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BACP's 'NHS Commissioning - a toolkit for psychological therapy providers' and IAPT
'NHS Commissioning - a toolkit for psychological therapy providers' is available to buy now. Click here for more information
7.3.1 Improving Access to Psychological Therapies (IAPT)
The notion of improving access to psychological therapies is a concept that is being adopted and adapted across the four UK nations - again the focus in this section is on the IAPT programme in England, but learning points may be relevant in other UK countries.
It is important to remember that IAPT is being implemented against a backdrop of existing provision. At the time of going to print a National Audit of Psychological Therapies for Anxiety and Depression is being planned, but there is not currently a definitive map of services. The aim of IAPT is to train 3,600 new therapists by 2010/11, this expansion presents various opportunities and challenges for existing service providers.
The national IAPT project team has developed a blueprint for IAPT services that currently focuses on treating anxiety and depression through a stepped care approach, with improved access to Cognitive Behavioural Therapy (CBT0, self-help and guided self-help CBT interventions. A key feature of IAPT sites is the focus on using recognised indicators to collect and monitor outcomes (see section 9.7.6 on outcome measures). The stated intention of the national IAPT programme was not to replace existing services but to improve access to evidence-based psychological therapy by increasing provision of therapies under-supplied in primary care, such as CBT. The IAPT initiative also aims to help remedy the patchy provision of all forms of NICE compliant, evidence based psychological therapies in primary care. Some areas had little or not existing provision, a situation that was clearly unacceptable.
It is important to be mindful that the IAPT model for improving access to CBT interventions will not meet all the psychological therapy needs of a local population. Patient populations vary and anxiety and depression are not the only presenting issues for which psychological therapy offers benefit to patients. In cases of depression and anxiety it is also well documented that CBT will not be effective for everyone, and the patient choice agenda is also important here (see section 4.1.2 on choice). Given that IAPT is not a ‘one size fits all' approach, this means that the national IAPT model requires interpretation in local contexts alongside other service provision.
If implemented effectively and with due consideration to wider psychological therapy needs and provision, IAPT has potential to strengthen psychological therapy services across the board. For example, the IAPT demonstration sites in Doncaster and Newham were established in 2006; both these sites work alongside pre-existing primary and secondary care psychological therapy services. In Doncaster one primary care counselling service was integrated with the IAPT service. Articles in Therapy Today and HCPJ indicate how incorporating the counselling service with IAP has enabled the whole service to improve outcomes for clients through effective assessment of need and appropriate referral.
In November 2008, three years after the launch of the demonstration sites, a further 32 IAPT sites were announced as part of the national IAPT programme in England. Further sites will be coming on stream in November 2009 and more services will tender to become IAPT services in 2010. This will take place both through further roll out of the national programme (with associated funding), and through PCTs taking the IAPT initiative forward within their own funding arrangements. Through commissioning, the IAPT tendering process is open to a wide range of provider types, not just NHS providers, and some third sector services have already been successful in gaining contracts to deliver IAPT services.
In addition to presenting opportunities for providers to secure new contracts, the implementation of IAPT does have implications for existing NHS services. If you are providing a psychological therapy service in a locality where IAPT has been commissioned, or is likely to be commissioned in the future. It is important to consider how your service will work alongside IAPT. You will need to consider how your service can adapt to fit within a systematic approach to stepped care and monitoring outcomes. If you already provide an NHS service you may already implement stepped care and outcome measurement, in which case it is important that your commissioner is aware of this. If your commissioner does not know much about your service it is important to look for early opportunities to engage with them. You need to ensure that any commissioners responsible for commissioning IAPT services are aware of the quality of service you can provide. It is also important to communicate how the service you provide is an essential part of meeting the needs for psychological therapies in your locality.
Another impact of IAPT is in raising awareness of psychological therapies among commissioners. There is a wealth of NHS guidance on the commissioning of IAPT services (see section 4.1.2) which is widely available and actually promoted to commissioners. This raises awareness of the IAPT model, but does not necessarily help commissioners to understand the wider needs of communities in relation to psychological therapies. Service providers may need to demonstrate to commissioners why it is necessary to commission a range of psychological therapy services in order to satisfy the range of need and provide patients with choice; while also demonstrating where their service fits.
It is advisable to consider how your service can be IAPT friendly in the eyes of commissioners who aim to adopt the IAPT model. Think about how your service fits with and/or supports the stepped care model; consider which NICE approved therapies you are able to offer and discuss how your service will monitor and present its outcome data (see section 9.7.6).
When engaging with commissioners responsible for implementing IAPT is also useful to be aware that some PCTs have chosen to re-commission existing primary care psychological therapy services, bringing them together in a new service following the IAPT model. Others are maintaining separate commissioning arrangements for counselling and/or wellbeing services as part of a wider primary care mental health service. The latter approach potentially offers primary care providers scope for marketing a wider range of interests, skills and specialisms. You need to understand the approach your PT is taking - noting that some PCTs are taking a dual approach, ie combining some services to form an IAPT service while maintaining some contracts with other psychological therapy providers.
'NHS Commissioning - a toolkit for psychological therapy providers' is available to buy now. Click here for more information