Meeting: / Clinical Network Improving Access to Psychological Therapies IAPT
Date: / Thursday 29 September 2016
Time: / 13.00 – 15.00pm
Venue: / Portland House, Belmont Business Park, Durham, DH1 1TW
Present: / Name: / Initials
Angela Kennedy, Network Lead for Psychological Therapies / AK
Jo Phillipson, Network Delivery Team Manager / JP
Ursula James, NHS England / UJ
Phil Gallagher, NE Commissioning Support (NECS) / PG
Erica Johanson, Talking Helps Newcastle / EJ
Leahan Garratt, Talking Helps Newcastle / LG
Paula Hegarty, Alliance Psychologist Services / PH
Toby Sweet, Sunderland Counselling Service / TS
Andrew Rowntree, NECS / AR
Steph Jorysz, Senior Commissioning Officer, NECS / SJ
Claire Studholme, Talking Therapies North Tyneside / CS
Tim Price, Sunderland Psychological Wellbeing Service / TP
Simon Reay, Gateshead and South Tyneside Talking Therapies / SR
Kerri Netherwood, Sunderland Psychological Wellbeing Services / KN
Heather Blackburn, Sunderland Psychological Wellbeing Services / HB
Isabelle Roney, North Tyneside Talking Therapies / IR
Mark Burdon, South Tees CCG / MB
Kate Kendell, Cancer Network Psychology Lead / KK
Gail Richardson, Northumbria Health Care / GR
Lynsey Terry, Insight Healthcare / LT
Liam Gilfellon, Insight Healthcare / LG
Michelle Wren, Network Delivery Facilitator, NECN / MW
Apologies: / Name: / Initials
Jill Smith, Health Education England
Carole Hirst, NHS England
Tim Cate, Tees, Esk and Wear Valleys NHS FT
Johnny Morton, Talking Matters Northumberland
Jo Kendall, Talking Changes
Kerry Robinson, Middlesbrough and Stockton Mind
MINUTES
1. / INTRODUCTION / Lead / Enclosure
1.1 / Welcome and Apologies
AK welcomed everyone to the meeting and apologies were noted as above.
AK highlighted the aim of the forum is to support providers and commissioners to achieve the current access and waiting times standards, work towards the stretch targets for 2020/21 and increase the capacity and capability to treat people with long term physical health conditions. / AK
1.2 / Declaration of Interest
None.
1.3 / Introduction and Membership
AK initiated introductions.
2. / AGENDA ITEMS
2.1 / Terms of Reference / AK
Discussions took place and the following was agreed:
  • Membership – not only senior management and target audience depending on meeting/workshops content.
  • Frequency – meetings or a sequence of events? The IAPT Provider Forum meeting 05/10/2016. JP to have a conversation with the forum on next steps.
  • Quorum – will be adjusted accordingly.
The group agreed the overall purpose. / JP
2.2 / National Update / UJ
UJ provided an update on the following:
  • IAPT expansion with early implementers funding from October 2016 to March 2017 but services start January 2017.
  • NHS Digital has recently conducted some changes to the IAPT Data Sets.
  • Annual IAPT report due October 2016 and will show a slight variance in the trend increase from older people and men.
  • On the horizon Adult Morbidity Survey coming out today which will show an increase in the number of people with mental illness. This will have an impact on access targets.
  • Need to be thinking about projections about increasing access.
  • Hidden waits a new item to be reported on.
  • Equity of access and equity of outcomes are likely to become increasingly important as the national team want to understand the effect of demographics on access and recovery as well as looking at outcomes for different therapy modalities.
  • Three job adverts out for Band 9 one day week Clinical Lead, LTC Clinical Lead Band 9 and Workforce and Wellbeing Band 8a.
  • Discussions with CCGs have taken place regarding the wording around continuity of the services in agreements for the LTC expansion pilots; NHS has not taken wording out but made slight amendments so the spirit of the agreement remains.
Key lessons from the bidding process for early implementers include:
  • Speak with someone before completing spreadsheet.
  • Run WebEx’s to demonstrate how to complete the spreadsheet for wave 2.
  • CCGs and providers must work together to develop the bids and ideally both should be represented on the WebEx.
UJ informed the group that she intends to convene a meeting between all of the network leads for IAPT. She then intends to develop a national forum to support local groups, possibly via a Yammer group.
2.3 / Priorities and main challenges / ALL
The group work session required members to capture facts and solutions for the following 11 challenges:
  • How to plan for the future when focused on short term targets.
  • Inequity between North East and North West.
  • Retention of Psychological Wellbeing Practitioners.
  • Regional Training Strategy.
  • Backfill issues.
  • Differences between commissioning levels.
  • Anxiety about sharing with competitors.
  • Training needs analysis.
  • Understanding and interpreting data.
  • Preparing for expansion into different conditions.
  • Interface with other services when dealing with comorbidity/complexity.
It was agreed the findings would be collated and form part of the network work plan. (See Appendix 1)
2.4 / Action planning for Clinical Network IAPT meetings/events/support
The group was asked what they wanted this group to provide and agreed the following:
  • Provide a conduit to the national team.
  • Provide a link to the other Clinical Networks to support the development of IAPT in acute trusts.
  • Support integration and collaborative working between providers and commissioners.
  • Provide a forum for sharing good practice and challenges.
  • Provide a forum to develop a shared understanding of data and shared interpretation of KPI’s etc.
A discussion took place and the group felt meetings should be focused on a headline task so delegates attending know whether the meetings/event is relevant to them. Potential meetings/workshops agreed:
  • Commissioning
  • Access
  • Recovery
  • LTC
  • Hidden Waits
  • Understanding Data
Each meeting/event might have different audiences as discussed under item 2.1 membership.
3. / STANDING ITEMS
3.1 / Any Other Business
  • The group felt there was added value having UJ in attendance or a national representative.
  • Duration of training was discussed. A conversation between HEE and universities is required to clarify 12, 18 or 24 months to complete training because this impact on finances and workforce.
  • JP reported that NECN had limited funding but would be supporting these meetings/events.
  • KK referred to the provision of psychological support for patients with physical health conditions in Northern England survey. The response rate has been very low KK to resend so members can complete and return the survey by 14 October 2016. JP will share the early findings with Liaison Psychiatry Event on 7 November 2016.
/ JP
KK & JP
3.2 / Next meeting
TBA
4. / MEETING CLOSE
Thank you to all in attendance.

