Academic, Clinical Service and Economic Evaluation of the Postgraduate Diploma Associate Psychological Practitioner (PgDip APP) Programme - Cohort 3

Abstract

Executive Summary

Introduction to the Evaluation

Early in 2019 the NHS Long Term Plan (LTP), followed by the NHS People Plan in 2020, both recognised the need to increase workforce supply of appropriately skilled and motivated psychological practitioners to meet need and improve outcomes. Challenges exist at all career levels: entry, transition, and development towards senior clinical and/or leadership roles. Strategic workforce programmes across the North-West Coast system (Lancashire & South Cumbria, L≻ Cheshire & Merseyside, C&M), anticipating this, commissioned this project to support sustainable expansion of a new psychological professions workforce to support NHS policy aims of improving access to psychological interventions. Sponsored by Health Education England (HEE) and led by The Innovation Agency (IA), The Academic Health Sciences Network for the North-West Coast, in partnership with Lancashire and South Cumbria NHS Foundation Trust (LSCFT) and The University of Central Lancashire (UCLan), the Trainee/Associate Psychological Practitioner (TAPP) was developed. Cohort 1 included 50 funded roles and ran January 2021 to January 2022, with an evaluation of this cohort evidencing the many successes and value of this new role, from the perspective of patients, services, NHS staff and TAPPs themselves. Cohort 2 included 90 roles and expanded to Greater Manchester, from March 2022 to March 2023. The positive impact on patient outcomes and staff capacity identified in Cohort 1 was replicated in Cohort 2, and preliminary cost-effectiveness analysis of TAPPs in primary care identified potentially similar costs and gains in patients’ generic health-related quality of life (when measured in quality-adjusted life years or QALYs) compared with usual care, which could liberate resources from GP time. Cohort 3 is the final cohort of this three-year pilot and included 63 funded roles across Cumbria, Lancashire, Liverpool & Merseyside, Manchester & Greater Manchester, and West Yorkshire. Cohort 3 is the focus of this evaluation report, but we end with overall recommendations and conclusions from our three years of TAPP.
Aims of the Evaluation
The overall aim of this report led by UCLan and LSCFT, was to evaluate the success of the programme and TAPP role in Cohort 3, via three criteria:
1) TAPP retention and course completion alongside academic training experience, during the 12-month training period (academic evaluation).
2) The acceptability and impact of TAPPs in clinical settings (clinical service evaluation).

Method
The academic and clinical service evaluation involved triangulation of data from: 1) patients, 2) clinical supervisors, and 3) the workforce (TAPPs).

Summary of Key Findings

1) Retention of TAPPs and course completion rate: Only 6% of TAPPs withdrew from the course due to factors outside of our control. Of the 94% remaining TAPPs, all who completed the course within the 12-month training period achieved the required clinical competencies and passed the PgDip APP programme.
2) TAPPs’ experience of the training: TAPPs valued their role and see it as a valued career pathway that can provide direct clinical experience and skills and support personal and professional development. Some TAPPs experienced challenges, particularly around the learning of new intervention skills and the amount of time spent teaching these.
3) Acceptability of the TAPP role to patients: positive feedback was received from patients regarding the support they received from a TAPP, the qualities of the TAPP, and the ability of the TAPP to support positive change via the learning of new skills and strategies. A common theme, however, across services and settings was the need for more intervention sessions and time.
4) Impact of the TAPP work on patient outcomes: there was evidence of improvements across mental health routine clinical outcome measures (ROMs) (e.g., depression, anxiety, wellbeing, goals, quality of life) across a range of services, following intervention with a TAPP.
5) Acceptability of the workforce to Clinical Supervisors: supervisors identified a myriad of ways in which the TAPP role had a positive impact, including the delivery of psychological interventions and increased patient satisfaction, generating additional workforce capacity within the service and wider service benefits (e.g., decreasing waiting times). Challenges included the embedding of the role into the service and the systematic and pragmatic factors associated with this (e.g., how the role sits within the service; training and support requirements).

Recommendations

As this three-year pilot comes to an end, our recommendations are shaped by the fact that a business case submitted in September 2023, for continued funding of the TAPP Programme for a further three years, was not supported. We will now be focusing on working with the national team and clinical stakeholder reference group to support the three cohorts of qualified APPs in their roles, their future development, and careers. Our recommendations are as follows:

1) To share the results of this final year evaluation with our stakeholders, including TAPPs, their supervisors, managers, and clinical leads; our main sponsors at NHSE; the North West MHLDA Regional Workforce and Supply Board; and NW PPN.
2) To replicate our first publication (Budd et al., 2022) by translating evaluation results into a second publishable Open Access service evaluation paper to share with the academic and clinical communities.
3) To continue to support APP development and career progression, working closely with the national team, The Psychological Professions Network North West and other key stakeholders.
4) To implement the option to grandparent APPs into Mental Health and Wellbeing Practitioner (MHWP) roles, in line with stakeholder preference.
5) To consolidate project materials, publications, and evaluation reports, as an exemplar of best practice, to support the development of future workforce projects.
6) To work with the national team to support the development of a Band 6 Senior MHWP role, to provide further career progression opportunities for APPs that transition into MHWP roles.
7) To track, as far as is possible, the career progression of current APPs, to understand destinations of this workforce to evaluate whether initial increased supply of psychological practitioners has been of benefit to the wider psychological workforce.

Conclusions
The evaluation of cohort 3 represents the final year of the proof-of-concept project in developing a new role that can deliver psychological intervention work in a range of settings. The role was well-received, and APPs are highly valued within the North-West region, as key contributors to workforce supply, delivering improved outcomes for patients.

The evaluation of all three cohorts highlights significant successes, the value the role contributed, and the challenges embedding this new role. This project has continued to demonstrate both excellent supply (over 500 applications for cohort 1, over 600 for cohort 2 and over 700 for cohort 3) and the benefits of recruiting career-focused psychology graduates to work in healthcare. This is a key area for development among psychological professions, where there is currently no direct route from the completion of a psychology undergraduate degree to working in healthcare in a professional role.

The APP role has been responsive to current rising demand and gaps in provision for mental health Services and the APPs have improved population health outcomes. The role has helped to meet the strategic priorities of NHS LTP that relate to the growth of the psychological workforce, new career pathways, and new ways of working.