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Patterns in the use of telephone treatment in NHS Talking Therapies
Enhancing the quality of psychological interventions delivered by telephone (EQUITy) is a £2.4 million research programme funded by the National Institute of Health Research’s Programme Grants for Applied Research funding stream. A partnership between the University of York, University of Manchester and University of Sheffield, work on EQUITy began in April 2018 and will continue for five years.
In this blog, we take a look at some of their recently published work around telephone treatment in the NHS Talking Therapies (formerly IAPT) programme, Saxon, D., Barkham, M., Bee, P. et al. Telephone treatments in Improving Access to Psychological Therapies services: an analysis of use and impact on treatment uptake. BMC Psychiatry 23, 95 (2023).
Before COVID, use of telephone therapy in NHS Talking Therapies (formerly IAPT) was varied, and there was some evidence that people who were offered telephone therapy were less likely to take it up. At that time, staff received little training in telephone therapy – which is why we set up an NIHR-funded project to explore this and provide additional support (see all our related work).
Of course, the pandemic changed how NHS Talking Therapies were delivered – but now restrictions have eased, there is a debate about how much therapy should be delivered face-to-face as we move forward (a debate faced by all NHS services).
With the help of our colleagues at PCMIS Health Technologies, we reached out to NHS Talking Therapies services and received approval to analyse anonymised pre-pandemic data to look at use of telephone therapy, and factors that influenced patterns of use. Although the data are from 2017, they provide a unique perspective on these issues before the pandemic struck.
They also complement other work described in another PCMIS blog.
We looked at data from nearly 50 thousand patients in 7 services, referred from over 600 general practices in 2017.
We explored 3 questions:
- What factors led to people being offered an assessment by telephone?
- What factors made it more likely for people to turn up to their assessment?
- What was the impact of an assessment by telephone on subsequent treatment?
Pre-pandemic, getting offered an initial assessment by telephone was less about who you were, and more about the local service – certain services were just more likely to offer telephone assessment as a policy.
Patient characteristics made a much bigger difference to whether someone attended at assessment. The types of patients who were more likely to attend were those who self-referred, who had a shorter wait, were older, and lived in areas of lower deprivation. Given the NHS focus on equity and diversity, these are important factors to consider
If people were offered a telephone assessment, it did not make a difference to the chance that they would attend further appointments – unless those appointments were also by telephone. It was the combination that seemed to be an issue.
We also found a ‘’PWP’ effect – the PWP doing the assessment had an impact on later treatment attendance, no matter the type of treatment. This suggests that some PWPs are better than others at helping patients engage.
Although the data were pre-pandemic, and many things have changed, analyses are still relevant to understand factors that may help or hinder engagement with telephone therapy, and who might be disadvantaged by a reduction in face-to-face provision. These findings can them be complemented by qualitative data (Faija et al., 2020, Rushton et al., 2020).
The work also highlights the power of NHS Talking Therapies data, in allowing ongoing assessment of what works in this huge service (Clark et al., 2018) , and where problems may occur. It also provides a test bed for intervention (Delgadillo et al., 2018), where different approaches can be rolled out and evaluated using the same data, as part of a ‘Learning Health System’ (Hardie et al., 2022).
This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research (grant reference number: RP-PG1016-20010). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection, analysis or interpretation, decision to publish, or preparation of the blog.
Clark, D.M. et al. (2018). Transparency about the outcomes of Mental Health Services (IAPT approach): An analysis of public data. The Lancet, 391(10121):679-686. doi: 10.1016/S0140-6736(17)32133-5.
Delgadillo, J. et al. (2018). Feedback-informed treatment versus usual psychological treatment for depression and anxiety: A multisite, open-label, cluster randomised controlled trial. The Lancet Psychiatry, 5(7):564-572. doi: 10.1016/S2215-0366(18)30162-7.
Faija, C.L. et al. (2020). What influences practitioners’ readiness to deliver psychological interventions by telephone? A qualitative study of behaviour change using the Theoretical Domains Framework. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02761-3.
Hardie, T. et al. (2022). Developing learning health systems in the UK: Priorities for action. The Health Foundation. https://doi.org/10.37829/HF-2022-I06.
Rushton, K. et al. (2020). ‘I didn’t know what to expect’: Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02564-6.