1

Appendix 1

Priorities and main challenges

  1. How to plan for the future when focused on short term targets

Challenges
  • Services have little flexibility within contracts to focus on anything other than access and recovery.
  • No room for innovation.
  • Short term targets can be knee jerked and time wasting.

Solutions
  • Need to be more strategic and understand how the short term contributes to wider long term goals.
  • Commissioning of contracts should allow for flexibility and recognise that innovation only comes when workforces have time to reflect and learn.
  • Move focus of targets from numbers to quality.
  • Increased implementation/design of SDIP in contract.
  • Prepare short, medium and long-term goals in line with overall vision.

  1. Inequity between North East and North West

Challenge
  • Different funding for training support ‘No salary support in ‘NE’ full in ‘NW’ – postcode lottery.

Solution
  • Develop consistent guidance for HEE to be adhered to and funded across all regions.

  1. Retention of Psychological Wellbeing Practitioners

Challenges
  • Length of contract term – job uncertainty. PWPs likely to switch provider if in doubt.
  • Local funding – AQP tariff making job increasingly less patient focused and is potentially skewing outcomes to hit 50% recovery target.
  • No obvious career pathway.
  • Stepping stone for graduates.
  • Not seen as ‘core profession’.
  • Need to protect from ‘burnout’.

Solutions
  • Closer monitoring and support of PWPs with outcomes not necessarily achieving – are these taking on more difficult cases?
  • Better accreditation and further level training.
  • Opportunities for supervision, specialism and project work.
  • Senior PWP roles.
  • Advanced PWP practitioner roles (clinically rather than management focused).
  • Career progression opportunities.
  • Ongoing CPD.
  • Regional events/interface.

  1. Regional Training Strategy

Challenges
  • Make appropriate CPD opportunities available to all (NHS and 3rd Sectors).
  • CPD to support accreditation.
  • Supervision capacity.
  • IAPT expansion need CPD for all staff as LTC’s come into both aspects of service (core and expanded IAPT).
  • Equity ensuring inclusion of all aspects of IAPT workforce.

