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Report criticises 'any qualified provider' policy

15th January 2014

A recent report, carried out by the University of Chester’s Centre for Psychological Therapies in Primary care, suggests the government’s any qualified provider (AQP) approach to service delivery is detrimental to the quality and consistency of mental healthcare.

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The report is based on qualitative interviews with providers and commissioners in the first trial areas implementing the AQP policy.

The AQP programme was introduced to extend patient choice and raise both service quality and efficiency through competition between providers. In essence, when patients are referred (usually by their GP) to a given service they should be given the opportunity to choose from a list of qualified providers who meet NHS service quality requirements.

One of the major components of AQP facing criticism is the payment by results (PbR) system. The report describes it as adding unnecessary pressure to psychologists’ duties and affects the reliability of their service. PbR can also discourage caring for patients who are difficult to treat because they will not be paid as much. This inevitably leads to a conveyor belt mentality and a rush to treat the highest number of low-risk patients possible in order to increase income.

The authors’ also claim that the payment tariffs per client have been set unrealistically low and that they did not taken hidden costs (including greater administrative burdens) into account.

Some AQP providers said that they were able to keep costs down by not employing staff on secure contracts. However, zero hour contracts affected retention, service continuity and caused difficulty in maintaining skill levels.

The overwhelming view of the providers and commissioners interviewed was that the online AQP qualification process was 'wasteful, bureaucratic, stressful and poorly structured and defined, demanding disproportionate resources and organisational change, particularly for small organisations'.

Speaking about their report, the Centre’s director Professor Patrick Pietroni said:

"It appears that there are some serious flaws in the way psychological therapies are being delivered, in particular a highly competitive environment which has been poorly thought through. We have learned a great deal from the study, and we need to now get together with providers, commissioners, GPs and others to review the IAPT programme and redesign its methodology in order to minimise the weakness and build on the strengths identified by the report. We need to develop a model of survive delivery that is integrated with general practice and other partners in order to address the wider determinants of poor mental health."

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