New psychology role in primary care

A new psychology trainee role in general practice settings is providing mental health support to individuals and community groups, offering techniques to prevent anxiety and low mood, stress and promote positive emotional wellbeing.

This role provides early stage psychological support to people presenting to primary care with concerns and signs of distress.

Primary Care Networks in Lancashire and South Cumbria have recruited 25 Trainee Associate Psychological Practitioners (TAPPs) with overwhelmingly positive feedback.

How it happened

Funding from Health Education England to improve workforce productivity was secured by the Innovation Agency, in a joint bid with the People Boards in Cheshire and Merseyside and Lancashire and South Cumbria.

The aim was to reduce the bottleneck of job opportunities faced by psychology graduates trying to join the NHS, to improve workforce supply and expand available psychological support.

A total of 50 fully-funded roles were created in a pilot project hosted by Lancashire and South Cumbria NHS Foundation Trust, with the University of Central Lancashire (UCLan) delivering a new Postgraduate Diploma Associate Practitioner Psychologist (PGDip APP) course; and leading on evaluation. 25 of the roles are in primary care.

What the service provides

The mental health prevention and promotion role offered by TAPPs can focus upon many different issues. They are helping people who suffer mild anxiety, low mood, work related stress and issues with sleep. Also people who are struggling as a result of the impact of Covid and young people who are having difficulties with returning to school or dealing with exam pressures.

The practitioners encourage individuals to bring along an ‘important other’ to at least one appointment, so they can learn about what is happening and how they can best support their loved one.

“We all understand the messages about how to look after our physical health, such as ‘eat five a day’, get enough sleep and do regular exercise. But are we as good at knowing how to look after our mental health? That is the focus of the prevention and promotion service.”

Dr Miranda Budd, Consultant Clinical Psychologist

Feasibility study in primary care

A feasibility study funded by Health Education England involved the creation of four assistant psychologist roles in general practice and community settings, two in Fleetwood and two in Burnley, from September 2020.

They offer one-to-one consultations and group sessions, reaching out to community groups and proactively contacting individuals struggling with the impact of COVID-19.

“The timing was a challenge but it also meant there was an even greater need to help people struggling with the impact of the pandemic. We were lucky to be able to appoint two fantastic practitioners who actively contacted patients with Covid 19 and their families to offer support; and offered sessions to community groups, sharing techniques to help people understand and manage feelings of anxiety.”

Professor Dr Umesh Chauhan, Pendle GP

“We shouldn’t leave people to deteriorate before they get help; in general practice settings you can make big changes soon after the onset of symptoms, it can be more difficult when these symptoms grow and become entrenched. “This feasibility evaluation looks at the acceptability of this level of psychology role in general practice and community settings; and at whether we can prevent mental health deterioration and promote positive emotional wellbeing.”

Dr Miranda Budd, Feasibility project lead

Interim evidence

The mid-way analysis shows that around 80 per cent of people referred to the assistant psychologists took up the offer of a brief intervention. Everyone who completed an experience of service questionnaire reported that they had learnt strategies about how to manage their wellbeing and gave positive comments about the service (see ‘What the patients say’ below).

The evaluation ends in summer 2021 with an ending report to be published. This dovetails with the launch of the 25 TAPP primary care training placements which began in February 2021.

New role pioneers

Charlotte Harding, and Ameera Iqbal, were appointed as Assistant Psychologists for the feasibility evaluation.

“It has been probably the best experience I could have asked for; it is a great way in to working in the field and providing support to those that need it. In the first month I wasn’t very confident but we’ve had training and support and we had the freedom to set up the service ourselves, overseen by our supervisor. I’ve even presented at a large conference about our work which was amazing.”

Ameera Iqbal

“I love this role, there is a lot of variety in what we do and it is a great opportunity for us. We have a great rapport with staff and service leads and with social prescribers and community groups.” “We see people with low level needs; if people feel low and isolated it can really help them to see one of us face to face. In the last few months we have also held 23 sessions with community groups and monthly wellbeing sessions with staff.”

Charlotte Harding

The duo have created projects such as ‘Positive Steps’, sending items including sunflower seeds, tea bags and biscuits to a community group as prompts for conversations about mindfulness.

