1. Could you please provide your CCG’s policy or care pathway for the following scenario in which a local patient and GP is seeking funding:
a) The patient concerned has a mental health disorder, namely body dysmorphic disorder / obsessive compulsive disorder.
The GP would refer to the mental health trust, South West Yorkshire Partnership Foundation Trust (SWYPFT), via Single Point of Access (SPA). This referral would then most likely be directed to secondary care psychology; although, there may be individual instances where the Community Mental Health Trust (CMHT) is more appropriate
b) The patient is being referred by the GP for a course of out-patient cognitive behaviour therapy which is specific for BDD/ OCD, for which there are NICE guidelines. The CCG has a commissioned provider for referrals through either a local primary care (Improving Access to Psychological Therapies – IAPT) service or for more complex problems with a local community mental health team (CMHT) and psychological therapy service.
Please see answer to 1a.
c) The GP and patient however wish the patient to be referred “out of area” to a provider that has existing NHS contracts with other CCGs. They have no other reason other than that it is the patient’s choice to be seen at different service for BDD/ OCD to that provided locally or is already commissioned. The patient and GP are fully aware of their local commissioned service but do not wish to use it.
NHS Calderdale CCG works closely with providers and GPs to ensure patient choice. There is an “Any Qualified Provider” contract for IAPT services. Through this we are able to offer the choice of two IAPT providers which are available via self-referral as well as GP referral. Although choice of out of area providers is not offered at the time of referral, if a patient wished to receive IAPT or secondary care psychology services out of area, the request would be managed through the Individual Funding Request (IFR) process. NHS Calderdale CCG’s “Operating Framework for Managing Individual Funding Requests” is provided with this response.
d) The GP believes the referral to be clinically appropriate. The referral would be to another IAPT provider or if the patient has more complex problems to a consultant led tam for medication advice and to a more experienced psychologist/ cognitive behaviour therapist.
Please see answer to 1a and 1c.
e) The GP has assessed for risk and the patient does not have any significant risk factors (e.g. a risk of suicide or self-neglect) that require local CMHT involvement. Neither does the patient need care integrated with social services nor inpatient care.
Either the GP or individual can refer directly to a choice of two locally commissioned IAPT services.
My questions for the FOI request all relate to the CCG’s policy documents or agreed care pathway in the above scenario.
2. Can the GP refer direct to an out of area provider? If not, what is the pathway for such referrals? For example, must such referrals go to a clinical triage service to determine it is appropriate to refer to another provider? Must the referral go first to a panel to determine exceptionality for the patient not to be treated locally?
No. Although choice of out of area providers is not offered at the time of referral, if a patient wished to receive IAPT or secondary care psychology services out of area, the request would be managed through the CCG’s Individual Funding Request (IFR) process. NHS Calderdale CCG’s Operating Framework for Managing Individual Funding Requests is provided with this response.
3. If yes, what are the criteria used in the scenario above for the patient to be referred out of area? When does the CCG consider the ”exceptionality” issue applies for a referral out of area? For example, must the patient have exhausted or tried treatment in local services?
Please see answer to Question 2.
4. If the patient can be referred direct for an assessment to another provider and the provider seeks authorization for funding, what is the pathway for such referrals – for example is the request taken to a special panel or dealt with by a commissioner? As in question (1) does the panel or commissioner use any specific criteria to agree to fund the assessment of the patient?
Please see answer to Question 2. Each request is assessed on a case by case basis
5. If a patient is assessed by another provider and found suitable for treatment, must a further application for funding be made for treatment? As in question (2) does the panel or commissioner use any criteria to agree to fund the patient’s treatment or suggest that they are treated locally?
Please see answer to Question 2.