Objectives: To develop a responsive CHL service for the 3000 care home residents within a Scottish Health region (Fife, population 365,000), to reduce their psychiatric admissions and to reduce levels of antipsychotic prescribing.
Background: The Fife CHL service was established in late 2017 funded by the Scottish Government’s Primary Care Transformation Fund, recognising the demands on Primary Care services from care home populations with mental health problems. Specialist mental health input to Care Homes prior to service development was variable.
Methods: The CHL team consisted of one psychiatrist and eight mental health nurses.  Training facilitation roles for CHL nurses were developed to enable them to offer a range of education and skills development for care home staff. CHL members attend hospitals to ensure knowledge of patients being discharged into Care Homes to facilitate successful discharge.  The CHL psychiatrist reviews residents on psychotropics and provides recommendations.  Routine service data were analysed, and satisfaction surveys were collected from referrers and users.
Results:  During 2018, 524 new referrals (73% dementia diagnoses) were actioned within operational guidelines (three days for urgent, 10 days for routine), with an average of 225 nursing visits per month. For residents with dementia prescribed antipsychotics 76% received recommendations to either reduce and/or discontinue with a potential pharmacy saving of £30k/year. A 33% reduction in admissions from Care Homes to psychiatric wards occurred when compared to the pre-CHL year.
Conclusions:  Development of the CHL service allowed a focussed, responsive service that achieved its primary objectives and with positive responses from those surveyed.

WCP-2019