Abstract

Background.
This thesis examined facilitative and inhibitory issues in the transfer of new
skills and learning to support implementation of national policy for Improving
Access to Psychological Therapy (IAPT) in primary care services within the
English National Health Service (NHS). The policy for IAPT had two principal
implementation strands; a) development of new services in primary care and
development of a new, national education and b) training programme to
support delivery of effective evidence based psychological treatments for a
specified range of common mental disorders; particularly depression and
anxiety.
There is a paucity of research on transfer of skills and learning from formal
education programmes to application in healthcare practice.
Methodology.
A mixed methods case study design was developed to obtain quantitative and
qualitative data on the experiences of IAPT therapists prior to commencing
their training programme; on completion of their educational programme and
again at a follow-up period. In-depth interviews were held with key policy
leads that devised, developed and implemented the IAPT initiative to examine
their expectations and reflections on the programme. Formal interviews were
held with IAPT therapists; their managers and clinical supervisors from a
single education cohort in an English region. Focus groups were also held
with other IAPT therapists to examine emerging findings from the data.
Results
A number of themes emerged from the merged quantitative and qualitative
data. Motivation to maintain fidelity to the work of being an IAPT therapist
was seen as crucial. This motivation was highly related to the self-reported
force of external pressures to adapt IAPT practice in line with changed NHS
commissioning requirements. System feedback was seen as a unique feature
of the programme and part of this feedback process centred on the role of
clinical supervision in supporting the transfer of learning and continuous
development of practice.
Educational programmes were based on a prescribed competency model
which was designed to provide core knowledge and skills to support new
workers in new roles in new service providers within Primary Care. However,
respondents reported high degrees of complexity, practice isolation and
political and economic stressors that were not reflected in the curriculum.
Therefore the role of the curriculum as a front end model to prepare
practitioners for practice was questioned.
Despite this, evidence existed of high levels of confidence and capability of
IAPT therapists in the extension of their core educational skills. This transfer
behaviour was a feature of practice when set within the context of supported
supervision.
Discussion on the implications from this research
Implementation of new services and a new workforce (such as IAPT) within
the NHS remains challenging with few significant successes. The IAPT
programme has a number of unique features, such as a focus on feedback
processes and clinical supervision. These enabling forces particularly those
of supervision, were considered to be under threat from cost saving initiatives.
Such financial pressures appear to have the potential to destabilise one of the
major enabling building blocks of learning transfer.
This thesis adds to the body of knowledge in workforce development and
education and training in the NHS by offering a detailed case study analysis of
a range of factors that can inhibit or enable transfer of learning and promote
change in professional practice. There is little research in the mental health
literature on the transfer of learning that takes such a comprehensive whole
systems and long term perspective on this issue.