Case study summary
Despite the pressure of living in a large urban area with a high cost of living, a more transient working population, and the changing nature of local services, Westminster Talking Therapies IAPT service in London enjoys a higher than average level of staff retention: 45 per cent of the team have worked in the service for more than four years. Managers asked some of their longest-serving staff to talk about their reasons for staying and a number of themes emerged.
Westminster Talking Therapies is an IAPT (Improving Access to Psychological Therapies) service providing cognitive behavioural therapy for mild to moderate mood disorders such as anxiety and depression to adult residents in Westminster. The team is based in two central hubs and embedded in several of the borough’s community GP surgeries. With 235,000 residents and a daytime population exceeding 800,000 Westminster can be an exciting and challenging place to work.
The NHS faces challenges in the area of staff retention across its disciplines and professions. Within the London IAPT services these issues are magnified by a range of factors summarised above.
Why people stay in the Westminster service
At Westminster Talking Therapies many staff have progressed through training roles and several have moved from roles as trainee Psychological Wellbeing Practitioners to working as qualified High Intensity therapists. It made sense, therefore, to approach the team to ask them about their reasons for staying.
Managers asked 10 of the longest serving staff to talk about their choice to stay in the service and a number of themes emerged. The senior managers have been in the team for a considerable length of time which allows an understanding and knowledge of the workforce and its needs. There is a strategy of reviewing recruitment, and a commitment to learning from staff feedback. There is the incentive of inner London weighting which in some way offsets increased living costs. The central London location is also attractive to our young workforce.
There is a robust appraisal system, continuing professional development, and a supervision structure that emphasises development of the individual staff member and their ability to grow within the team. There are many platforms for individuals to express ideas, personal needs, and concerns. Individuals with specific skills are encouraged to use these and find the areas that allow them to thrive professionally. There has always been a commitment to listening to staff needs in respect to their work/life balance and several of the workforce have benefited from career breaks, flexible working, and reduced working hours. Staff say they feel genuinely listened to and their ideas and opinions about service development are valued and acted upon.
Staff indicated they understand and buy into the values which drive the team. Several talked about feeling that patient needs and clinical effectiveness are at the heart of decisions about service delivery. The overall culture of the team featured heavily in staff members’ reasons for remaining in the service. The atmosphere is very much one of a shared endeavour and mutual support.
Here are the individual experiences of four team members of Westminster Talking Therapies service:
I started off at Westminster IAPT as a trainee PWP and I am currently working as a trainee cognitive behavioural therapist. I have never been so well supported in my progression and my work. No matter how busy I get, the team and management always finds time to support and talk through any issues I encounter. I feel I am trusted to work at my own pace and have protected time for supervision and for learning whilst I work.’
Psychological Wellbeing Practitioner and High Intensity trainee
First of all, we allow part-time working which means parents, people with family issues and people who want to pursue private work or teaching opportunities can still work for the service. Secondly, we do have policies and procedures which are the general rule, but if needed a decision can be made on a case by case basis. The focus of the service is on patient need and clinical effectiveness. We have targets to meet and we work hard on that, but there is less pressure on numbers and more focus on clinical practice which imply a trust in the clinicians’ competencies and on the clinical judgement of the therapists. In Westminster step 3 and step 2 clinicians do a different job, but they are equally valued and the attitude is of mutual support and professional growth. I think Westminster has a strong management structure with clear competences and responsibilities.’
Psychological Wellbeing Practitioner:
Working within a diverse team of various backgrounds and experiences is enticing as it allows for more learning and sharing of knowledge. Having consistent supervision is valued as you always feel secure in your clinical decisions. Even when things go wrong, this isn’t taken as a negative, but more as a learning opportunity for both the supervisor and trainee. Working in a well-equipped office is a factor as having the necessary tools to be able to do the job in an environment which is pleasant and accessible for patients makes the role easier and allows for better delivery of therapy. Working within a borough which has a contrasting socio-economic and ethnically diverse population allows for invaluable experiences of working with populations which you wouldn’t necessarily have access to in other boroughs. Working within a multidisciplinary team with individuals working at various levels allows one to progress and develop. Being in a positon where you feel that you can discuss any issues without fear of being judged or observed as being unskilled has been vital in making me feel more comfortable to ask anything I want and therefore develop more.
High Intensity Therapist:
I think one of the main things about Westminster that makes staff want to stay is the collaborative nature of the team. When there are new or more demanding targets we are made aware of the rationale and why we are being asked to do things. It feels as if staff input is valued. The team are extremely supportive of each other. Advice and supervision is often provided, not only in the allocated times but at any time in the office. I think the management team are also accommodating and supportive of staff personal issues. All of these elements help to create an environment that people want to work hard in, train and develop their skills in and stay in the longer term.