakalyan A, Hafekost K, Tarverdi Y, Ngo H, Nguyen H, Wingrove C, Katz I (2015) Is headspace making a difference to young people’s lives? Final report of the independent evaluation of the headspace program. Social Policy Research Centre, University of New South Wales, Sydney, NSW, Australia.

Jacobs R, Martin S, Goddard M, Gravelle H, Smith P (2006) Exploring the determinants of NHS performance ratings: lessons for performance assessment systems. Journal of Health Services Research & Policy 11, 211–217.
Exploring the determinants of NHS performance ratings: lessons for performance assessment systems.CrossRef |

Ludwick D, Manca D, Doucette J (2010) Primary care physicians’ experiences with electronic medical records: implementation experience in community, urban, hospital, and academic family medicine. Canadian Family Physician Medecin de Famille Canadien 56, 40–47.

Marshall L, Charlesworth A, Hurst J (2014) The NHS payment system: evolving policy and emerging evidence research report. Nuffield Trust, London, UK.

May J, Cooper R, Magin P, Critchley A (2008) Integrated models or mayhem? Lessons learnt from three integrated primary health care entities in regional New South Wales. Australian Health Review 32, 595–604.
Integrated models or mayhem? Lessons learnt from three integrated primary health care entities in regional New South Wales.CrossRef |

McCafferty S, Williams I, Hunter D, Robinson S, Donaldson C, Bate A (2012) Implementing world class commissioning competencies. Journal of Health Services Research & Policy 17, 40–48.
Implementing world class commissioning competencies.CrossRef |

McDonald J, Harris MF, Cumming J, Powell Davies G, Burns P (2008) The implementation and impact of different funding initiatives on access to multidisciplinary primary health care and policy implications. The Medical Journal of Australia 188, S69–S72.

Meurk C, Leung J, Hall W, Head BW, Whiteford H (2016) Establishing and governing e-mental health care in Australia: a systematic review of challenges and a call for policy-focussed research. Journal of Medical Internet Research 18, e10
Establishing and governing e-mental health care in Australia: a systematic review of challenges and a call for policy-focussed research.CrossRef |

Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6, e1000097
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.CrossRef |

Moore TG, McHugh-Dillon H, Bull K, Fry R, Laidlaw B, West S (2014) The evidence: what we know about place-based approaches to support children’s wellbeing. Murdoch Children’s Research Institute and The Royal Children’s Hospital Centre for Community Child Health, Melbourne, Vic., Australia.

Mossialos E, Wenzl M, Osborn R, Sarnak D (Eds) (2016) 2015 international profile of health care systems. (Commonwealth Fund: New York, NY, USA, and Washington, DC, USA) Available at http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf [Verified 24 May 2017]

Naik YJ, Anderton C, Fell G (2013) Integrating specialist advice following reforms: an interview-based survey. JRSM Short Reports 4, 24
Integrating specialist advice following reforms: an interview-based survey.CrossRef |

National Institute for Health and Care Excellence (2011) Commissioning stepped care for people with common mental health disorders. National Institute for Health and Care Excellence, London, UK.

National Mental Health Commission (2014) The national review of mental health programmes and services. National Mental Health Commission: Sydney, NSW, Australia.

Naylor C, Goodwin N (2011) The use of external consultants by NHS commissioners in England: what lessons can be drawn for GP commissioning? Journal of Health Services Research & Policy 16, 153–160.
The use of external consultants by NHS commissioners in England: what lessons can be drawn for GP commissioning?CrossRef |

Noble D, Smith D, Mathur R, Robson J, Greenhalgh T (2012) Feasibility study of geospatial mapping of chronic disease risk to inform public health commissioning. BMJ Open 2, e000711
Feasibility study of geospatial mapping of chronic disease risk to inform public health commissioning.CrossRef |

Nolan E, Hewison A (2008) Teamwork in primary care mental health: a policy analysis. Journal of Nursing Management 16, 649–661.
Teamwork in primary care mental health: a policy analysis.CrossRef |

O’Cathain A, Sampson F, Strong M, Pickin M, Goyder E, Dixon S (2015) Do marginal investments made by NHS healthcare commissioners in the UK produce the outcomes they hope to achieve? Observational study. BMJ Open 5, e009336
Do marginal investments made by NHS healthcare commissioners in the UK produce the outcomes they hope to achieve? Observational study.CrossRef |

OED Online (2017) Competition, n. (Oxford University Press) Available at http://www.oed.com/view/Entry/37578?rskey=SVqmqC&result=1 [Verified 6 June 2017]

Pearce CM, de Lusignan S, Phillips C, Hall S, Travaglia J (2013) The computerized medical record as a tool for clinical governance in Australian primary care. Interactive Journal of Medical Research 2, e26
The computerized medical record as a tool for clinical governance in Australian primary care.CrossRef |

