Psychological therapy helps people with long-term conditions to Live Well in Buckinghamshire

Thousands of people in Buckinghamshire are benefiting from a programme offering psychological therapies to those with long-term conditions.

Live Well helps people who are struggling with illnesses such as Chronic Obstructive Pulmonary Disorder (COPD) and diabetes who are more likely to experience anxiety or depression which can worsen their condition, affect their ability to self-manage, and lead to increased and longer hospital admissions.

The programme is run by Healthy Minds, the Buckinghamshire Improving Access to Pscychological Therapies (IAPT) service provided by Oxford Health NHS Foundation Trust, with support from Chiltern and Aylesbury Vale Clinical Commissioning Groups, and Buckinghamshire Healthcare NHS Foundation Trust.

It was created following Breathe Well, a successful pathfinder project funded by the Department of Health from 2012-14, which focused on people with COPD.

In this, a three-tier integrated pathway meant people could be identified earlier through the services they were already in touch with, allowing them to have tailored support through clinics at GP surgeries, through pulmonary rehabilitation groups, and, for those who were severely ill, at their own home.

Breathe Well helped patients understand their condition and how it could affect them, offered guided self-help, as well as cognitive behavioural therapy to those who needed it.

Training was offered to staff to make sure everyone in contact with patients understood their physical and psychological needs and how those might affect the management of their condition.

John Pimm, clinical lead for the Psychological Therapies Pathway in Buckinghamshire, said: “At a primary care level, GPs and practice nurses were seeing people with COPD for annual health checks, but with little training to identify people who needed mental health input or what to do if they found someone with anxiety or depression.

“We were able to identify people at the earliest stage, to get them in to see a psychological therapist and the outcomes were very good. People’s anxiety and depression improved significantly with a limited intervention.

“Practice nurses found it extremely helpful. They were saying they had seen some patients for years and now understood where that patient was struggling where they hadn’t before.”

Out of 370 people given support, 84 people presented above the treatment threshold for depression, with a recovery rate of 49 per cent; while 82 presented above the threshold for treatment for anxiety, with a recovery rate of 60 per cent.

“We had Pathfinder finance for two years, but were supported by commissioners to continue the work after that ended,” Dr Pimm said.

“In 2014 we created Live Well, which is the same idea as Breathe Well, but for anyone with a long-term condition rather than just COPD. We’ve had over 2,400 people with LTCs referred in to the service in a year. Some people need to focus on mental health, some people need a focus on physical, some need integrated. It depends very much on the conversation with the person.”

During its two-year pilot in a GP locality in Aylesbury Vale, Live Well delivered a recovery rate of 77 per cent. People received help via support groups specific to their condition, as well as online, by phone, one to one, and through linking to specialist services such as pain and nutrition clinics.

The model has extended and will be rolled out to cover the whole of Buckinghamshire (550,000 people) over the next year as part of the national integrated IAPT early implementer programme. It has also been embedded into a strategic health and wellbeing programme for primary care alongside other priority services, which include diet and alcohol advice, and diabetes prevention.

“Buckinghamshire CCGs and Public Health have recently agreed a five-year plan to commission lifestyle and Live Well services via a single point of access. The ‘Live Well, Stay Well’ Service will focus on helping people with long-term conditions as well as preventing people developing them,” Dr Pimm added.  “Now we’re joining it up with our lifestyle services, smoking cessation and so on, which are all so relevant for people with long-term conditions.”

Using a single telephone line and website, provided by Parkwood Healthcare, anyone can self-refer through Live Well, Stay Well and trained health coaches take calls to signpost people to the most relevant service. Coaches will follow up the contact to check people have been able to access appropriate support, which will also mean they can identify people who might benefit from psychological therapy.

Jackie Prosser, Commissioning lead for Chiltern and Aylesbury Vale CCGs, said: “Patients repeatedly ask for services to be ‘more joined up’ to support both their mental wellbeing as well as physical needs.

“This new way of delivering services is very accessible and responds directly to this request, as well as making it much easier for GP’s, nurses and other health care professionals to refer or signpost to interventions that really make a difference to people’s lives and can reduce the need for onward healthcare.  We are delighted with this new way of working.”

Tim Kendall, NHS England’s National Clinical Director for Mental Health, said: “People with a long-term condition can become trapped in a worsening cycle of ill-health when services focus solely on physical health without considering the impact on their mental health.
“Live Well in Buckinghamshire is a prime example of how integrated care helps to improve patients’ resilience, allowing them to manage their condition more confidently, and reducing the emotional strain which poses a real risk of harm to their physical and mental wellbeing.”