Concerns for the future of CP's....

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Concerns for the future of CP's....

Postby Dude Love » Mon Aug 24, 2009 5:04 pm

Hi all,

I know there are a few of these types of thread knocking about, but I thought I would start my own based on a few thoughts and worries I have.

Basically, having decided that Clinical Psychology is the professional route that I want to pursue, I am now growing concerned as to what the future holds for the typical CP post.

I am currently working as an IAPT Low Intensity worker, and today visited the local NHS CMHT team for guidance on referrals to them etc.

When describing the CMHT team, the CPN showing us around said that they no longer had a Psychologist on board, as he had resigned over his application for band 8b being denied. Apparently, the plan is for the team to not replace him with another Psychologist, but instead probably a social worker with a formal CBT qualification (or the like...basically an IAPT High Intensity worker for all intents and purposes). The powers that be apparently see that they can slash at least 10k off their yearly wage bill replacing a Psychologist with someone of the High Intensity level.

This situation mirrors the sentiments of my team manager, who was only telling me last week about how Psychology posts are being downgraded certainly in our area. She stated that in her recent meeting with the Department of Health, she got the impression that beyond the initial IAPT funding which runs out in 2011, more and more focus and money is set to be put into the scheme, with an increased emphasis on prevention and early intervention at the lower levels (e.g. GP watchful waiting, signposting, low intensity work), to cut the need for help further on and higher up the stepped care model (e.g. more expensive Psychologists).

With the Health Service looking towards self management of health problems (not just mental health, physical health as well), I guess it seems that their ideal would be to create a situation where Psychologists are no longer needed and where High Intensity work can fill the void at a much cheaper cost (lower pay band and minus 3 years of salaried training). Further in addition, I hear CP courses now seem to be incorporating IAPT into the final year placements, and more and more newly qualified CP's are taking High Intensity posts, with the doctorate being actively touted as desirable on job specifications for High Intensity posts.

What are anyone's thoughts on this? I'm at the point now where I am preparing for the form to come out this year, but part of me is thinking that maybe I would be smarter to think about ways I can improve my credentials for the progression to High Intensity work and such like.

All input much appreciated
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Postby BlueCat » Mon Aug 24, 2009 6:57 pm

Clinical psychologists are more than just therapists. In some services where the role of a clinical psychologist has been pretty much exclusively therapy, I am also seeing psychologists leaving and their posts being advertised as Band 6 Generic CAMHS/AMH worker posts. However, in other services, I am seeing active investment in clinical psychology posts, and these seem to be in services where clinical psychology has historically been valued and promoted for more than just expensive therapy - supervision, leadership, consultation, complex case work, complex assessment work, work where more that 1:1 therapeutic intervention is required, teaching and training, working with the wider systems, serious seats at serious tables for service development, preventative work, community focus.....etc

There seem to be huge numbers of factors involved in how different services treat their psychologists, and it seems like one of them is WHO has been in post, WHO has managed the service, and how well those people have promoted the many facets of the role. Another factor seems to be how the management team have allowed the psychologists to define their role. If the service you are currently in think a CP's is equivalent to a HIW role, just more expensive, there has been some miscommunication smewhere along the way!

Further to the patchwork privatisation argument, there certainly does seem to be a patchwork valuing of clinical psychology developing. One large Trust by me doesn't seem to value and invest in Clinical Psychology (CAMHS teams get 0.5 each at most, with some having none at all, and plans to generate generic worker posts I think), the similarly sized neighbouring Trust really seems to value and invest in Clinical Psychology (CAMHS teams get 1.5 to 2.5 each and three entirely new 8a/8b posts funded in the last year that I am aware of).

It really seems that so much is down to service preference If you are in an area where CP is perhaps not valued, it must seem disheartening. However, if you are somewhere that is seeing active investment, it can seem quite encouraging. Unfortunately, it seems to rest largely on what has been done by our predecessors and how that was viewed by senior anagement.

Also, as an aside, we might see more roles developing outside of MENTAL health per se, but in other areas where application of psychological principles to effect change at individual or systemic levels are desirable - such as physical health or back to work services?