Perera GAR, Dowell AC, Morris CJ (2013) Constructing a framework for quality activity in primary care. Australian Health Review 37, 98–103.
Constructing a framework for quality activity in primary care.CrossRef |

Perkins N, Coleman A, Wright M, Gadsby E, McDermott I, Petsoulas C, Checkland K (2014) The ‘added value’ GPs bring to commissioning: a qualitative study in primary care. The British Journal of General Practice 64, e728–e734.
The ‘added value’ GPs bring to commissioning: a qualitative study in primary care.CrossRef |

Petsoulas C, Allen P, Checkland K, Coleman A, Segar J, Peckham S, McDermott I (2014) Views of NHS commissioners on commissioning support provision. Evidence from a qualitative study examining the early development of clinical commissioning groups in England. BMJ Open 4, e005970
Views of NHS commissioners on commissioning support provision. Evidence from a qualitative study examining the early development of clinical commissioning groups in England.CrossRef |

Petsoulas C, Peckham S, Smiddy J, Wilson P (2015) Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past. Primary Health Care Research and Development 16, 289–303.
Primary care-led commissioning and public involvement in the English National Health Service. Lessons from the past.CrossRef |

Phillips CB, Pearce CM, Hall S, Travaglia J, De Lusignan S, Love T, Kljakovic M (2010) Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence. The Medical Journal of Australia 193, 602–607.

Primary Health Care Advisory Group (2016) Better outcomes for people with chronic and complex health conditions. Primary Health Care Advisory Group final report. Department of Health, Canberra, ACT, Australia.

Roberts M, Hsiao W, Berman P, Reich M (2009) ‘Getting Health Reform Right: A Guide to Improving Performance and Equity.’ (Oxford Scholarship Online: New York, NY, USA)

Robinson S, Dickinson H, Freeman T, Rumbold B, Williams I (2012) Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England. Health Services Management Research 25, 113–120.
Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England.CrossRef |

Salway S, Mir G, Turner D, Ellison GTH, Carter L, Gerrish K (2016) Obstacles to “race equality” in the English National Health Service: insights from the healthcare commissioning arena. Social Science & Medicine 152, 102–110.
Obstacles to “race equality” in the English National Health Service: insights from the healthcare commissioning arena.CrossRef |

Samra R, Bottle A, Aylin P (2015) Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews. BMJ Open 5, e008128
Monitoring patient safety in primary care: an exploratory study using in-depth semistructured interviews.CrossRef |

Schwartzkoff J, Sturgess GL (2015) Commissioning and contracting for better mental health outcomes. Research report, October 2015. (Rooftop Social for Mental Health Australia) Available at https://mhaustralia.org/sites/default/files/docs/system_reform_-_mhca_project_-_flagship_ng_and_contracting_for_better_m.pdf [Verified 10 November 2017].

Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D (2011) The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database of Systematic Reviews 2011, CD008451

Shepperd S, Adams R, Hill A, Garner S, Dopson S (2013) Challenges to using evidence from systematic reviews to stop ineffective practice: an interview study. Journal of Health Services Research & Policy 18, 160–166.
Challenges to using evidence from systematic reviews to stop ineffective practice: an interview study.CrossRef |

Silvester BV, Carr SJ (2009) A shared electronic health record: lessons from the coalface. The Medical Journal of Australia 190, S113–S116.

Smiddy J, Reay J, Peckham S, Williams L, Wilson P (2015) Developing patient reference groups within general practice: a mixed-methods study. The British Journal of General Practice 65, e177–e183.
Developing patient reference groups within general practice: a mixed-methods study.CrossRef |

WentWest Ltd (2015) High performing mental health in primary care: options for system and funding innovation. Western Sydney Primary Health Network, Sydney, NSW, Australia.

WentWest Ltd (2016) Western Sydney Primary Health Network commissioning framework consultation paper. Commissioning innovative solutions and monitoring outcomes. WentWest Ltd, Sydney, NSW, Australia.

Whiteford H (2011) Shaping National Mental Health Policy. In ‘Oxford Textbook of Community Mental Health.’ (Eds G Thornicroft, G Szmukler, K Mueser, R Drake) pp. 273–278. (Oxford University Press: New York, NY, USA)

Wilks S, Lahausse J, Edwards B (2015) Commonwealth place-based service delivery initiatives: key learnings project. Australian Institute of Family Studies, Melbourne, Vic., Australia.

Zachariadis M, Oborn E, Barrett M, Zollinger-Read P (2013) Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups. BMJ Open 3, e002112
Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.CrossRef |


Full Text PDF (322 KB) Export Citation

View Altmetrics