The Islington IAPT Service, named ‘iCope’ by service users, is dedicated to the provision of high quality Cognitive Behavioural Therapy and other NICE guideline adherent psychological approaches to the treatment of anxiety and depression for adults living in or with a GP in the London Borough of Islington.
iCope serves a population of 206,100 people (according to the 2011 Census) , and referral rates are increasing, from 2033 referrals in 2011 and 8194 in 2015.
Using the stepped care approach, the service is staffed with a larger force of step 2 workers (psychological wellbeing practitioners) offering guided self-help, low intensity behavioural activation, psychoeducational groups and workshops, computerised CBT, and community linking. Step 3 workers see clients who are looking for more support following step 2 interventions as well as offering more in depth assessment and treatment for clients of higher need though still within the primary care IAPT remit.
Working in GP surgeries and out of community settings enables close working with GP colleagues, and makes the service accessible to the local population. The service pride themselves on service user involvement.
In 2014 a working group was formed within iCope with a passion to bring recovery firmly to the foreground so as to ensure they can meet (and with hopes to surpass) the national target of 50% of patients recovered, not just averaged across the service overall, but also on an individual clinician basis. Inspired by successful interventions in other IAPT services, they set about implementing their own approach, which they termed ‘recovery consultations’.
Recovery consultations were born out of the idea that this was to neither take up already overburdened supervision time nor to be a target driven approach from line management. Instead recovery consultation was put forward as an invitation to a supportive and curious professional learning environment, focussed on development in the quality of the therapy delivered by individual clinicians. For example, where a clinician’s recovery rate was low, the approach was to be mindful that this can be in part owing to a higher proportion of clients being more complex than expected for an IAPT setting, or inconsistencies in coding of data on patient record systems, and a number of other factors, rather than reflecting a deficiency in the quality of their clinical work. This opened up the possibility for the recovery rates discussed in the consultation to be viewed as a baseline from which an improvement were to be sought via open-minded, problem solving exploration, and agreement on specific learning points and targets to be reviewed post-consultation.
Looking at the service outcomes overall for the time period during and following these recovery consultations across the team, data has shown a successful increase in recovery rates from 40.9% in September 2015 to surpassing the 50% national target for IAPT services and reaching an average of 51% for the last six months for both step 2 and 3 combined (or 53% for step 3 only), as calculated for March 2016- September 2016.
An audit of these consultations is still underway. Initial results from the first 12 clinicians that had recovery consultations and stayed with the service for at least three months afterwards, showed that their recovery rates three months prior to the consultation compared to three months after the consultation improved markedly for 9 of the 12. Improvements ranged from an increase in recovery rate of 2.25% to 44.45%, with the mean increase in recovery rate pre-to-post consultation for those that showed any improvements of 12.58%.
for further information https://www.england.nhs.uk/mental-health/case-studies/mh-islington/ and http://www.icope.nhs.uk/