Important Information for Gps About the Changes to Primary Care Psychological Therapy

Important information for GPs about the changes to Primary Care Psychological Therapy services in Derbyshire

Primary Care Psychological Therapies was selected as one of the areas to be implemented under the Any Qualified provider process in Derby City and Derbyshire County and as a result there will be 5 providers offering services across Derbyshire from April 1st 2013.

This means that patients will be able to choose from any one of the providers based on factors most important to them, e.g. location, waiting times, quality, etc.

In order to understand the impact this will have on referrers and patients we have produced FAQs see below and information leaflets for GPs and patients which are attached as Appendix A and Appendix B. As the service is new and likely to undergo a number of changes and developments we have not yet produced professional leaflets at this stage.

FAQ’s for GPs and Practice Staff

When can I start referring patients to the new service?

The service under AQP will start from April 1st 2013. The new Providers under AQP cannot accept referrals prior to this date (unless they are existing providers that have a contract from April 1st under AQP).

How many providers can patients choose from?

Patients can choose from up to 5 providers.

Patients may choose the provider based on location, time of appointment, waiting list, quality etc. Patients generally will not have a choice of type of therapy or therapist.

Am I allowed to charge providers rental costs for use of practice space?

Where a practice is reimbursed Cost Rent, Notional Rent or direct rent reimbursement by the PCT (or, In future, the NHSCB), any rental received is deducted pound for pound from Cost Rent, Notional Rent or direct rent reimbursement (NHS General Medical Services –Premises Costs Regulations 2004) so there is no point in charging rent. Practices are however able to charge a nominal sum for the cost of heating, lighting, telephone etc as these costs are not reimbursed by the PCT. Some practice premises do have areas which are for third party use and not reimbursed by the PCT by way of Cost Rent, Notional Rent or direct rent reimbursement. If another health professional /provider use space within that third party area, the practices are able to charge rent on that space.

Providers may seek alternatives to GP practice rooms where rent or service charges are being implemented.

What assurance do we have that the IAPT service will be local to my practice /patients and in place from April 1st2013?

We have met with all of the providers and have encouraged them to start making contact with practices to discuss issues such as accommodation, location etc. This will enable us to have a better idea of the coverage across the County. Whilst we are not in a position to give any total guarantees that ALL providers will be fully operational on April 1st in EVERY location we are aware that there will be coverage across the entire County.

Are all providers offering the same service?

In the main, yes they are. All providers will be offering Step 2 (low intensity) and Step 3 (high intensity) NICE recommended therapies for anxiety and depression but they may use different methods of delivery, e.g. telephone treatments, computerised treatments, group therapies etc.

Self-employed counsellor s work in my locality – what will happen to them?

ALL primary care psychological therapies provision will be via AQP so unless the counsellors are employed/contracted to work with an AQP provider they will no longer be able to offer the service. We have met with the counsellors and have met with all affected practices to discuss the implications for each including issues such as transition from existing to new provision, notice periods etc.

No new referrals to existing providers can be made after 1st April unless they are a provider under the new arrangements.

What will happen to patients who are still being seen by our current counsellor or existing IAPT service as of April 1st 2103?

We want to ensure that patient care is not affected, so we need to make sure that patients’ therapy programmes are seen through to their natural conclusion even if this means a brief period of double running. We anticipate that this can be negotiated with all service providers and have met with all practices where this is an issue.

How do I make a referral to one of the providers?

Referrals can be made via Choose and Book or via self-referral. If the provider has not been set up on the Choose and Book system by April 1st then they will need to offer practices an alternative method whilst they set this up. The likelihood initially is that patients will have the option to choose the provider but will book directly with that provider for their appointments. Tina Pottrell, the C&B Lead for Derbyshire, will advise Practices as and when providers go live with their IAPT service on C&B.

Can patients self-refer?

Yes patients will have the ability to self-refer.The practice will always be informed of the self- referral unless the patient has explicitly requested the practice is not advised.

Can I refer a patient to another service under AQP outside of Derbyshire?

