Aim of the study

Partners2 logo

PARTNERS2 aims to help primary care and community based mental health services work more closely together.

We think this could be achieved by developing a system of collaborative care based in GP surgeries where many adult service users are seen regularly by an experienced mental health worker who acts both as overall co-ordinator (supporting individuals to access other services and activities) and therapist. This person would see the person regularly, help them help themselves and facilitate recovery in the broadest sense and, where required, call on the talents of other parts of the health service, particularly secondary mental health care and voluntary/community organisations.

This is a simple idea - but we need to work through all the details carefully by testing the programme. We have run a test of this model with some GP practices, and are now in the process of setting up a randomised control trial.

At the end of the five year Programme, we will know if collaborative care for people with a diagnosis of schizophrenia or bipolar in England is likely to work, based on the views of all the people involved in setting it up and using it, how well people are feeling in themselves, the quality of their lives, how many feel they are more recovered, and what the system costs to run.

Design...

This will be a 2-stage programme, conducted in 3 centres in England; Birmingham, Devon and Lancashire. The first stage will involve developing a model of collaborative care using evidence from users, carers, GPs, Trust clinicians and CCG commissioners. We will also gather evidence from community mental health teams practices to understand the nature of current practice. We will then conduct a randomised control trial in the second phase to examine the effectiveness and acceptability of the new model. The research will be divided into 6 workstreams.

Stage 1

Workstream 1

Purpose: To describe the process of current care, help better target those who would most benefit from collaborative care and assess potential risk and safety issues.

Methodology: We conducted an observational retrospective cohort study (notes review), development of an economic decision analytic model and focus groups with service users and carers.

Status: Data collection and analysis for the notes review and focus groups has been completed. We have used these findings to inform the next stages of the study.

Workstream 2

Purpose: To develop a core outcome set and measures for use in mental health trials involving people with a diagnosis of schizophrenia or bipolar in a community based setting.

Methodology: Currently there is no gold standard for the development of core outcome sets. Our approach is therefore based on current practice and includes focus groups with key stakeholders, a Delphi process, systematic review and stated preference survey.

Status: Focus groups and systematic reviews have been completed. We are nearing completion of the core outcome set for bipolar, and hope to conduct the Delphi survey for schizophrenia in 2018.

Workstream 3

Purpose: To define and develop the key components of collaborative care for people with a diagnosis of schizophrenia or bipolar in an English context.

Methodology: Iterative development of the model building on the team’s recent Cochrane review using a range of qualitative and quantitative data.

Status: We have developed the initial model and have trialled this to test the effectiveness.

Workstream 4

Purpose: To test the feasibility of patient and practice recruitment and commissioning.

Methodology: Qualitative work involving semi-structured interviews, and patient and practice structured surveys.

Status: We have conducted interviews and data has been collected from practices and service users.  

Stage 2                                

Workstream 5

Purpose: To draw the findings of the previous four WS into a pilot trial protocol and process evaluation.

Methodology: Data synthesis and economic analysis.

Status: We are currently setting up a cluster randomised control trial. The three sites are in the process of recruiting 60 GP practices to participate in the trial, and the Care Partners who will be working with the participants. We anticipate the trial to begin in June 2017.

Workstream 6

Purpose: To establish the proof of concept of the intervention, estimate effects within a pilot trial and inform the design a definitive trial of collaborative care.

Methodology: Carry out a pilot trial based upon the information we have gathered and model formulated. This is in the format of a randomised cluster control trial, operating within 60 GP surgeries and with 300 participants across the three sites.

Setting...

PARTNERS2 represents a collaboration between four leading Universities and is strongly supported by research networks and Clinical Commissioning Groups and Mental Health Trusts in Birmingham, Lancashire and South Devon.