From where I'm sitting, it doesn't seem all doom and gloom, but I can see some clouds on the horizon, and certain parts of the country do seem to have full on storms!
Last edited by BlueCat on Mon Aug 24, 2009 7:15 pm, edited 1 time in total.
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Postby baa » Mon Aug 24, 2009 7:12 pm

BlueCat wrote: However, in other services, I am seeing active investment in clinical psychology posts, and these seem to be in services where clinical psychology has historically been valued and promoted for more than just expensive therapy - supervision, leadership, consultation, complex case work, teaching and training, working with the wider systems, serious seats at serious tables for service development, preventative work, community focus.....etc


This. A lot of the clinical work can be done, and done well, by HIW type bods. I don't see that as a bad thing, given the amount spent on CP training, I do see that they should be doing more than just the clinical side of things.
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Postby helloimnew » Mon Aug 24, 2009 7:24 pm

As a to-be-first-year-trainee with little NHS experience/knowledge I find this chat both compelling and terrifying! The suggestion that in three years time there might not be a CP post available for me at the end at all, never mind in the speciality I'd like to work in, or location I'd like to live, is just plain awful. But then I think surely if the future is so bleak for Clinical Psychologists then the number of DClinPsych places would have been cut this year rather than the extra 8 places (on my course at least) that were allocated at the last minute? Why did this extra money not go from NES to the MSc course (IAPT Scotland) instead? I think this is one demonstration that CPs are valued. How would the NHS benefit from a bunch of expensively trained people not working for their intended purpose?
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Postby h2eau » Mon Aug 24, 2009 9:12 pm

In response to helloimnew, the extra funding for 8 more places on the Edinburgh course came from increased investment in CAMHS by the Scottish government, who have also invested in more places on the Glasgow clinical course, the MSc in Applied Psychology for CAYP and qualified CP jobs.

With respect to the debate, I can sort of appreciate why the NHS is looking to minimise costs but it could be argued that this sort of approach is short-sighted/misinformed. If clinical psychologists were indeed doing a similar job to another sort of therapist who was paid less and whose training was less expensive, I would find this unethical and the NHS would have every right to disregard clinical psychologists as a more expensive alternative.

I personally believe that clinical psychologists have a lot to offer to a number of client groups and in different settings. However, we need to play to our unique selling points (e.g. assessment, supervision, leadership, consultancy, service development and clinical research to inform the evidence base) in order to justify the expense of our training (circa £90k+ per head?) and employment.

The role of clinical psychologists is changing as the NHS becomes increasingly business-minded so I think we need to embrace this and get involved by promoting our strengths and widening awareness of the role. In my opinion we need more psychologists at higher levels within the NHS to realise this, but I certainly haven't come across many who aspire to this sort of role.

There's also the political agenda of whichever government is in power to consider as this obviously impacts on funding initiatives such as IAPT. For example, we don't have IAPT up in Scotland and a different approach has been taken to increasing access and broadening the psychological workforce.
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Postby miriam » Mon Aug 24, 2009 9:32 pm

These panic mongering rumours have been around longer than I've been interested in the profession, and yet our numbers are not reducing and in fact the government and its advisors are increasingly aware of the value of CPs.

So lets dispel some myths.

Firstly, the research shows that increasing primary and early intervention services does not reduce demand for secondary and tertiary mental health services, it increases it. This is because it accesses populations that had not previously had a service, makes referrers think it is worth referring, and does not address serious an enduring mental health problems or environmental/social issues.

Secondly, services do sometimes think that there are cheaper alternatives to CP posts. However, they then find that the people involved can not fulfil the non-therapy aspects of what CPs do - so the service development, systemic issues, consultation, supervision, research/audit disappear, and this leaves a void that we can later show our value by filling. So services may lose posts, but others regain them. It is our responsibility to demonstrate the value we offer beyond these cheaper posts - and it is a challenge I am not afraid to rise to!

Some CP posts are banded higher than any other professional group (except medics) and we need to show we are worth that price tag. If we prefer to just offer therapy, and some CPs do, then we need to accept that progression up band 8 is not justified. We can't have both the high pay and the cushy post simply because of high level training or long service. It is the role that justifies the pay, and skilled therapy is now a band 6/7/8a role, so we have to offer the skills that place us in higher bands to earn more money. That is the purpose of AfC and doesn't just apply to CPs.