Derbyshire GPs can only refer patients under AQP where there is a contract in place. In some cases it may be possible for patients to be seen outside of Derbyshire, e.g. in Nottinghamshire, but only if we have a contract with the provider.

How will I know which provider to refer to?

You will have access to information about the services including; waiting times, venues/location, recovery rates etc. We are developing an information template that we can make available to GPs and patients about the service.

Will this push activity over the estimated demand for IAPT services?

Self-referral is already in place for many services across the Country. Providers have seen a rise in activity but in most cases the patients who self-refer tend to be more motivated to attend sessions and recovery rates tend to be better. Contract leads will be monitoring numbers of self-referrals and will report on this element of the contract.

Is activity capped under AQP?

No. The Department's response to the Cooperation and Competition Panel report on patient choice makes clear that activity caps can work to restrict patient choice and their use is not in the best interests of patients. Commissioners have been required to remove such practices by 31 March 2012 at the latest.

It is expected that performance and quality information will be made available. The format of this is still to be determined.

Appendix A

Choosing your primary care psychological therapies service

Information for patients

Choice of primary care psychological therapies (PCPT) services

For the past few years GPs in some areas of Derbyshire have been able to refer patients to a locally based primary care psychological therapies service. From April 1st 2013 you can be referred by GP or refer yourself to a number primary care psychological therapies services based in various clinics and settings across Derby City or Derbyshire County. You might choose to have your care where it is more convenient to your workplace or where relatives live or where there are shorter waiting times.

In 2010 the Government made a commitment to extend this sort of choice to a variety of health services. In practice this would mean that when you are referred (usually by your GP) or refer yourself to a particular service you should be able to choose from a list of ‘qualified providers’ that meet NHS quality standards.

In Derbyshire, one of the services which now offer more choice about who provides your care is the primary care psychological therapies service.

Information about the primary care psychological therapies service

What the PCPT service covers

PCPT services include care for common mental health disorders such as:

• Anxiety
• Depression
• Phobias
• Panic

It does not cover treatment for people with more severe and complicated mental health difficulties and is only for adults over the age of 18.

Criteria for treatment

Patients will be assessed against their mental health and wellbeing needs. This means that the patient will be assessed according to standard guidelines for the treatment of common mental health problems such as anxiety and depression.

Following assessment, some patients may not be eligible for treatment and as such will be discharged from the service. If this is the case, appropriate information and advice will be given.

How you can be referred

There are two ways to be referred:

1. GP referral, where the patient sees their GP and is referred to the service.
2. Self-referral, where the patient accesses PCPT services directly.

If you are referred by your GP you can use ‘Choose and Book’ to view the list of providers and make your choice. Patients will be given information by their GP so that they can choose according to the information available and make a direct call to the service.

Self-referral patients can view the list of providers through the NHS Derbyshire website, GP surgeries or via PALS (Patient Advice and Liaison Service) on 0800 032 32 35. The chosen provider will assess the referral against the treatment criteria. If the referral is not accepted, you or your GP will be informed, or you may be referred to an alternative, more appropriate service.

If your referral is accepted then the provider will contact you to arrange an initial assessment with you.

Expected outcomes

The PCPT service should:

• Assess monitor and treat patients with common mental health problems who meet the criteria for the service.
• Offer a range talking therapies and approaches that meet recommended best practice guidance
• Provide information and advice on how to manage difficulties
• Offer and advice and information on other sources of help in your local area and advice that will enable you to help yourself manage some of your problems.

The key outcomes should be:

• Improvement in symptoms affecting your health and wellbeing
• Better understanding of symptoms affecting how you feel
• Feeling better able to manage your problems
• A good patient experience.

How to complain

If you are not happy with the services you receive, you should complain to the provider. They must have a formal complaints procedure, and respond to complaints in line with NHS policy. If they do not respond to your complaint, or you are unhappy with their response, you should contact your local Clinical Commissioning Group. PALS service can provide contact details.

Local providers

The PCPT services will be based in various locations and settings across Derbyshire.

