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What does the IAPT Commissioning Toolkit say for counsellors?
The IAPT Commissioning Toolkit is an important document for counsellors. It is intended as a guide for commissioners and PCTs in establishing IAPT or IAPT model services. Counsellors will find the guidelines useful to remind commissioners of the undertakings which are relevant to existing services and to counsellors. Below is a selection of pertinent extracts from the document but it is also worth reading in its entirety.
On maintaining existing services:
p.5, 2.2 ‘The IAPT programme is not intended to fund all the psychological therapies needed but to increase the amount of therapies available and the expenditure on healthcare.'
2.3 ‘PCTs have an opportunity to map existing psychological therapies services, review their effectiveness (including cost-effectiveness) and build on and complement them, whether they are provided by the statutory, third or independent sector. While it is the duty of commissioners to ensure service efficiencies, this should not be funded by inappropriate cuts in other mental health services.'
p.9, 2.15 ‘In developing psychological therapies services, commissioners and their Practice Based Commissioning (PBC) groups may consider how existing primary care counselling services can be integrated into stepped-care psychological therapies services.'
p.10, 2.16 ‘It will be helpful to review the services that are currently available, including counselling services, to ensure that their current role is understood and gaps in services are identified.'
p.17, 4.4 ‘ It is important to remember that the new IAPT investment is intended to fund additional psychological therapies, not to replace any funding that PCTs have already been making available for those services'.
On counsellors as a source of IAPT workforce:
p.10, 2.16 ‘Counsellors are an important source of the IAPT workforce supply, and so it will be helpful to offer additional training to enable them to deliver the broader range of psychological therapies.'
On training the existing workforce:
p.28, 6.1 ‘Psychological therapies services require competent and qualified therapists to deliver evidence-based treatments within the stepped care model. Many existing practitioners deliver these therapies. Some of these therapists will need to undertake further training in more specialist psychological therapies (such as high-intensity interventions or CBT) in order to provide the range and depth of therapeutic skills needed'.
p.11 Bullet point two: ‘Collaborate with clinicians - ensuring that, through the involvement of clinicians in strategic planning and service design, commissioned services build on the current evidence base, maximise local care pathways and utilise resources effectively.'
p.18, 4.7 ‘Commissioners should consider involving current and potential providers in the needs assessment (at both population and individual level) and in planning how to address identified need. The planning should include reviewing the range of providers best able to meet the needs of the community and considering how best to incentivise providers to improve or meet gaps in current service provision'.
On patient choice and equity of access:
p.14, 3.11 ‘Commissioning a balanced portfolio of clinically effective psychological therapies is key to promoting equity of access'
p.25, 5.16 ‘Patient choice is an important factor in determining outcomes of psychological therapy. There is a wide individual variation in the degree to which different therapies are tolerated. Retaining choice within commissioned care pathways therefore remains critical in promoting positive outcomes'.
See also: 5.17, 5.18
High intensity interventions = counselling
p.21, 5.4 The section on high intensity interventions lists counselling as one of the evidence based NICE recommended interventions.
p.22, 5.5 States that high intensity interventions should be provided by a qualified therapist (not specifying CBT therapists)
p.23 Counselling is included in the table for high intensity interventions for mild to moderate depression at Step 3.
What is the evidence base for counselling in the NICE Guidelines?
Counselling is recommended in the NICE Guidelines (2004) as one of the evidence based treatments for mild to moderate depression.
NICE Guidelines on Depression
See for example, pages: 47,54,56,120,140-44, 155,266.