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Ensuring workforce skills mix is optimally utilised to reduce waiting times

Ensuring workforce skills mix is optimally utilised to reduce waiting times

Patients receiving a course of treatment in an NHS Improving Access to Psychological Therapies (IAPT) service (talking therapies) will be allocated either to step 2 or to step 3 treatment. Step 2 is delivered by an IAPT trained Psychological Wellbeing Practitioner (PWP) and step 3 by an IAPT trained High Intensity therapist (HI therapist). The majority of step 2 treatments (usually around six sessions) take place by telephone and are based on ‘guided self-help’. The majority of step 3 treatments are delivered face-to-face if possible, or by video link if COVID-restricted or preferred by the patient. Quite a number of staff within the IAPT services will first complete their PWP training and follow this with the High Intensity training after two years or more. These staff members are known as ‘dual trained’ and are able to offer both step 2 and step 3 treatment protocols.


The A&D Network has identified a cohort of patients (thought to be about 10%) who started treatment at step 2 but needed more intensive help to move towards recovery and who were ‘stepped up’ to step 3. Currently this means the patient will have to be placed on a waiting list for a HI therapist and, when one becomes available, start from scratch with a different therapist. Patients have told us that this is stressful for them.

Potential solution

Allocate patients who meet the criteria for inclusion to a dual trained therapist who can offer both step 2 and step 3 interventions as needed. This should result in patients being able to work with and complete treatment with one therapist, it should reduce waiting times and it should increase productivity as it is anticipated that, overall, a reduced number of sessions will be needed to move these patients to recovery.

Current status

All services are piloting this new way of working and are working together on understanding what works and patient outcomes, as well as on evaluating this initiative.