Current issues in NHS clinical psychology

Issues related to pay, contracts, Agenda for Change, the NHS, the BPS, unions, etc.
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maven
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Current issues in NHS clinical psychology

Post by maven » Sun Apr 08, 2007 12:15 am

I guess there are a lot of ethical/theoretical issues buzzing at the moment. Like whether psychologists should be able to train to prescribe medicines or not, or whether we should have statutory registration or not, or whether CPD should be compulsory and monitored, or whether real clinical cases respond to the treatments advised for "clean" or "textbook" cases, and how valid it is to ad lib as a clinician. But there are also issues like whether performance as a clinician should be measured by the number of face to face contacts, the number of clients discharged from the service or picked up from the waiting list, user satisfaction ratings, change in SDQ scores or other questionnaires, or a more sophisticated system. Its a very real question, as face-to-faces and waiting lists are what are measured, but may not reflect the full range of work that we do (I, for example, do teaching, research, consultation, supervision etc for half of my week or more). I bet every CP would have some issues of the current changes from Agenda for Change, New Ways of Working for Apllied Psychologists, the Mental Health Act, the new Competency laws, the move from Health Authority to GP and PCT purchasing and competitive tendering, etc that impacts in their daily life.

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Re: Current issues in NHS clinical psychology

Post by miriam » Mon Sep 05, 2011 12:52 pm

We should get some ideas together for this thread that are more up to date! Any suggestions? I will start the ball rolling with:

- pros and cons of IAPT
- changes to commissioning
- NHS cuts (cost improvements)
- the proposed health bill and its implications
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Re: Current issues in NHS clinical psychology

Post by baa » Mon Sep 05, 2011 2:47 pm

i think we should move from 'pros and cons of iapt' to something more productive like 'how to improve relationships/links between iapt and secondary services' or 'the cp role within iapt'. IAPT is here, and i think the debate needs to move on to something more focused/useful.
At least I'm not as mad as that one!

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Re: Current issues in NHS clinical psychology

Post by Claudia » Mon Sep 05, 2011 6:58 pm

Am in agreement with Baa on this one - it would be nice if a wiki in the section to do with "professional issues & lingo" was reframed in this way

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Re: Current issues in NHS clinical psychology

Post by miriam » Sun Dec 11, 2011 1:29 pm

Well, lets have a bit of a brainstorm about topics that ought to go into this wiki (ie what are the hot topics around at the moment that people should be aware of), and then we can re-write the top post and put it back into the wiki section.

BTW I wasn't meaning for the note about IAPT to sound like 'should we have it or not' but more 'what are the strengths and limitations of the way this has been set up, and what are the implications for mental health services at higher tiers, and do we think that rolling out this model to other groups (like children, people with LD, older people) is the way to make services more accessible?' and also 'is IAPT now an alternative route to CP and employer of qualified CPs, or should people chose one or the other?' The plans for a children and families IAPT, for example, deviate significantly from the adult IAPT model and come with much much much less funding. Anyway, that's a long winded way of saying I do think all the issues around IAPT are a significant talking point in mental health services, and it has been very controversial/divisive. To put my personal opinion on the record, I think on balance IAPT is an improvement to mental health services because it is a big accessible service for the milder problems and means that problems do not have to become severe or entrenched to reach the thresholds for accessing traditional mental health teams. I just wish that it was funded from genuinely new money, and not money clawed back from cuts in other mental health services, and that they were as willing to put money in where there isn't incapacity benefit to be saved and income tax to be gained.
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Re: Current issues in NHS clinical psychology

Post by cral » Sat Mar 31, 2012 9:43 pm

Can i ask has this wiki been created yet? I might be being a bit dense but i can't seem to find it if it has so i appologise if this is the case.

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Re: Current issues in NHS clinical psychology

Post by miriam » Sat Mar 31, 2012 10:39 pm

The OP of this thread was the wiki, but it became dated and I asked for suggestions to update it. None were forthcoming, the wiki wasn't updated. I hate to disappoint you but we don't just magically create everything needed to spoon feed it to the forum, other people do have to chip in.
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Re: Current issues in NHS clinical psychology

Post by cral » Sun Apr 01, 2012 2:04 pm

Oki doke as an attempt to start the discussion going i'll post some of my thoughts on the proposed health and social care bill. I'm not very politically minded and this kind of thing is really not my fortay and therefore some of my thoughts may be completely wrong and perhaps a bit naive. If this is the case i'd actually really appreciate people pointing this out as it would actually help me see the bigger picture-which i'm guilty of not seeing sometimes!!

So here goes:
-The bill recognises that we are an ageing population and long term conditions are becoming increasing common-could this perhaps not identify an arguement to invest more in services which target these. Although in my trust they have actually merged older adult teams with CMHT's- is this not somewhat counterproductive?? i.e. perhaps loosing specialism??
-CCG's will take the place of PCT's and GP's will have alot of power in comissioning services-perhaps a good thing as GP's appointments are often dominated by MH problems and therefore aren't they more likely to commission these services? However, on the flip side do GP's value physical health services more favourably than psychological services and are they not more likely to comission these services?
-service users can choose from voluntary and independent sectors as long as it is within the NHS budget-perhaps concerns about the privatising of the NHS? However, is it not a positive things that service users have more choice and control over their treatment package? Will these services be of the same quality??
-Nice will extend its role to social care-i'll be honest i came up blank with implications about this. Although i'm sure there's several so if anybody had any thoughts it would be good to know.
-CCG's have more responsibility than what PCT's had in that they have a duty to reduce inequality, improve service user involvement at all stages including commissioning of services and promoting innovation and research. One thought was CCG's have a lot of power and responisbility, however at the same time it seems Service users are remaining at the forefront and it appears like services are being encouraged to move forward which is surely a positive.
-Objectives for the NHS will be made and they will be measured against these-concerns about payment by results. However, it also means that its very transparent at the same time.
-Commitment to research-obviously clinical psychologists engage in research but quite often you hear that due to service demands there is little time to engage in research activities. Perhaps with the commitment to research in this bill it may help employers see the value of research and allow cp's to invest some more of their time in this.

