CONTINUING THE PHILOSOPHY OF REGINALD O. KAPP

9.81 Proposal for a licencing system to procure NICE recommended Mindfulness Based Cognitive Therapy (MBCT) courses for depressed patients on GP referral by voucher prescription           8.11.14

Paper for Clinical Commission Group (CCG) Board meeting on 25.11.14 and Health and Wellbeing Board (HWB) meeting on 9.12.14


By John Kapp under Patient and Public Involvement (PPI)
of 22, Saxon Rd Hove BN3 4LE 01273 417997, johnkapp@btinternet.com,
whose previous papers are published on section 9 of www.reginaldkapp.org

Contents
Summary of this proposal
Invitation to apply for a licence to provide NICE recommended Mindfulness Based Cognitive Therapy (MBCT) 10 week courses for depressed patients on GP referral by voucher prescription.
1 What is the intention of this invitation?
2 What does this licence entitle my organisation to do?
3 What are the tariff prices?
4 Who may apply for a licence?
5 What is the prospective demand for MBCT courses on the NHS in the city?
6 What sort of contract is this licence?
7 What are the terms of this licence?
8 Desired outcomes for participants of MBCT courses
9 Desired outcomes for doctors referring to these MBCT courses
10 Desired outcomes for taxpayers paying for these courses
11 Contra indications
12 Entry qualifications for patients to become participants
13 Model rules for MBCT course participants
14 At which venues are these MBCT courses to be held?
15 Duration of courses
16 Enhanced sandwich course of supporting meditations before and after the MBCT course.
17 Suggested schedule of provision of enhanced sandwich courses
18 Qualifications for MBCT facilitators under this licence
19Qualifications for trainers of mindfulness based teachers under this licence.
20 Proformer voucher prescription for MBCT courses and supporting meditations
21 Licence contract for the provision of MBCT courses by voucher prescription between commissioners and licenced providers
22 Paperwork administration required
23 NICE recommended MBCT Course content.
24 Application form for a licence
Appendix 1 UK Network for Mindfulness-Based Teachers Good practice guidelines for teaching mindfulness-based courses
Appendix 2 Good Practice Guidelines for Trainers of Mindfulness-Based Teachers
Appendix 3 PRESCRIPTION VOUCHER FOR A NICE-RECOMMENDED MINDFULNESS BASED COGNITIVE THERAPY (MBCT) COURSE FROM LICENCED PROVIDERS
Appendix 4 Licence Agreement contract for the provision of MBCT courses by voucher prescription between commissioners and licenced providers
Appendix 5 Application form for a licence to provide Mindfulness Based Cognitive Therapy (MBCT) courses
Appendix 6 Model Memorandum and Articles for licenced providers of MBCT courses

Summary of this proposal

Under the Improving Access to Psychological Therapies (IAPT) programme (2006) and NICE guidelines for mild to moderate depression, (CG123 2011) GPs are supposed to prescribe talking therapies rather than antidepressants, but can’t because waiting times are too long (6 months). Antidepressants do not even claim to cure depression, so patients keep coming back, causing the crisis in primary care.

This proposal would solve the crisis by empowering GPs to prescribe NICE recommended Mindfulness Based Cognitive Therapy (MBCT) courses (which are 100 times more cost effective than Cognitive Behaviour Therapy, CBT) as quickly and easily as Prozac.

Commissioners have not done this hitherto because the method of procurement of block performance contracts takes 2 years, and has to wait until the present providers’ contracts are due for renewal. This paper proposes a new and quick procurement system by which commissioners would invite complementary therapy organisations in the city to apply for a licence to provide talking therapies. This would enable GPs to prescribe MBCT courses, and patients to access a course near them within a few weeks, thereby meeting the following government imperatives by their due date of 1.4.15 (in 4.5 months time):

  • The need for the NHS to meet the new access standards for mental health of 2 weeks for psychotic patients, and 6 to 18 weeks for depression by 1.4.15 (announced by Nick Clegg on 8.10.14, and David Cameron on 5.11.14)
  • The need for innovative better care (such as MBCT courses) for vulnerable people, from 1.4.15 under the Better Care Fund of £3.8 bn pa nationally, of which the city of Brighton and Hove is allocated £20 million pa.
  • The statutory right of patients under the NHS Constitution to be treated with NICE recommended talking therapies (such as the NICE recommended MBCT 8 week course), which needs to be offered to all the 31,000 depressed patients in the city.
  • The need for letting outcome based contracts, (rather than performance based block contracts) in reasonable time.
  • The need for integration into the NHS of the best of complementary treatments, (including the MBCT course as it is NICE recommended) as called for by Prince Charles in his keynote address to the health ministers of the world at the World Health Organisation conference in 2006.

This system would work like the licencing of taxi drivers, whereby the Council lays down standards for vehicles and a tariff for carrying fare paying passengers. Standards are kept high by each licenced taxi driver having to compete in the market for fares. Under this proposal standards would be kept high for MBCT courses as each licenced provider would have to compete in the market for patients on GP referral.

The commissioners (the Health and Wellbeing Board (HWB) of the Brighton and Hove City Council, and their Clinical Commissioning Group, (CCG) would jointly issue the following invitation before the end of 2014 to complementary therapy organisations in the city to apply for a licence to provide the MBCT course, and supporting meditations on GP referral by prescription voucher.
The aim should be that they should start providing courses from 1.1.15, and be paid for them in arrears in the next financial year, from 1.4.15.

The aim would be to commission up to 1,000 MBCT courses and supporting meditations for up to 15,000 patients pa, (half of the 31,000 depressed patients in the city) spread proportionally between the 46 surgeries in the city. This would cost up to £15 million pa, which would come out of the Better Care Fund (£20 million pa) and financed from the prescribing budget of about £55 million pa (leaving £40 million pa for drugs). Other than office time in procurement, there would be no cost to the Council, CCG or GP surgeries.

Each surgery (such as Portslade Health Centre) would link up with a meditation centre (such as the author’s therapy centre at 3, Boundary Rd Hove BN3 4EH) to run about 25 MBCT courses and supporting meditations annually for 375 patients (at 15 per class) at up to £1,000 per patient satisfactorily treated. This service would cost each surgery up to £375,000 pa, paid out of the prescribing budget (about £1 million pa per surgery) as the MBCT course would be prescribed instead of antidepressants. The only loser in this proposal would be the drug companies.

This proposal would create better health outcomes and reduced health inequalities at less cost, as detailed in paper 9.76 on www.reginaldkapp.org ‘Meditation centres for heart sink patients for half the drugs budget, saving £7 for every £1 invested’ On £15 million invested in this initiative, the potential savings in public sector costs could be £100 million in reduced patient contacts, hospital admissions, brushes with the criminal justice and housing system.

Recommendation. That the following draft proposed invitation be issued to providers by the commissioners in the city preferably before the end of 2014.


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