IAPT – the New Kid on the Block?

1. IAPT – the New Kid on the Block? Dr Alan Cohen FRCGP National Primary Care Advisor Relieving distress, transforming lives

2. Overview Long Term Conditions Medically Unexplained Symptoms

4. Risk Profiling - Diabetes Depression is 2 – 3 times as common in people with diabetes Associated with Increased health care consumption Increased self perceived symptom load NOT associated with improved glycaemic control?

5. Potential Efficiency Savings Cost of treating diabetes is 250% greater when the patient has depression Cost of all treatments in people with diabetes is 400% greater when depression is co-morbid Proportion of NHS hospital expenditure on diabetes is 10% of total spend QOF indicator

6. Risk Profiling - IHD Depression is 2 – 3 times as common in people with ischaemic heart disease The best predictor of death following MI is the presence of depression QOF indicator

7. Potential Efficiency Savings 40% of admissions can be prevented by providing psychological treatments 50% of revascularisation procedures (CABG and PTCA) can be prevented by providing psychological treatments

8. Risk Profiling - Anxiety Anxiety occurs in 25% of people with COPD People with COPD make up the largest group of “frequent flyers” A fear of becoming of short of breath, or actually becoming short of breath?

9. Other conditions to be considered for this model of care • Neurology • Gynaecology • Gastroenterology • ENT • Pain clinics • A&E • Cancer

10. NICE Guidelines for Depression in LTC

11. A few examples • Chesterfield • Hillingdon/Merton/Whittington

12. Chesterfield

13. Chesterfield Results • 25 patients -2 cohorts • 6 x PCI saved • 3 x CABG saved • 1 Angiogram • All improved with programme

14. Savings • £43,888 in procedures ( not including a transplant ) • £40,221 on hospital activity • Total £84,109

15. After Cost • 25 Patients £52,250 • Overall saving = £31,859 • £1,274 per patient

16. Hillingdon

17. Hillingdon

18. Hillingdon • Cost of admissions (6 month period) • Intervention £71,799 • Control £128,344

19. Medically Unexplained Symptoms • 20% of Primary Care consultations are for people with medically unexplained symptoms • 50% of OPD appointments are for people with medically unexplained symptoms

20. Primary Care • Nottingham Medical School have delivered a commissioning tool for practice based commissioners • It is NOT validated to identify individuals • It uses the practice data base to identify people who are likely to have MUS

21. How many? • Factors included • Age • Chronic fatigue • Life stress • Long term illness • Negative ESR • Anti-depressants • Z= -1.9269 + -0.0292(X1) + 1.7709(X2) + 0.6125(X3) + 0.8156(X4) + 0.8648(X5) + 0.9476(X6)

22. How many severe patients? • Factors • Age • Anti-depressants • Dryness • Obesity • Sleep problems • Negative ESR • Life stress • Asthma • Z= -3.3399 + -0.0106(X1) + 1.2742(X2) + 0.9175(X3) + -0.7362(X4) + 0.6755(X5) +1.1049(X6) + 1.1388(X7) + 0.5055(X8) www.iapt.nhs.uk and search for “MUS The Nottingham Tool”

23. Acute OPD Prevalence of MUS in acute out patients in a London Teaching Hospital • Clinic % • Chest 59% • Cardiology 56% • Gastroenterology 60% • Rheumatology 58% • Neurology 55% • Dental 49% • Gynaecology 57%

24. Cost to the NHS Bermingham et al in press

25. Summary • LTCs and MUS is costing the NHS lots of money • We know that psychological support will influence outcomes • What are you doing about it?

26. Thank you Alan.cohen@dh.gsi.gov.uk