Patients are missing out because health providers won't play by the rules

For the past year Babylon Health has been calling for all mental health service providers to follow NHS England rules and offer care to local people - most providers do the right thing but thousands of patients are still let down by a significant minority of providers who incorrectly force people to travel across London for their care

One in six people have a mental health issue at any given time¹, but many struggle to get timely treatment². The NHS set up a system to enable people speedier access to psychological therapies - it’s known as IAPT (Improving Access to Psychological Therapies). It launched in 2008 and NHS England say it has transformed the treatment of adult anxiety disorders and depression in England as over 900,00 people now access IAPT services each year³. However, many people are still not getting the care that they should.

More than 60,000 people across England choose to register with a GP practice that is based away from where they live⁴ (and that’s excluding people who use Babylon GP at Hand). They might want a GP practice near where they work, or a service that offers better out of hours care, or they may not want friends and family to know about the care they are receiving. Whatever the reason, that choice is protected by the NHS rules and NHS England say everybody should be able to use the combination of GP practice and IAPT service that best suits them.

The reality is it doesn’t always work out this way - our experience has been that in London, one third of IAPT providers don’t accept referrals from a GP who is located outside their area, even when the patient lives locally. For example, if a Babylon GP at Hand patient lives in Enfield then their mental health service provider is very happy to give them treatment in Enfield. However, if the patient lives next door in Walthamstow, their provider refuses and so patients living in Walthamstow have to travel all the way to Hammersmith and Fulham for their IAPT care.

These are patients who value being able to speak to a doctor day/night and without having to leave their home. They get great GP care 24 hours a day, 365 days a year and they decide this means having a GP out of their area is worth it. But because some providers aren’t following the rules these patients are being made to trek across London.

Choice is enshrined in the NHS⁵ and for more than a year, Babylon Health has been lobbying for these rules to be upheld and for patients’ choice to be protected. This is not necessarily a case of providers skimping on patient care, it may simply be the result of an aged system and a ‘computer says no’ attitude. Every area of the country is split into geographical blocks, with a Clinical Commissioning Group (CCG) responsible for the care of patients in that area. CCGs provide services such as IAPT by paying a provider organisation who will actually carry out the care. The CCGs and the providers usually then agree a contract to pay a fixed amount to treat a predicted number of patients. For example, a CCG might pay the provider £100,000 to treat 1,000 people - if only 100 people actually need treatment that year then the service provider incurs lower costs, whilst if 1,500 people need care then the CCG gets more patient treatment for its money. This setup means that providers can end up looking for ways to limit the number of people they care for. Some organisations seem to worry they won’t be paid if they accept local patients referred by a GP practice from further afield. This isn’t the case - there is a well-established payment system that exists because patients have this right to choose their care. In particular, Hammersmith and Fulham CCG has expressly guaranteed payment to any provider for any patient referred to the provider’s service by Babylon GP at Hand.

The rules are clear and the systems are already in place, but more needs to be done to ensure patients aren’t suffering because of bureaucracy or ignorance. We are calling on all NHS commissioners and IAPT providers to put patients first and ensure they get the local care they deserve.

References:

1. https://webarchive.nationalarchives.gov.uk/20180328130852tf_/http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pdf/#page=8
2. https://www.bma.org.uk/news/2018/february/the-devastating-cost-of-treatment-delays
3. https://www.england.nhs.uk/mental-health/adults/iapt/
4. https://www.engage.england.nhs.uk/survey/digital-first-primary-care/user_uploads/digital-first-access-to-gp-care-engagement-v2.pdf
5. https://improvement.nhs.uk/documents/60/choice_in_mh_services_service_users.pdf