Physical health

Introduction

Issues around governance and workforce for clinical psychologists working in physical healthcare settings have come into sharp focus during the pandemic and a Group was set up by the Workforce and Training Subcommittee to consider these and scope out what was needed

Scoping Discussion

In the first meeting we identified the following issues:

What is happening?

• Widespread concerns about psychologists working alone/ unsupported in physical healthcare settings which seems to have increased as a result of the pandemic, especially in staff support roles
• Some funding initiatives e.g. for diabetes lead to Trust employing individuals in stand alone without supporting structures and often in junior grades
• Comparisons with nursing where an 8b post is at deputy matron level means Trusts can be reluctant to employ senior psychologists
• PPN survey is taking place. Angela conducted an adult survey in 2015 which can give comparative data
• There has been a massive increase in psychologists employed in ICUs. 6 years ago there were 12 posts, now 80 and increasing rapidly. 50% were at 8b or above
• Need to speak the language of non-psychologist managers to make progress

Decided there were two differing and overlapping issues:

1. Grading

• Tony gave some background. Almost 60% more training places for CPs in the last 2 years in England, similar in other nations though Wales is lagging
• As AHP and nursing training have moved out of HEE budgets, CP is suddenly the largest component and very visible leading to further questions about VFM
• Problem of who we are compared to.
• Union also concerned about downbanding and have produced a paper
• We appear to be losing senior staff due to downbanding and loss of career opportunities
• Issues of shortages of placements jeopardising increased numbers. Taking trainees has to become the norm not a choice

2. Governance

• CPs in physical healthcare, even if appropriately banded, may not be adequately supported

Other Groups we need to be aware of and work with:

• BPS Clinical Health Task and Finish Group ( on which we have representation)
• Psychological Professions National Workforce Advisory Group are establishing a Physical Healthcare Working Group

Strategy

We identified a lack of strategy across the physical health field Key questions:

• What would integrated Care look like?
• What about equity of provision e.g. there are more and less fashionable areas.
• Why are there such disparities across specialities and geographical areas
• We have a seat on the NHSE multidisciplinary Mental Health in Physical Health Advisory Group (CYP). Will be releasing a strategy doc
• We want to make sure it is psychological not mental health
• Need to have Advisors at a senior enough level in NHSE

Training and competencies

• There is a UCL project on competencies for people working in physical healthcare
• What are the courses actually doing?
• Placements can be key
• Academic training is very crowded. Should be focusing on how we adapt our key skills to medical settings rather condition based
• Need to change language/mind-set to working in medical settings rather than saying physical health
• Other professions will have had specialist training in a specialist area of work and others do not necessarily understand we are coming from a more generalist background. Similarly managers don't necessarily understand this means we need external support structures rather than the directorate being sufficient

Proposals for a Task and Finish Group

The Group decided to recommend a Task and Finish Group with a suggested remit to the DCP Executive.

This was approved in principle and the Group has now refined the membership and remit

Remit

1. Working into the BPS Physical Healthcare T&F Group, primarily by supporting and advising DCP members and
2. Working into the NHSE/PPN working group both directly and by supporting any DCP members on the group. This will include working towards getting physical health psychology advisors into the heart of NHSE as we have for mental health
3. Working on Governance and Workforce issues for Clinical Psychology
4. Looking at training, competencies and CPD. This is expected to be a priority later in the process

Membership

The current group members will all continue.

We will seek additional members from:

1. The Faculties working directly in physical healthcare settings (the group already has some people from these Faculties)

• Clinical Health
• Paediatric Psychology Network in CYPF Faculty
• Oncology and Palliative Care
• HIV and Sexual Health

We recognise that other Faculties include a focus on physical healthcare and have members working acute hospital settings and may wish to join.

2. GTiCP

3. The devolved nations

We need to maintain awareness of Public Health issues and also Primary/Community Care. We will seek additional representatives from these areas if they are coming into the discussions of the BPS and NHSE groups.

• Terms of Reference - Psychological Practice in Physical Health Expert Advisory Group

• Statement of Interest - Psychological Practice in Physical Health Expert Advisory Group

• Statement of interest - British Orthopaedic Association Standard for Trauma and Orthopaedics

• Statement of interest - Intercollegiate Stroke Working Party