And this exact issue of the impact of IAPT on CPs is discussed here
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Postby Spatch » Mon Aug 24, 2009 11:27 pm

I would also draw your attention to other countries where clinical psychology flourishes despite competition from other therapy providers. In the US social workers have masters in therapy as do a whole raft of other potential rivals. Yet CPs not only survive but prosper.

Look at the bigger picture, you have to remember that clinical psychology is an international profession and as a discipline pre-dates the formation of the NHS by over half a century. I daresay it will outlive it too. (Moreso than any Nu-labour-get-em-off-the-dole-queue-initiative that is currently the flavour of the month).

If we prefer to just offer therapy, and some CPs do, then we need to accept that progression up band 8 is not justified. We can't have both the high pay and the cushy post simply because of high level training or long service.


It is this attitude of entitlement that is what seriously holds the profession back. Instead of researching, innovating, going for positions of clinical leadership, effecting political and organisational change you have CPs that are content to just stay in a limited therapy-only post. I don't think this was ever sustainable for long, and I see the changes as a positive move to get rid of complacency and keep the profession lean, fit and relevant.
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Postby Dude Love » Tue Aug 25, 2009 7:53 am

Thank you very much for the replies all, very interesting indeed, and it all makes sense. Needless to say, I will be filling the form out as soon as it comes out in September :D

I think what draws me towards the doctorate, is, as a number of you have said here, it is about more than therapy, so is very applicable to a variety of sectors and services. Also, the international nature of the profession could provide a lot of opportunities.

Thanks again for putting my mind at rest everyone, it is great to be able to hear both sides of the argument and make an informed decision :thumleft:
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Postby miriam » Tue Aug 25, 2009 10:20 am

Oh, two final thoughts I forgot to post before:

1) The public value CPs. Survey the public and ask who they would like to see and they name us (maybe because other roles are newer and have more ambiguous/sillier names). Not medication, and not "a therapist". Ask people who have used mental health services and CPs get great user feedback and recomendations. That is why even if the market privatises we will still be purchased.

2) We have roles that are vaued outside the NHS. Take insurance work - we are increasingly recognised as good value for money in terms of offering work with trauma, personal injury, etc by insurance companies. We are also the expert of choice in much court work. These are both partly due to the standard of qualifications, but also the fact we can evidence and evaluate our work.
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Postby Spatch » Tue Aug 25, 2009 11:56 am

If you ask me I think this thread alone also highlights our effectiveness at PR.
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Postby miriam » Tue Aug 25, 2009 12:01 pm

Spatch wrote:If you ask me I think this thread alone also highlights our effectiveness at PR.
We are rubbish at it! CPs don't have a unified definition of what we do, or unified language to talk about how we add value. Our professional body has a weak voice, and most of us are afraid to speak to the media, leaving gaps for pseudo-psychologists to fill which taint our public image...

(ooh, I didn't realise that I felt so strongly about that until I wrote it!)
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Postby noodle » Tue Aug 25, 2009 12:31 pm

Yeah the psyeudo-psychologisty people aren't great. I think CPs have a better definition of themselves than health psychologists though, they seem to have a real identity crisis!
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Postby baa » Tue Aug 25, 2009 12:44 pm

Charlotte wrote:Yeah the psyeudo-psychologisty people aren't great. I think CPs have a better definition of themselves than health psychologists though, they seem to have a real identity crisis!


Trouble is, no one other than the CPs really knows about the definitiion etc, I'd agree with miriam that CPs are impressively bad at PR!
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Postby vars » Tue Aug 25, 2009 1:48 pm

hmm not so sure as service I'm in has just taken on a new psychologist by creating a whole new post and in Scotland there is money going to CAMHS for new psychologists

This debate seems to come up every year but I've yet to hear of any trainees who have really struggled to find a job on graduating
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Postby Spatch » Tue Aug 25, 2009 3:20 pm

We are rubbish at it! CPs don't have a unified definition of what we do, or unified language to talk about how we add value. Our professional body has a weak voice, and most of us are afraid to speak to the media, leaving gaps for pseudo-psychologists to fill which taint our public image...



Um. I meant the posters speaking on this thread. See your point completely about the wider "us".

My bad. :oops:
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