New TAPP Eleanor Newton

TAPP Eleanor Newton who started her role at Bay Medical Group in March 2021:

“I see this role as an incredible opportunity: to gain experience in delivering quality, personalised interventions; to promote psychological wellbeing within the broader community; and to play an active role in the transformation of our societal approach to mental illness and psychological wellbeing. I have already received substantial training and support and had the privilege of working alongside so many passionate, empathic and conscientious individuals. “This scheme will not only benefit my own personal and career development as a psychological professional, it has the potential to play a significant role in transforming mental health provision within the NHS and our local communities. For any prospective applicants, I cannot recommend the role highly enough.”

Eleanor Newton

What the patients say

All individuals are asked to complete an experience of service questionnaire before discharge and the comments are overwhelmingly positive. Feedback included the following:

“Talking to a neutral person has really helped. I am now able to see that everything isn’t my fault. It has made me put things into perspective and I am able to cope a lot better nowadays.”

“My overall mental health has been improved, just through talking to someone who is completely impartial. I was not expecting to feel so much better after just four weeks, but I have been given great tips and advice and have learned a lot!”

Patient story

Syed (not his real name) was in his late 30s and was referred by a GP after a visit to discuss back pain, at which the doctor picked up signs of anxiety and low mood.

Syed was reluctant when he attended the first appointment as he had never had any support for his mental health or spoken to anyone about his feelings and was not sure what to expect.

He worked as a builder and said that due to a difficult relationship with his girlfriend he was struggling with low self-esteem and overthinking. He said he wanted to be happier, enjoy his life more and learn to stop worrying so much. At the end of the first appointment Syed said he felt as though a weight had been lifted and was enthusiastic to continue the sessions.

Intervention

Syed was given helpful information and explanations which improved his understanding of his feelings, for instance about the ‘flight or fight’ response; how to manage ‘worry time’ and problem solving. He was given tips on actions to help with motivation, which he uses with his daughter to keep them in a good routine. He was also referred to the Social Prescribing Team to explore volunteering opportunities.

“If I hadn’t been in a GP practice I probably wouldn’t have attended or if I had to wait six weeks to go to therapy I know my mental health would suffer and I don’t know where I’d be right now.”

Syed Not patient’s real name

He said he is back to the confident, happy and carefree man he used to be and is now open about his mental health with friends and family.

Academic view

The new Postgraduate Diploma Associate Practitioner Psychologist course was developed by Dr Kathryn Gardner and Dr Mark Roy, who are also leading on evaluation, at the School of Psychology at the University of Central Lancashire.

“If I hadn’t been in a GP practice I probably wouldn’t have attended or if I had to wait six weeks to go to therapy I know my mental health would suffer and I don’t know where I’d be right now.” Syed Not patient’s real name “The course philosophy is to develop core practitioner psychologist competencies that are central to effective clinical practice in all services, at the same time as allowing trainees to develop specialist expertise within their service speciality.”

Dr Mark Roy, School of Psychology at the University of Central Lancashire

Employer view

“This is a fantastic route into a career in psychology; allowing students to continue working while learning on the job, from day one. The role of Trainee Associate Psychology Practitioner helps us to provide early intervention for the many people looking for support with symptoms such as mild anxiety, of which we have seen a significant increase due to the pandemic.”

Maria Nelligan, Chief Nurse and Quality Officer at Lancashire and South Cumbria NHS FT

Next steps

The plan is to spread the TAPP role to other areas, through partnerships created by Health Education England with People Boards, mental health trusts and universities, based on the Lancashire and South Cumbria model.

“This role provides an innovative opportunity to address the challenges of workforce expansion in the NHS Long Term Plan ambitions for the psychological professions workforce. It will also provide better access to psychological approaches for all those who could benefit.”

Dr Gita Bhutani National Development Lead Psychological Professions Network, Health Education England

Find out more

Contact: Carole Spencer, Innovation Agency Director of Transformation. carole.spencer@innovationagencynwc.nhs.uk

Partners

• Lancashire and South Cumbria NHS Foundation Trust • University of Central Lancashire (UCLan) • Health Education England North West • Innovation Agency • PPN North West • People Boards in Cheshire and Merseyside and Lancashire and South Cumbria; Psychological Professions Network North West