1. Psychological therapies – Penrith, Cumbria Alan Cohen FRCGP Senior Primary Care Advisor

2. Summary The development of the Improving Access to Psychological Therapies (IAPT) programme The current state of play The role of primary care and general practice

3. First, there was the case for change The impact of untreated depression & anxiety –1 in 6 adults (16% population) –10% new mothers (of whom only 20% receive any treatment) –1.3m older people –700k children and younger people –30% of GP consultations –Long Term conditions –Medically unexplained symptoms

4. What happened? 2005: Manifesto commitment to improved access to psychological therapies 2006: 2 demonstration sites created –Doncaster and Newham each funded with £1.5m

5. Demonstration Site Progress report Access –5,000 more people treated –70% GP referrals –30% Self-Referrals (anti-stigma & inclusive) –Wait times down to 2 weeks –3 days to assessment Service Models (Stepped Care) –Low Intensity (>8 hours) –High Intensity (>20 hours)

6. Demonstration Site Progress report Right Results –Systematic outcome monitoring system –Health & well-being gains Exceeded NICE guidelines (>50% recovery rate) –Social Inclusion 100% job retention 30% back to work or education 7% off benefits –Choice and user experience 90% satisfaction rates 89% able to make choices

7. Then what happened? May 2007: 11 “Pathfinder” sites, each funded with £200K

8. The IAPT Pathfinders 11 PCT-led Pathfinder sites –1 in each SHA area –Service redesign & capacity planning –1 additional site in Bury (NW) CAMHS Progress –109 (70%) PCTs expressed an interest in Pathfinders –76 (50%) full applications –Sites announced 31 July & commitment to Regional Networks

9. And then... October 2007: SoS announces £30m/£100m/£170m new funding for IAPT programme

10. What the investment will provide: 800,000 more people treated; 400,000 recovered 20,000 fewer people on sick pay & benefits 3,000 more psychological therapists Universal GP access to therapies Waiting times down from 18 months to 2 weeks

11. The Characteristics of an IAPT Service Multi-disciplinary team –Teams of therapists Equality of access Delivering NICE compliant treatment –Stepped care system Low intensity interventions <7 High intensity interventions >20

12. The Characteristics of an IAPT Service Routine outcome monitoring –Clinical and service indicators –At least 90% of patients/users/people will have outcome data Right workforce –60:40 high:low intensity workers –Supervision requires that at least a third of workers are fully trained.

13. What an IAPT service delivers Psychological therapy services –NICE compliant Links/partnership with employment services Links/partnership with social care Need not be delivered by a statutory sector provider

14. The Role of Primary Care - Commissioning Development of a commissioning tool kit –Designed for any commissioner Practice Based Commissioning –Does PBC have a role? –What are the risks associated with PBC?

15. The Role of Primary Care - Clinical Identification, management and onward referral (where clinically indicated) to the new service The generalist approach: –Association between mental and physical health –Use of acute services Appropriate prescribing –Anti-depressant prescribing –Benzo prescribing Information sharing –about the new service –with the new services

16. Physical health Strong associations exist between depression and Ischaemic Heart Disease Diabetes COPD Better management improves outcomes, and burden of disease in these areas

17. Acute services Close association between physical symptoms and mental distress Probably one of the elements in why recognition of mental health conditions in primary care can be “poor” Lots of referrals to acute out patient services, for people with medically unexplained symptoms

18. Clinic% Chest59% Cardiology56% Gastroenterology60% Rheumatology58% Neurology55% Dental49% Gynaecology57% Prevalence of unexplained symptoms in consecutive attendees at a UK teaching hospital

19. Prescribing Will IAPT services slow the inexorable growth in prescribing of anti-depressants? –Awaiting detailed evaluation from St George’s HMS Benzo and Z withdrawal –http://www.benzo.org.uk/manual/bzcha02.htmhttp://www.benzo.org.uk/manual/bzcha02.htm –http://cks.library.nhs.uk/benzos_z_drug_withdrawal/in _summary/scenario_starting_withdrawalhttp://cks.library.nhs.uk/benzos_z_drug_withdrawal/in _summary/scenario_starting_withdrawal –http://www.pjonline.com/medicinesmanagement/editori al/200503/features/p03benzodiazepine.htmlhttp://www.pjonline.com/medicinesmanagement/editori al/200503/features/p03benzodiazepine.html

20. Benzo/Z drug withdrawal Guidelines on withdrawal process are consistent that... –Psychological assessment is necessary –Psychological support during and after withdrawal is necessary In the past adequate and timely availability of this support, and in the management of common mental health problems, has been poor IAPT provides the opportunity to deliver that psychological support

21. What happens next? PCT delivery incentives –PSA target –HSC Outcomes Framework objective –NHS Operating Framework 08/09 SHA leadership for local implementation –Performance management –Ensuring Regional Workforce & Training solutions –Capacity (& demand) planning –Commissioning Toolkit

22. A forward look: 2008/09 Each SHA will identify at least 2 sites to act as training centres of excellence for therapists Each SHA will identify providers of training Each SHA has a budget for development, including… –GP lead –PC lead –Development fund It is up to each SHA how the development budget is used!

23. Summary IAPT programme entering a planned dissemination phase Engaging with groups other than “adults of working age” Engaging with commissioners Developing regional networks as part of the programme of dissemination and spread.

24. Further information www.mhchoice.csip.org.uk/Pathfinder/Resources