Challenges and Barriers

Specific challenges to IAPT transformation are highlighted within the relevant section of these resources. However, some challenges have been raised consistently in our discussions with IAPT services. These are:

  • Recruiting and retaining staff – some IAPT services are non-NHS (e.g. Mind), which can be a less attractive employer than NHS-provided IAPT services. Some services are outer London, so a less attractive area to work compared to inner London boroughs, due to lower HCA supplement.
  • Turnover of staff is high, particularly for PWPs (many are promoted to HITs). Constantly having to replace staff and recruit new ones is time consuming.
  • Recruitment and retention of mother tongue trainees or therapists (very few available), and several issues with the quality and cost of interpreting services have been raised.
  • Many IAPT services do not have a workforce that reflect the population they serve (in terms of gender or ethnicity), particularly in more senior roles.
  • Funding of staff – some services have to employ PWPs / HITs on a lower banding than other services due to lower level of funding by CCG relative to targets. This negatively impacts on recruitment and retention.
  • Currently many services are unable to offer trainees permanent contracts; some services have lost three cohorts of trainees due to not being able to offer permanent contracts (due to lack of funding). This has led to a significant loss of experience within team, and it is harder to then support new trainees.
  • There is variation in IAPT services current approaches to reducing inequalities for those accessing their services.
  • IAPT services need to balance providing IAPT compliant services that also meet the needs (and wants) of different parts of the population. There are examples of excellent practice in producing tailored materials that are ‘culturally sensitive’ and meet the needs of different population groups; although this is not common [see case study].
  • Similarly, IAPT services aren’t necessarily funded to treat ‘non-core IAPT’ patients, i.e. patients who don’t fit into standard IAPT depression/anxiety categories, for example trans-diagnostic anxiety and depression treatment groups.
  • There is no specific funding for outreach or engagement work within the IAPT model, therefore it is dependent on local commissioners being willing or able to fund this within IAPT services. There is significant variation in funding between IAPT services across London.
  • Many IAPT services have to balance meeting increasing access targets, clearing waiting lists and seeing patients with carrying out meaningful engagement work. In the longer term, investment in community engagement and outcomes should lead to increases in access rates. However, in short-medium term, spending time on meaningful outreach work could reduce achievement of access targets, as it pulls staff away from seeing patients. If commissioners are able and willing to fund outreach work as part of a broader, more integrated model of IAPT delivery, then this could lead to greater focus on outreach and engagement within IAPT services.
  • The pandemic has hampered engagement and partnership working, as co-location has not been possible. Since services have returned to face-to-face appointments, some services have lost access to clinical rooms, due to other services needing to spread out across more rooms in order to be Covid-safe.
  • Integrating patient records systems with other partners (e.g. secondary care, voluntary sector), along with processes, information governance and safeguarding arrangements, can be a challenge when working in partnership.
  • Very few IAPT services are currently engaging with emerging Primary Care Networks; this could result in IAPT being left out of discussions about local mental health care pathway redesign, and may weaken relationships with primary care. (Case studies: Tower Hamlets and Hillingdon)
  • Lack of awareness of IAPT services has been raised many times by Lived Experience Practitioners and the IAPT services we’ve spoken to.
  • Raising awareness, and simplifying self-referral processes would improve access targets for IAPT services.
  • Many IAPT services currently don’t have the capacity or capability to market their services or tailor materials for different population groups.