We set up a low cost 6 session model for problem solving counselling, within a general practice of 15000 patients, which has benefited patients, provided counsellors with training and reduced general practitioner consultations. The lead counsellors on the project are: Mrs Christine Dunkley Advanced practitioner in psychological therapy: Hampshire Partnership Mental Health Trust and Mrs Christine Smith CBT Counsellor and Counselling co-ordinator: Park Surgery Chandlers Ford Hampshire. Within the NHS there has, until now, been very limited funding for counselling for moderately severe depression and anxiety and this innovative model represents a low cost way in which NHS primary care can rapidly expand counselling provision. Please note that this example was originally submitted to demonstrate implementation of CG23 Depression. CG23 has now been updated and replaced by CG90. The example continues to align with the updated guidance.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
We aimed to provide counselling support to patients with anxiety and depression related to life events within a primary care setting. The model enabled trainee counsellors to gain experience within a supportive, well supervised, setting. Our overall aim being to improve well-being, and speed the recovery of patients, which would also release general practitioner consultations for other patients
Within the NHS there has been limited funding for counselling and as general practitioners we were unable to access any funding. As a baseline there was no provision at all for counselling within our practice. We depended on outside volunteer agencies who provided a listening service or patients had to fund their counselling from private counsellors. Patients attended frequently to see a GP for support within the limited timeframe of 7 minutes face to face consultations. Only severe depression or anxiety with psychosis was accepted for care by the overwhelmed mental health services locally.
1) Provide local counsellors: We linked with three local colleges providing training for counsellors and offered to provide a setting to their students to gain practice based experience. 2a) Provide an experienced supervisor: We identified an experienced teacher and counsellor to act as supervisor and provide a monthly supervisory meeting for all the trainees as well as full telephone support at any time 2b) Provide a counselling co-ordinator: We asked an experienced counsellor to design a referral form and assess the suitability of each referral before allocating it to each trainee counsellor. This was funded in kind, by the provision of a room for private counselling use. 3)Encourage personal funding: We asked each general practitioner in our practice to provide £100 per annum to fund the service (total £840 supervisor costs) The main barrier has been funding to expand the service. It is seen as a very successful model and we have additional counsellors and counselling supervision ready for when we can obtain further funding of this very low cost service to the NHS.
The counselling co-ordinator has monitored each referral and matched it to the ability of the trainee counsellor. A traffic light system severity rating has been published. The co-ordinator monitors the waiting time and reports this to the doctors along with the progress of patients that are of concern. On average 36 patients are seen a year within 216 hour long sessions. Waiting times are between 3 and 12 weeks. The supervisor discusses each referral with the counsellors as a group and individually. Counsellors record a progress summary in the surgery medical records. Anxiety and depression rating scales, including the CORE system, are used to monitor patient progress over the 6 sessions they are seen. The service is reviewed at regular intervals with monitoring of costs, waiting times, and number of patients seen. Previous studies have shown that over half of those completing 6 sessions were rated as recovered on HADs Anxiety and depression and SCL-90-R scales (n=95, P<0.05) compared to no change in those who had not yet had counselling. This was maintained over a 2 year period afterwards (n=40, P<0.05) There has been a reduction in required GP consultations and an improvement in well-being of counselled patients noted by the counsellors and general practitioners. There have been no adverse events and a high quality caring service has been maintained over the last three years. The only criticism is that the service is not funded sufficiently to meet the demand from patients and there is therefore a waiting list. We have facilitated a researcher from the Wessex Deanery NHS Education South Central to interview counsellors and general practitioners and evaluate the project. Related articles have been published, and a summary is awaiting publication by Primary Health Care Research & Development under the title "Educational Model for Providing Financially Realistic Psychological Therapy in Primary Care" Zolle.O, Rickenbach.M, Courtney.C
By combining education of counsellors with provision of a counselling service high quality, low cost counselling can be provided with most NHS general practice surgeries throughout the UK. The key is the funding of an experienced counsellor supervisor and counsellor co-ordinator. Funding can be direct or in kind with the access to room space. Provision of space is sufficient to encourage trainee counsellors and the only limiting factor to the service other than funding A six session counselling service can provide care for up to 40 patients a year at a cost of £840 per year or approximately £4 an hour using this reciprocal educational model which benefits both patients and counsellors in training.
Dr Mark Rickenbach,
General Practitioner and Associate Dean
Is the example industry-sponsored in any way?