Below is a table that shows you who the providers are and the main localities where they will be providing services. However, you can be referred to any of the providers below but in some cases you may need to travel to a venue where they are based. The PCPT services will be able to tell you about waiting times etc. and you can make a choice based on where service providers can see you and when. Providers will continually be updating their information so the advice is to either ring them to find out more about them and where they are offering services or if you have internet access go to their website, details below.

Provider / Website & Contact Number / Main Locality where service based
Let’s Talk Wellbeing /
Tel: 01159 560888 / Derbyshire/Nottinghamshire border, Nottinghamshire
Mental Health Concern & Oakdale LTD /
Tel: 0300 555 582 / Derbyshire Wide
steps2change /
Tel: 01246 277440 / Chesterfield, North East Derbyshire
Talking Mental Health Derbyshire /
Tel: 0300 123 0542 / Derbyshire wide
Trent Psychological Therapy Services /
Tel: 01332 265659 / Derby City, Chesterfield, Swadlincote

Appendix B

Primary Care Psychological Therapies

Information Leaflet for GPs and Practice staff

This is one of the services that has been selected under the Governments AQP agenda by NHS Derby City and NHS Derbyshire and will affect how patients are referred to primary care psychological therapy services from April 1st 2013

Suitability

The service is for adults over 18 years with problems including:

• Mild to moderate anxiety
• Mild to moderate depression
• Mild – moderate mixed anxiety and depression
• Panic disorder
• Phobias
• Mild to moderate post- traumatic stress disorder (PTSD)
• Mild to moderate obsessive compulsive disorder (OCD)

And will also include services for other presentations including:

• Eating disorders – mild to moderate
• Anger management
• Adjustment Disorders
• Substance misuse – where anxiety and depression is present
• Personality disorder – where anxiety and depression is present
• Depression or anxiety in adults with chronic physical health problems
• Mild learning disability or cognitive impairment- where depression or anxiety is present

Exclusions

• Severe risk of suicide and self-harm
• Psychosis
• Severe depressive disorders
• Severe anxiety disorders, e.g. OCD, PTSD

What services are provided?

• Cognitive Behaviour Therapy (CBT)
• Counselling for depression
• Interpersonal Therapy
• Stress management
• Guided self-help
• Bibliotherapy
• Computerised CBT

Services will be delivered in a number of ways including:

• Individual one-one sessions
• Group approaches
• Telephone approaches
• Computerised CBT
• Books and leaflets

Who are the Providers and where are they located?

Providers will be operating from a variety of locations. Some will be practice based and some will be in rented space in a variety of locations across Derbyshire. The providers will be able to give you further details of exact locations. All providers will be able to accept referrals but it may be in some cases patients will need to travel as not all providers will have bases in every locality. However, as providers start to receive more referrals they may increase the number of localities where they deliver services.

Provider Details

Provider Lead Organisation / PCPT service name / Main Locations / Telephone / Web Link
Derbyshire Healthcare NHS Foundation Trust / Talking Mental Health Derbyshire / Derbyshire Wide / 0300 123 0542 /
Lincolnshire Partnership NHS Trust / steps2change / Chesterfield
North East Derbyshire / 01246 277440 /
Trent Psychological Therapy Services / Trent PTS / Derby City
Chesterfield
Swadlincote / 01332 265659 /
Mental Health Concern and Oakdale Limited / MHCO LTD / Derbyshire-wide / 0300 555 582 /
Nottinghamshire Healthcare NHS Trust / Let’s talk Wellbeing / Derbyshire/
Nottinghamshire border and Nottinghamshire / 01159 560888 /

How to refer

Referrals will be either by choose and book or by self-referral. Providers should be able to provide information packs as to how patients can self-refer to the service or you can give patients one of the leaflets or provider details and they can refer directly to their chosen organisation. Tina Pottrell, the C&B Lead for Derbyshire, will advise Practices as and when providers go live with their service on C&B.

If you have any queries about the PCPT services under AQP please contact;

Tracy McGonagle –

Tel: 01773 599462