Clinical Commissioning Groups, IAPT’s Fairy Godmother

bestowing their munificence without any audit by GPs of local benefit, at a cost nationally of billions of pounds. Yet it should be a simple matter for any GP to interrogate the practice database of IAPT ‘beneficiaries’ and ask the patient the basic question ‘are you back to your usual self since seeing IAPT’? and to further determine whether recovery is stable and reliable by asking ‘for how long have you been back to your usual self?’ Then to integrate the responses with any recent record of functioning in the record of Consultations. Such data can then be presented to the local GP reps on the CCG’s to decide whether the local IAPT is value for money.

CCG’s need to move beyond simple operational matters of numbers of patients seen and waiting times, to a determination of the percentage of people recovering. The randomised controlled trials of cognitive behaviour therapy for depression and the anxiety disorders have suggested a 50% recovery rate when there has been blind assesment of patients. This was the original justification for IAPT. The suspicion is from my independent analysis of 90 IAPT cases that in routine practice the recovery rate is about 10% see link below

However when IAPT marks its’ own homework it miraculously comes up with a 50% recovery rate and has seduced CCGs with its own data. The response of most GPs to this is ‘give us a break, but I am nevertheless grateful for a respite from the patient if they are seeing someone else, so I can get on with my core tasks’. We need to move on to a point where GPs are to a degree advocates for their patients, if they don’t do it no one else will. Without such advocacy mental health patients become not just Cinderellas compared to patients with physical problems but confined to their own personal asylum.

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It is perfectly possible transform IAPT so that it properly translates the findings of rcts into routine practice, see my trio of Simply Effective Cognitive Behaviour Therapy books published by Routledge and my last book Towards a Mental Health System that Works (2017) London; Routledge. But we need to wake up and smell the coffee.

Dr Mike Scott

8 replies on “Clinical Commissioning Groups, IAPT’s Fairy Godmother”

It seems that CCGs have long been ‘in on’ this charade , more so now in this age ‘of anything goes’… So much for the old notions of clinical governance and evidence based practise …..gosh I’m feeling nostalgic !!!

Why can’t patients be given/sent forms by their GPs as a matter of course, x time after their IAPT has finished, to complete anonymously and return direct to the CCGs? Then there would be little extra work for the GPs, it should be easy to process by the CCGs who can then hold IAPT accountable for the results, and patients will be far more likely to be honest in their answers.

yes u could do Liz and it would be a step in the right direction, but it would then depend entirely on self-report of the patient, and they can give a more positive response because they dont want to feel they have wasted their time in IAPT. Having multiple sources of info which would include not only what the patient says but what info might be in the records from post IAPT GP Consultations and perhaps some knowledge of the persons current functioning would make conclusions more reliable.

I’m not convinced that people would be completely honest with their GPs about their experience of IAPT, especially if the GP had recommended IAPT in the first place. In wanting to appear as positive, upbeat people (that really helps these days if you want good care) then I suspect they’d give a more positive response to their GP than they would on an anonymous form to the CCG that they completed at home. I take your point about post IAPT and current functioning being useful information though.

I think that I ought to have added that as part of their audit GPs ought also to ask those who have been through IAPT, the question ‘would you be prepared go through the same in the future, if not your usual self?’

I’ve seen today that the East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is asking local people and service users to complete a questionnaire about the ‘Let’s Talk Wellbeing’ IAPT service (that serves the Leicester City, Leicestershire and Rutland area) in order to review how well the service is doing at the moment and to enable them to plan and improve the service. The 5 minute max long confidential survey can apparently be completed by anyone.

At least an independent body, a CCG, is asking some questions about IAPT, but they are woefully inadequate, there can be no indication of the % who fully recover, the length of that recovery or whether they would play the part of an IAPT client again. We need hard measures of outcome, (ideally independent assessment using a standardised diagnostic interview), not what are in effect surrogate measures.

I wasn’t implying that I have faith in the CCG to gain good evidence or act on their findings. I don’t have much faith in ‘independent’ or ‘arms length’ bodies in general. In my experience all that ‘independence’ means is that you have no clear way of accessing the information that you want/need to see and that nobody in the organization is accountable to the public. (Take NICE for example.) Any worthwhile independent assessment of IAPT would have to be set up in such a way that it couldn’t be easily interfered with by the powers that be.

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