Telephone First Consultations Fail

IAPT is synonymous with telephone first consultations, but the first independent study of this intended cost saving device, with GP’s, has shown it fails to deliver. An editorial in this week’s British Medical Journal on the Newbould et al study* (2017) states:

‘ Telephone first systems alone will not solve the perennial problem of ensuring timely, safe, and equitable access….It is also yet another reminder of the importance of independent evaluation of initiatives before investment in widespread implementation’

Instead of piloting and having an independent evaluation, IAPT has ploughed on regardless. Accountability is a major issue for IAPT, it positions itself between primary  and secondary care but is accountable to neither. It claims comprehensive data collection on almost all its clients. Yet in the authors examination of 90 cases (In preparation) that went through IAPT, for clients having two or more treatment sessions, before and end of treatment psychometric test data was given to GPs in less than half of cases. One quarter of cases did not clear the first hurdle of either ringing IAPT for a telephone assessment or IAPT being unable to contact the person. Whilst 13.3% ‘attended’ only the initial assessment. Thus IAPT is failing to engage just less than 4 out of 10 clients.

 

In GP practices with telephone first consultation the proportion of patients who would recommend their practice to friends fell. There was also a reported increase in emergency admissions associated with telephone first systems.

Clinical Commissioning Groups should insist on IAPT reforming itself, by dropping telephone first consultations.

* Newbould et al (2017 Evaluation of telephone first approach to demand management in English general practice: observational study. BMJ: 358:j4187

Dr Mike Scott

2 thoughts to “Telephone First Consultations Fail”

  1. Whilst I agree that iapt services must be accountable for the work they do (or fail to do) and the results of that work, I do think that tarring all iapt services with the same brush is both inaccurate and unfair. The service I work for does an extremely good job, making a huge difference to many people’s lives, demonstrated by good results and excellent feedback from the people who are best placed to comment – the patients themselves. I’m very proud of the work I do at Step 3 and I know I am playing an important role in helping people take back control of their lives, respect themselves and ultimately live more happily. So please don’t imagine that there’s no difference between services, or between individual therapists, many of whom are doing a fine job and working very hard to make a difference to people’s lives.

    1. I think you are right some people in IAPT do great work at step 3, but I was commenting on the service as a whole. My own independent analysis of 90 cases using a gold standard diagnostic interview, showed that only 10% recover from the disorders from which they suffered. On the subset of data for which PHQ-9’s and GAD-7’s were made available using IAPT’s own definition of recovery (which is highly questionable) 24% ‘recovered’. Either way as a Service it is failing but I take your point that this does not mean every individual IAPT worker is failing.
      Regards

      Mike

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