Insight Healthcare build upon existing experience of delivering Improving Access to Psychological Therapies (IAPT) services for older people and people with long-term physical health conditions (LTCs). As a wave 1 early-implementer site, this work has been extended to focus on delivering NICE-recommended psychological therapies for people with chronic pain.
Insight Healthcare build upon existing experience of delivering Improving Access to Psychological Therapies (IAPT) services for older people and people with long-term physical health conditions (LTCs). As a wave 1 early-implementer site, this work has been extended to focus on delivering NICE-recommended psychological therapies for people with chronic pain. The services approach to developing the chronic pain service includes:
- liaising with Primary and Secondary Care providers to gain support for the integration of IAPT services into existing physical health pathways. This has helped to ensure that all partners have a clear understanding of the pathway and referral process
- developing and distributing joint LTC promotional material with the CCG
- drafting and presenting a project paper to the CCG Clinical Cabinet to support the project and gain the support of the senior cabinet
- presentations for the Local Authority Health and Wellbeing Board.
A person can access the chronic pain service via self-referrals, or a referral from their GP, healthcare professionals and Local Authorities. To promote access to the service the services has developed new leaflets and referral forms and worked with GP practices and the local pain management team.
Referrals come directly to the services and are triaged by a trained LTC psychological wellbeing practitioner (PWP) with the referral sent to the appropriate treatment pathway. In most cases referral to assessment occurs within 10 days, unless a home assessment is required, which usually occurs within 21 days. Urgent referrals or those where risk is identified may be fast tracked into the service, otherwise the person is offered the next available appointment.
|IAPT (whole service) referrals||369||99.8% of people began treatment within 6 weeks of referral and 99.3% began treatment within 18 weeks of referral.|
|IAPT-LTC referrals only||40*||100% within 6 weeks|
Note – figures for referrals entering treatment from January 2016
* referrals for chronic pain pathway
All assessments are carried out by a designated experienced PWP who has received LTC training. Assessments can be face-to-face, telephone or Skype. If required a person can also have a home assessments (once a risk assessment has been completed).
Interventions are delivered by a therapist who has received LTC training with supervision from the Clinical Lead. Interventions are NICE compliant and include low and high intensity CBT (including Acceptance and Commitment Therapy, Mindfulness and Compassion Focused Therapy), eye movement desensitisation and reprocessing, interpersonal psychotherapy and counselling for depression. Home treatment is an option if deemed appropriate.
All outcomes are captured on an internal reporting system – Insight+. This data is submitted along with CORE IAPT activity to the National Mental Health Services Data Set. Since January 2017 patient experience questionnaires are undertaken before and after assessment and treatment. 100% of data was complete for the chronic pain cohort.
All staff have an annual appraisal, that is reviewed throughout the year. Case management takes place weekly and clinical supervision occurs once a month. Team meeting and peer support take place bi-monthly and clinicians know they can access support from their clinical lead daily. All staff are also part of the staff benefits and wellbeing programme.
|Leads and managers||0.08 clinical lead (band 8a), 0.09 service lead, 0.04 PWP team lead and 0.4 CBT team lead|
|Therapy staff||0.04 PWP therapist and 1 CBT therapist|
Note – the workforce numbers above are whole-time equivalents for the chronic pain service
Working with the wider system
The service uses a step care model with direct access to community mental health teams and a road into secondary care via a Nottingham University NHS Foundation Trust consultant. They also work with the CCG commissioned PICS team who provide primary care services in for Nottingham West CCG and have promoted and embedded their services with the Broxtowe Borough Council.
Key learning and achievements
Integrating into physical health teams at the early stages was challenging with the need to meet with several organisations, and to gain support of physical health colleagues. The timing of the LTC training would have been beneficial if it was earlier in the process to enable us to start with a fully skilled team. Having our clinical lead attend the training was an advantage as she is now drawing from her learning and sharing with the broader team ensuring efficient experienced supervision is available for all therapists. We now have a truly integrated service that is supported by the CCG, GP’s, Primary and Secondary Care – this was challenging to establish and is growing from strength to strength. We meet on a regular basis with the Lead Commissioner and Secondary care and regularly review our processes and look for areas to improve the pathway to ensure the clients are seem at the right place and the right time.
|Commissioning||Nottingham West CCG|
|Operating hours||Monday to Thursday 8am to 8pm, Friday 8am to 4pm|