Comments on the commissioning of IAPT+

by Arthur Musgrave on December 1, 2012

This is my concerned account of the local (Bristol and South Gloucestershire) introduction of IAPT+ (Increased Access to Psychology Therapies – Plus) at the beginning of November. Although an improvement on the initial IAPT, it is still far from satisfactory.

The new services were introduced in a great hurry and changes are being made all the time. The short critique is that there’s no doubt that in many respects the situation is a considerable improvement over IAPT (without the +) – counselling and psychotherapy are now treated equally with CBT and people can, in principle, choose not only what ‘treatment’ they want but also from whom they want to receive it.  But, reading between the lines, you can perhaps see more clearly than ever before the future shape of state approved therapy.

The context is that, while all 151 PCTs in England have been required to select from a list of services at least one service to commission through AQP during the current financial year, only 10 of these 151 have decided to pilot AQPin Primary Mental Health. I understand that few of these ten have shown anything like the creativity and imagination shown by Bristol and South Gloucestershire NHS.

The commissioners locally have a therapy background and have worked closely with Oasis Talk, an Any Qualified Provider (AQP) and a Community Interest Company, that – in a former incarnation – had years of experience working creatively within IAPT. What’s emerged is both interesting – because it’s creative – and scary – because despite everything, it’s still (IMHO – in my humble opinion) a mad way of doing therapy.

One key statistic: The cost per session of IAPT in South Gloucestershire under the previous regime was £104 per session and the tariff under IAPT+ will be £47.20 – a 45% cut. This is known already since, although there is competition under AQP, there is no competition on price. Tariffs are set locally by the PCT.

So this is more or less the best there is (or likely to be under IAPT+), certainly from my experience here in Bristol.

So although there has been a significant improvement in IAPT, due to the inclusion (after much pressure) of therapies other than cbt and choice of therapist, IAPT remains problematic.  Eventually I fear that what will emerge is a poor relation of private practice (poor evaluation, poor outcomes, poor rates of pay, poor practice). Despite the rhetoric and the enthusiasm of those trying to make it work, it will be a clunky, unresponsive and bureaucratic state service.