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Rise in patients leaving IAPT treatment early prompts GP concern

Exclusive  Long waits between therapy sessions may be prompting patients with mental health problems to quit their treatment, leaving GPs to pick up the slack.

Some 42% of patients starting the Improving Access to Psychological Therapies (IAPT)  programme only ever complete one treatment session, according to data analysis by Pulse as part of an investigation.

At the same time, and contrary to NICE guidelines, more than half now have to wait longer than a month between their first and second appointment.

Experts and GPs suggested the issue may stem from the introduction of waiting time targets by NHS England, which mean CCGs rush initial appointments but are not incentivised to provide timely follow-ups.

In April 2015, NHS England brought in the target for 75% of people to start treatment within six weeks of referral, and 95% within 18 weeks – both of which are being met at a national level.

GPs have warned patients leaving treatment and waiting between sessions often means the clinical risk of patients is ‘conveniently being dumped’ on primary care.

NHS Digital’s data on why referrals end do not include a specific breakdown showing the reasons why treatment stops, so these figures are likely to be attributable at least in part to patients choosing to drop out or being referred to another service deemed more appropriate than IAPT.

But Pulse’s analysis of the latest NHS Digital data, shows both the proportion of patients leaving treatment earlier and also those waiting over a month between sessions is increasing.

In July 2018:

  •  37,051 patients (42%) did not continue beyond one treatment appointment;
  •  26,254 patients (50.3%) waited over 28 days between their first and second treatment.

In April 2015, when the IAPT targets were introduced:

  • 23,204 people (34%) stopped therapy after one treatment session;
  • In July 2015, the first month with comparable data, 18,836 patients (36.5%) waited more than 28 days between their first and second session.

Delays between appointments go against NICE’s guidance on cognitive behavioural therapy (CBT) for common mental health problems, which states treatment for people with depression should consist of '16 to 20 sessions over three to four months’, while for people with generalised anxiety disorder 'it should usually consist of 12 to 15 weekly sessions’.

West Kent LMC representative Dr Zishan Syed, a GP in Maidstone, said the pressure to meet initial waiting time targets ‘seems to have a knock-on impact on waiting times for the following appointments’.

‘What we are seeing is a tickbox approach used to give the impression of progress when in fact nothing worthwhile is achieved for patients.

‘By the time a patient is seen at the second appointment, any value from the first will have been lost. These are very worrying times.’

He added: 'In some cases patients are effectively being discharged with no option but to be seen by the GP, despite extremely high level needs for which we’re not resourced.

‘It often feels that the risk associated with mental health care is conveniently being dumped onto GPs to manage.’

BMA GP committee chair Dr Richard Vautrey said: ‘Commissioners need to be vigilant that people don’t fall through the cracks between different services when their referral isn’t accepted or patients don’t complete treatment.

He added: ‘It’s vital GPs are informed of a patients’ progress to ensure people are getting the follow up they require, and aren’t being put off seeking help or deteriorate further.’

An NHS England spokesperson said: ‘IAPT is widely-recognised as the most ambitious programme of talking therapies in the world.

'In the past year alone has had over one million people referred for care, met every performance target consistently and most importantly has helped hundreds of thousands of people to overcome their depression and anxiety, and better manage their mental health.’

They added that the NHS ‘continues to support the expansion of the mental health service workforce, including delivering 3,000 more therapists in primary care’.

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Readers' comments (6)

  • Jmd

    This is not surprising!
    Has anyone looked into the funding agreed for Mental Health is actually going into Mental health or is teh money being used to balance books.
    GPs should write to DOH/NHS England and make it clear that once referred to IAPT then the responsibility of outcomes will be the responsibility of the CCG or the contracted organisation.It is too convenient to dump things on PS.
    There has been cases when IAPT rings GPs to say patient is suicidal, can the GP take on this assessment.NO!, the responsibilities lies with IAPT and they need to liaise with MHT teams to have the patient assessed.
    These political sound bites of more resources to MH is a
    baloney!

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  • IAPT teams in some areas are touting for patients. I have received several flyers through my home letterbox encouraging me to contact IAPT for anything that might not feel quite right, and I don't think I've been targeted because I'm a GP!
    Perhaps some of these patients aren't really that invested in IAPT treatment, having only contacted them on a whim after some target driven advertising.

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  • The ‘problem’ with therapy is that it isn’t magic and requires considerable hard work from patients in between sessions to be at all effective. This leads to the high drop out rates we see for ‘ therapy’

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  • Vinci Ho

    An NHS England spokesperson said: ‘IAPT is widely-recognised as the most ambitious programme of talking therapies in the world.

    NHSE needs to know the word ‘humility’ properly . Keep bragging that NHS is the first in the world to do this and that; the philosophy that we are ‘good’ because many countries are worse than us , does not take you very far in solving problems.
    Sort out the arithmetics , consistently fund a mental health therapist for each locality of GP practices ( ideally , one for each practice ). After all , it was a pledge in GP Forward View , anyway.

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  • Over here, we refer to psychiatry only to have a mental health nurse write back to us for advice as there are no psychiatrists. Patients DNA services too. No wonder GPs are feeling more and more stressed. The problems lies in a free system full of bureaucracy and a lack of patient responsibility.

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  • If the government stopped breaking people with austerity, poor housing, crap or no job, maybe they wouldn’t need fixed, and really ‘talking therapies ‘ fashionable but effective? Society’s ills will not be sorted by the well meaning.

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