SECTION B PART 1 - OUTCOME SPECIFICATIONS
NB: Whilst this specification relates primarily to providers who provide the complete pathway, psychological therapy services in primary care are increasingly being commissioned under Any Qualified Provider contracts. Included in this link is the National IAPT’s team 2011 “Top Tips” for considering AQP
The following outcomes are still relevant to AQP specifications
Mandatory headings 1 – 5. Mandatory but detail for local determination and agreement.
Optional heading 6. Optional to use, detail for local determination and agreement.
All subheadings for local determination and agreement.
Outcome Specification No.Service / Primary Mental Health Care including Improving Access to Psychological Therapy services.
Commissioner Lead
Provider Lead
1. Population Needs
1.1 Local context and evidence base
Local
Locally defined
2. Key Outcomes
No Health Without Mental Health sets out a clear and compelling vision, centred around six objectives:
(i) More people have better mental health
(ii) More people will recover
(iii) Better physical health
(iv) Positive experience of care and support
(v) Fewer people suffer avoidable harm
(vi) Fewer people experience stigma and discrimination
Each objective in the Implementation Framework (see Appendix) is relevant to primary health care especially physical health care, early intervention, suicide prevention and management of mild to moderate problems.
2.1 Specified Outcomes
Please note these outcomes are a list of examples (including the percentages) and are not proposed as mandatory. Local Commissioners will need to prioritise according to local need. Percentages or numbers need to be decided locally and where current measures do not exist, baseline data should be collected and increase or decrease negotiated within the timeframe of the contract. The percentages stated are “educated guesses” and will vary locally. This specification assumes the use of the IAPT minimum data set.
At least 50% of people accessing the services must show a recovery (as defined in the national guidance) improvement in clinical screening scores at the end of treatment and at follow up
Manage 15% of anxiety and depression disorder prevalence by 2014/15
Increase access for Black and Minority Ethnic Groups and Older people
- % negotiate
- % negotiate
- Baseline to be established (by the commissioner) in the first year and reasonable target negotiated
To reduce referrals to acute hospitals for physical conditions, where mental health problems are an exacerbating factor
- Baseline to be established (by the commissioner) in the first year reasonable target negotiated)
- The service on commencement will have a minimum of ? people who have returned to work who were previously on benefits by?
- A further minimum of ? people will return to work from benefits by ?
- A further minimum of ? people will return to work from benefits by ?
- A further minimum of 20 people will return to work from benefits by?
- By ?, protocols are established that detail referral pathways and/or joint working with the local employment projects and local employers and occupational health services
- Baseline to be established in first year (by the provider/s) and then 4% per yearly decrease in those receiving Statutory Sick Pay or other employment based sick pay.
- Baseline to be established (by the provider/s) of those scoring on the work screening tool that they have thought about taking time off work and then receiving interventions that have enabled them to continue with work.
3. Scope
3.1Population covered
The service is based on assumptions regarding the presentation, recognition and subsequent referral of people with common mental health problems. It is reasonable to assume that not all common mental health sufferers will present at primary care and it is reasonable to assume that not all people with these problems will be diagnosed and referred on
Assumptions:
Of those expected to experience the mental health problems which the IAPT service is there to support, 50% are expected to present at primary care. Of these, 50% are expected to be referred to the IAPT service. Of those referred it is expected that between 60% and 80% will present to the service. Of these it is expected that 24% will be referred immediately to Step 3 with 10% of these accessing Step2 also going on to Step 3.
Improving Access to Psychological Therapies (IAPT) is a national programme of commissioning and service re-design that aims to ensure delivery of psychological treatments compliant with National Institute for Clinical Excellence (NICE) guidelines within primary care, to as wide a population as possible.
3.2 Service description/care pathway
Primary care has a responsibility to identify and provide mental and physical health care for those presenting with emotional problems whether these are primary or secondary to physical conditions. Evidence suggests that those with severe mental health problems, despite their needs, receive no additional surgery time from their general practitioner and less care from practice nurses than the general population. If the outcomes specified in this contract are to be achieved, the strategy established will need to take this into account.
Improving access to psychological treatment services have been developed nationally to cost-effectively meet unmet need for treatment of common mental health problems. They will be available locally to all people registered to the practices covered by the service who are over 16 yrs and with common mental health problems that would benefit from NICE compliant treatment for these conditions.
