Trainee Associate Psychological Practitioner (T/APP) working in General Practice settings to meet mental health need. The pilot year evaluation.

Problem

With so many individuals presenting in general practice with mental health need, a proactive and preventative approach to mental healthcare is required. Recommendations have been made for a wider range of practice staff within primary care, including mental health practitioners (MHPs). As the need and demand increases, new workforce supply routes are required to meet this growth. A novel development in the North West of England is the deployment of Trainee Associate Psychological Practitioners (TAPPs) to deliver brief psychological interventions focusing on preventing mental health deterioration and promoting emotional wellbeing in general practice settings. This piece of work aimed to evaluate the clinical impact, efficacy of the service provided and the acceptability of the role from the perspective of patients, services and the workforce themselves.

Approach

A mixed-methods design was used. To evaluate clinical outcomes, patients completed measures of depression (PHQ-9), anxiety (GAD-7), wellbeing (WEMWBS) and resilience (BRS) at the first session, final session and at a 4-6 week follow up. Paired-samples t-tests were conducted comparing scores from session 1 and session 4, and session 1 and follow up for each of the four outcome measures. To evaluate acceptability, three questionnaires were sent to general practice staff, TAPPs and patients to gather qualitative and quantitative feedback on their views of the TAPP role. Quantitative responses were collated and summarised. Qualitative responses were analysed using inductive summative content analysis to identify themes.

Findings

T-test analysis revealed clinically and statistically significant reductions in depression and anxiety and elevations in wellbeing and resiliency between session 1 and session 4, and at follow up. Moderate-large effect sizes were recorded. Acceptability of the TAPP role was established across general practice staff, TAPPs and patients. Content analysis revealed two main themes: positive feedback and constructive feedback. Positive sub-themes included: accessibility of support, type of support, patient benefit and PCN benefit. Constructive sub-themes included: integration of the role and limitations to the support. Overall, the introduction of TAPPs into General Practice, to deliver brief mental health prevention and promotion interventions, is both clinically effective and acceptable to all.

Consequences

The results of this service evaluation highlight the potential for psychology graduates, trained through programmes such as the TAPP course, to fill a mental health workforce gap within General Practice. This has important implications, as we move to meet the recommendations set out in the NHS Long Term plan in relation to care in the community and more people having access to psychological interventions. This work also helps to highlight the importance and benefits of engaging in preventative and promotional approaches in mental health care.