Solutions
  • Develop a Regional Strategy:
-Analysis of workforce gaps.
-Ensure training is available.
-Co-ordination of training – timing (avoid holiday times).
-Resourcing funding to allow services to employ trainees.
-Resource someone to develop and deliver strategy.
  • Centralised training pool.
  • Training for supervisors and pool of supervisors (e.g. EMDR, LTCs and IPT).
  • Utilise existing resources e.g. Universities, CBT Centre, Regional BABCP etc.
  • Provider forum well placed to identify need and co-ordinate.

  1. Backfill issues

Challenges
  • Reduced capacity when trainees and in early months after training:
  • Provision of supervision.
  • Reduced caseload.
  • Pressure on existing staff.
  • Pressure on team leads.
  • Always a time lag for backfill.
  • Allow trainees to retrain often too much pressure to take on too much clinical responsibility.
  • Backfill should cover whole length of training not just 12 months (courses can be 18 or 24 months locally).
  • Recruitment into fixed past contracts.

Solutions
  • More planning and lead in times – not such ‘do it yesterday’.
  • Centralised training pool.
  • Develop a system that encourages services to employ trainees not ‘punish’ them.
  • Cost/funding needs to be incorporated in initial commissioning process so that there is enough slack in system to manage annual leave, sick leave, study etc.
  • Central IAPT Employment Bank.
  • Full backfill and on costs.
  • 1st student model to be completed before project commenced.

  1. Differences between commissioning levels

Challenges
  • Lack of equity is very important for the public.
  • Who holds CCGs to account for this – probably not this group! not providers! – NHS England or CN Leads

Solution
  • CCGs hold responsibility for ensuring National IAPT Guidelines are implemented which should promote equitable funding/tariffs.

  1. Anxiety about sharing with competitors
Challenges
  • Historically services/managers have been reluctant to share ideas/information.
  • It’s a competitive market place.
  • Not Just about AQP’s

Solutions
  • We’ve got to think about the bigger picture/collective goals.
  • There are ‘safe subjects’ that we are prepared to talk about.
  • Network to take a role in collating good practice and ensuring contributions from providers are equal e.g. audits of digital technologies used – pros and cons. Providers that don’t ‘invest’ in sharing don’t share the benefits.
  • Highlight gains, engage all services in process.
  • Utilise influence of CCG’s.

  1. Training needs analysis

Challenges
  • Priorities.
  • Staff turnover.
  • Cost/limited resource.
  • Need for standard requirements for content and quality of training.

Solutions
  • Starting point for LTCs would be to complete and submit the current NECN survey.
  • Use of data to determine areas requiring improvement (e.g. therapy, conditions, step, individual practitioners)
  • Regional IAPT Training Programme.
  • Shared initiatives.
  • Use of expertise on regional level.

  1. Understanding and interpreting data

Challenges
  • Variations in how individual services report.
  • Data received by services from NHS Digital is 3 months old creates delay in rectifying mistakes.
  • Lack of clarity regarding how data/targets defined e.g. steps and treatment modalities.
  • Data access to national NHS Digital outcomes is impenetrable.

Solutions
  • Local dedicated data analyst.
  • Support from IST.
  • National agreement on how to report.
  • Regional Data feedback (consistent and transparent).
  • Specific template design with training on use, completion and manipulation.
  • Specialist IAPT focused analyst.
  • Share understanding – expertise.
  • When approaching IAPT about changes do this as a group of providers rather than individual providers.
  • Link database providers more clearly to what CCG’s require.

  1. Preparing for expansion into different conditions

Challenges
  • Training and supervision needs.
  • All LTC’s lumped together or specific conditions identified.

Solutions
  • Collaboration with other providers of psychological care/physical healthcare. Include costs of training and supervision in commissioning.
  • Utilise expertise within existing services.
  • Link in with Regional IAPT Training Programme/Training Needs Analysis.

  1. Interface with other services when dealing with comorbidity/complexity

Challenge
  • Patients with complex/comorbid presentations are often clinically managed/treated within one service only.
  • Patients difficult to manage safely in IAPT or bounced around services.
  • Access to mental and physical health records, protecting confidentiality for patients while having access to important information that should influence treatment offered.
  • Physical health workforce doesn’t see mental health as their business and vice versa.

Solutions
  • Meet regularly (monthly) to agree the most appropriate patients for specialist/PC services.
  • Agree on patient pathway flow.
  • CCG Care Pathways with Service Involvement/Joint Development.
  • Mutually agreed framework e.g. Care Chartering.
  • Building relationships with Clinical Leads in those services.
  • Joint training between physical and mental health workforces.

1