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GPs forced to prescribe as psychological therapies services are ‘bursting at seams’

Talking therapies are so overstretched they are ‘bursting at the seams’, with GPs turning to prescribe more antidepressants to combat the long waiting times, Pulse has learned.

Dr Felix Davies, consultant clinical psychologist and managing director for mental health at the social enterprise Turning Point, said psychological therapy services are in an ‘invidious position’ due to big funding cuts and increasing expectations both in terms of the number of patients being referred and the range of psychological problems they deal with.

GP experts in mental health said Dr Davies’ comments chimed with their experience on the frontline, and warned the increasing difficulties for patients in accessing services is potentially forcing GPs to prescribe more patients antidepressants.

A Pulse investigation last October revealed patients in some areas were waiting over a year for treatment on Improving Access to Psychological Therapies (IAPT) programmes, while services were struggling to achieve the target 50% recovery rate for those patients engaging with therapy.

The Government has said it is committed to enforcing maximum waiting times for talking therapies in order to improve access and NHS England is urging CCGs to commission more mental health services locally through enhanced services.

However Dr Davies - who led one of the original IAPT pilot studies - said he feared the emphasis on hitting targets without necessary investment could mean service collapse.

Speaking at a conference on IAPT servcies, Dr Davies said: ‘I think IAPT services are, for the most part, bursting at the seams. They are struggling with the referral to treatment target at a national level while at the same time there is an expectation that the breadth and access is increased. That’s a very invidious position for IAPT services to be put in.’

‘IAPT services have been subject to cuts to a greater extent than a lot of mental health services. I think this is something that hasn’t been flagged up – this has been going on for a good five or so years where IAPT is seen as an easier target, as it is not part of a block contract.’

He added: ‘My concern is there will be even more of a drive to try and hit these targets coming up to the election and I think there needs to be some realism, some flexibility and recognition of the issues that are being faced by IAPT services – otherwise they will crumble.’

Professor Carolyn Chew-Graham, professor of general practice research at Keele University and a specialist in mental health, told Pulse the impact is being felt in her area, with the longer waiting times making it harder for GPs to manage patients.

Professor Chew-Graham said: ‘I agree with Dr Davies’ comments. Waiting times for our primary care mental health team (incorporating IAPT, and predominantly provided by third sector) is running at months, not weeks.

‘[It is] very difficult to “hold” patients who often present at a time of crisis for them. I am sure this results in antidepressants being prescribed because the GP needs to feel they are doing something.’

Dr Anna Livingstone, a GP in Tower Hamlets, where she is the lead on drugs and alcohol services as well as one of the CCG’s leads on medicines management, agreed the situation is getting worse and could end up impacting on prescribing.

Dr Livingstone said: ‘There’s never been enough service and it’s getting worse. Colleagues in the rest of East London and that I’ve met in other areas are saying the same thing - nobody feels the situation is satisfactory and the need is greater.’

She added: ‘I think it may well be [impacting on prescribing]. The normal tendency would be for GPs to feel, “I must support someone” and as a result they may prescribe sooner.’

Note: This article was amended on 21 August 2014 to provide Dr Davies’ correct role. He was originally described as a consultant psychiatrist, but is a consultant clinical psychologist, and managing director for mental health at Turning Point

Readers' comments (16)

  • As a talking therapies practitioner working in Wales, I can add that this problem is not confined to England. The service I work for operates in only one group of practices in this county, and has had its funding frozen for at least the last three years while being expected to expand provision significantly.

    We are currently operating a waiting list of, on average, 13-16 weeks.

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  • We complained to our local IAPT 12-16 weeks is an unreasonable wait - only to be told this is pretty much standard across the country and some area with waiting for 28 weeks!

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  • Funny how when a service fails for whatever reason it all falls back on GPs to patch up the system...General Patcherupers. But then again it is the best health service in the world.

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  • The whole effin system is creaking at the seams - including me.

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  • Vinci Ho

    We all have to be 'honest' to ourselves that the government is lying when it said it was committed to reduce this waiting time( alongside everything else ) . I can understand academics always want to be 'politically neutral' and humble, not to be combative.
    But enough is enough , as simple as that . the common enemy of our patients is to be named, shamed and 'punished'..........

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  • best health system in the world according to s study funded by organisation with vested interest in US not looking good!

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  • CBT and antidepressant therapy are proven to be of approximately equal effectiveness

    A month's prescription of an SSRI costs £2

    How much does a course of CBT cost? Factor in the delay involved, and the immensely high DNA and dropout rates, and you have to question the economic sense. For all the investment, therapists are probably twiddling their thumbs for half of all appointments. Meanwhile, for most patients (6 month wait for 6 sessions) CBT as delivered by the NHS is arguably not really worthwhile.

    However, there's other ways to deliver some of the benefit of Therapy cheaply, effectively, and immediately. Books (such as Feeling Good, by David Burns) will suit many patients. Also, for example, our CCG commissions Foundation for Positive Mental Health audio tracks on CD and downloads. Both these approaches are probably a better way to deliver CBT to a population

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  • Actually IAPT effectiveness is not that good, according to Pulse article

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  • One of the problems with IAPT is that it has tended to drive longer-term non-CBT psychological therapies out of the NHS. Many therapists working in private practice are offering free and very-low fee psychotherapy to some of their clients. We always have to some degree. A group of us are now working on a national network to encourage colleagues to offer more free therapy in response to growing demand and failing supply for people on low incomes - see

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  • What happened to the plan for large scale, cheap computer based CBT?

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