IAPT services are an integral part of community wide efforts to develop services that are person centred, inclusive and accessible to all that require them by offering intervention that reflects need in a timely manner.
The basic IAPT service model envisages a team of therapists within a specified locality taking referrals from primary care, as well as self-referrals, and delivering NICE-compliant therapies at the level required. The service should operate in convenient settings, and employment advice and support would be an integral part of the service, with strong links to other social care and support services as required.
The service will be available to all people registered to the practices covered by the service who are over 18 yrs and with common mental health problems that would benefit from NICE compliant treatment for these conditions.
The provider will complete an appropriate screening process, which will determine the patient’s pathway. It will involve the use of appropriate measures (such as GAD7 & PHQ9).
Step 2 Interventions include:
- Guided self-help based on CBT
- Computerised CBT
- Behavioural Activation
- Psycho-educational groups
- Bibliotherapy
- Psycho education
- Sign posting on to other appropriate services and supports
- Problem solving techniques
- Medication advice & support for those on antidepressant medication
- Healthy Living Support
- Access to employment support/employment return services
- NICE compliant Psychological treatments for common mental health problems.
- Couple therapy where appropriate
- Counselling or brief dynamic interpersonal therapy
- Psychological treatments including Individual and Group CBT, and Interpersonal Therapy for depression.
- EMDR therapy for Post-traumatic stress disorder
- Mindfulness for Long Term Conditions and resistant depression
- Medication advice & support (to improve compliance) e.g. rationale for medication, benefits, side effects etc.
- Referral on to other agencies as indicated
- Access to employment and vocational support
3.3 IAPT Service Delivery (locally defined)
Locality
Days/Hours of operation (locally defined)
Referral criteria & sources (locally defined)
Referral route
- Access times
- Referral totreatment in Step 2 = 14 days
- Referral to Step 3 treatment = no more than 12 weeks
- Any acceptance and exclusion criteria
The service will not discriminate on any grounds and will be inclusive, and reasonable adjustments will be made for people with co morbidity to ensure the delivery of collaborative evidence based interventions
Services will not exclude adults on the basis of age, gender, race or sexual orientation.
The trusts operational policy will explicitly address issues of staff safety including a statement of zero tolerance for racial or physical abuse. This will ensure adequate assessment to ensure that treatment is not withdrawn inappropriately e.g. when abusive behaviour is a manifestation of psychotic illness.
- Interdependencies with other services (needs referral to local provision)
- Primary Care especially where Mental Health specialists are providing training to primary care and IAPT staff
- Secondary Care Specialist Mental health Teams
- Acute and Community Health Services
- Adult and Older People Social Care Services
- Employment Services
- Third Sector Providers
- Single management and unambiguous lines of responsibility;
- Consistent gate-keeping procedures;
- Consistent care planning arrangements across the pathway;
- Single assessment at point of entry, including risk assessment, which is consistently revised;
- Discharge planning from the start;
- A clear purpose for each admission to the pathway;
- Effective and consistent communication mechanisms between clinicians, teams, and agencies.
4. Applicable Service Standards
4.1 Applicable national standards e.g. NICE, Royal College
- No Health Without Mental Health (2011)
- NHS Commissioning Support for London (2011) Medically Unexplained Symptoms (MUS): Project Implementation Report. NHS Commissioning Support for London.
- NHS Institute for Innovation and Improvement (2006) Improving Care for People with Long-Term Conditions: A Review of UK and International Frameworks. NHS Institute for Innovation and Improvement.
- Talking Therapies: A four-year plan of action – (2011)
- NHS Operating Framework – (2012)
- Mild-moderate to severe depression (NICE CG023)
- Mild – moderate to severe anxiety disorders – generalised anxiety disorder (GAD), panic disorder, phobias(NICE CG022) ,
- Obsessive Compulsive Disorder (NICE CG 031)
- Post-traumatic Stress Disorder (PTSD) (NICE CG026)
- Emotional wellbeing – Cases for change
Locally Defined
5. Location of Provider Premises
The Provider’s Premises are located at:
[Name and address of the Provider’s Premises OR details of the Provider’s Premises OR state “Not Applicable”]
6. Price
[Insert details including price where appropriate of Individual Service User Placement]
Primary Care Mental Health v3 JK