This may be a really stupid question also but in light of the CCG's could it also mean more of a role for CP's acting as a consultant to help inform the commissioning of psychological services??

Any further thoughts anyone??

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Re: Current issues in NHS clinical psychology

Post by miriam » Sun Apr 01, 2012 9:56 pm

Fantastic, thanks!

I think the new bill has lots that is very concerning about what will happen to the NHS (and many of us with it) but also some opportunities for new models of work like social enterprises and private collectives...
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Re: Current issues in NHS clinical psychology

Post by cral » Sun Apr 01, 2012 10:07 pm

Miriam or anyone else for that matter would you mind explaining what you find concerning especially for cps. I had one or two concerns when reading it but on the whole I thought it reflected positive change! However as I said I'm pretty politically naive and whilst I'm pretty sceptical what they 'plan' to do will transfer into reality, i thought on paper it didn't look too bad!

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Re: Current issues in NHS clinical psychology

Post by miriam » Mon Apr 02, 2012 12:04 am

Well, there are lots of things really.

- certain areas may drop out of being universal health services and require funding per referral (so for example adoption support where attachment is an issue may not be considered related to CAMHS work any more, as it is not 'mental health')
- the people commissioning services might have less (or no) idea what we do, so they might not understand what needs to be in the tender specification, they might omit essential aspects of the service, and they might fail to understand what makes CP or multi-disciplinary services better than cheaper alternatives
- related to the above costs may be ever more pressured in a competitive marketplace, so more appointments and cheaper appointments gain precedence over 'better' appointments by clinicians who are not overloaded
- our terms and conditions as employees will start to be whittled away now that foundation trusts are not bound by using unified NHS contracts of employment, and will not be echoed in private providers
- more posts will be temporary, or contract, or bank or on lower grades because companies and commissioners will be wary of risking expensive redundancy costs at the end of each 5 year contract period
- NHS costs will be undercut by more streamlined organisations, so less contracts will be awarded to the NHS and more posts will TUPE to other providers

If you read the BMJ articles and the ones on 38 degrees, Ben Goldacre and other NHS campaign sites you can think more about the implications, but I think we are entering worrying times for the NHS. As a private provider I have potentially got more opportunities, but that wasn't how I saw my career panning out.
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Re: Current issues in NHS clinical psychology

Post by Borrowed Cone » Mon Apr 02, 2012 12:06 am

cral wrote:Miriam or anyone else for that matter would you mind explaining what you find concerning especially for cps. I had one or two concerns when reading it but on the whole I thought it reflected positive change! However as I said I'm pretty politically naive and whilst I'm pretty sceptical what they 'plan' to do will transfer into reality, i thought on paper it didn't look too bad!
The thing is cral, I'm not sure many people know EXACTLY how the changes are going to impact CPs specifically, because it all depends on decisions yet to be made concerning service commissioning, and whether the services will be provided by the "NHS" or private/social enterprises. So my point would be that it is actually too early to judge how "good" or "bad" the changes will be. We can speculate on what might happen, but CPs should be trying to influence the way services are changing as soon as possible, rather than sit back and wait to see what happens!
"We can rebuild him. We have the technology. But I don't want to spend a lot of money..."

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Re: Current issues in NHS clinical psychology

Post by cral » Mon Apr 02, 2012 8:21 am

Ah okay thanks that's really helpful! I'm going to have a look at those suggested articles etc to further my own understanding! And yup i totally agree with your comment about trying to shape it now as its much more difficult to change something when it's been implemented.

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Re: Current issues in NHS clinical psychology

Post by Borrowed Cone » Mon Apr 02, 2012 5:42 pm

You may find this diagram useful. It is basically what the "NHS" looks like now the Health and Social Care Act 2012 has come into law:

Image

My crude analysis is that CPs must be involved to varying extents in three of these green boxes:

The NHS Commissioning Board

Clinical Commissioning Groups

and obviously, Providers.

The "providers" bit is where I think it gets interesting. Some of these providers may be Foundation Trusts (all NHS Trusts will have to either gain Foundation status, or be taken over by existing Foundation Trusts), and some will be private companies / consortia, and some will be social enterprises and registered charities.

In practice, what this means is that specific services that are not already commissioned by Foundation Trusts will be up for tender (many are already) and this will mean many people not having contracts renewed, having to take redundancy, or re-apply for their jobs with the "new" employers (Foundation Trusts OR private providers - whoever wins the bid).

This is now law, and it will do us no favours to moan about it. We must now be actively involved.

The optimist in me think that increased choice of services, all demonstrating their effectiveness via outcomes, will mean better care for people using the health service.

However, this must remain free at the point of use (e.g. private providers will negotiate payments with the CCGs, not patients), and the regulatory and quality assurance bodies (Monitor, CQC, and HealthWatch ) must have bite.

I hope this might inspire others to think about creating the current issues for clinical psychology in the context of a new health system, and not sit back and wait for the issues to be decided for us!

For those of you who want to study the Act in more detail, you can read all 473 pages of it here.

The Cone
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Re: Current issues in NHS clinical psychology

Post by cral » Mon Apr 02, 2012 6:12 pm

Thanks cone all useful stuff in helping me get my head around it! Just a quick question what do you mean when you say quality Assurance providers must have bite??

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