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IAPT - Flow Model

Please note that all data used is purely for illustration and cannot be attributed to any NHS Trust.

What's the Strategy?

Improving Access to Psychological Therapies (IAPT) may prove to be one of the most important strategies of the National Health Service for people who suffer some of the more common mental health problems such as anxiety and depression.

Why does this seem difficult?

What's the Plan?

Part1: - Do your PatientFlows

1.   Recognise that existing NHS tools are inadequate & get new ones
2.   Understand your data, its quality, & get clinical input from the outset
3.   Analyse your resources, their skills, and availability (e.g. who can do what when & where?)
4.   Collaborate & produce agreed PatientFlow drawings
5.   Exploit the benefits of simple process mapping (eliminate gaps, duplication, & waste)

After this part you will have a thoroughly documented specification of what you want to achieve. This will be available in a precise and crisp visual form. Your Clinicians and Management will share understanding of your Trust's objectives and will hence work more effectively as a team.

Part2: - Do your FlowModel

1.   Use your revised PatientFlows to inform the design of a simulation FlowModel
2.   See & understand the process dynamics (Where do Patients Wait? Why? How long for?)
3.   Identify the constraints then imagine & test your preferred solutions
4.   Gain a strong, evidence-based consensus & implement with confidence
5.   Find new and leaner processes to deliver prompt, effective treatment

After this part you will have gained a much more detailed understanding of the dynamics of your processes - Which skills are in short supply ? Why are delays occuring? Which staff are working under undesirable workloads? Should we re-train / recuit?

You will have consensus on targets and evidence as to how these targets are best achieved.

Then you have the challenge of putting it into practice!

An IAPT FlowModel

This is based on the PatientFlow drawings of the 3-Step Care Pathway for Improving Access to Psychological Therapies (IAPT) that are described in this web-site (Recognition, Brief and Complex Interventions).


Step1 - Patients are Recognised in Primary Care:- this work is done in the yellow blocks in our FlowModel.
Step2 - Brief Interventions:- this work is done in the green blocks in our FlowModel
Step3- Complex Interventions (non-psychotic patients):- this work is done in the blue blocks in our FlowModel and the parallel work done by STR workers is highlighted.

In principle, each of the blocks in the screenshot below relates to a single or group of activities in the Patient Flows. We get usage and queuing statistics for each of these parts of the system.

At the outset, it is very important to understand that in a discrete event simulation FlowModel like the one we've prepared for IAPT, each number in each of the blocks represents Patients - for example, it shows over 400 Patients are on a Waiting List (Queue) just to be Telephone Triaged but over 12,500 Patients went through this Activity during the Period in question.

Likewise, we can see that this particular calibration of our FlowModel highlights a serious problem in several of the Therapy services in Step2, including EFT (Emotional Freedom Therapy) (0 completed and 362 waiting), CBT (343 on Queue), the Relate service (4 times more queued than completed)

Having created such a simulation FlowModel, it is now easy to test potential changes and see their likely effects on Patient Flow, staff utilisation, and costs. Our IAPT FlowModel gives you the ability to analyse Staff Utilisation and automatically plots charts for the main Waiting Lists (Queues) to show you the number of Patients Waiting and their Waiting Times.

For example, in the Chart of Patients Waiting for Telephone Triage, the queue steadily grows to over 400 Patients and their Wait increases to more than 2 months (69 Days). This is an immediate indicator that the Telephone Triage is understaffed.

Any queue which consistently grows is out of control and will create future problems. One objective of calibration is to balance the resource input so that no activities produce undue delay and all activities are stable in that they produce acceptable service, even considering the variation in demand which is inherent in Mental Health where the effectiveness of different treatments is so subjective.

OPTIMISED RESOURCES : GREATER PATIENT CARE