Workforce challenges / barriers

Some of the challenges on the ‘Challenges/ barriers’ section relate to the IAPT workforce and staffing:


  • Recruiting and retaining staff – some IAPT services are non-NHS (e.g. Mind), which is a less attractive employer than NHS-provided IAPT services. Some services are outer London so a less attractive area to work compared to inner London boroughs, due to lower HCA supplement.
  • Recruitment and retention of mother tongue trainees or therapists (very few available).
  • Turnover of staff is high, particularly for PWPs (many are promoted to HITs). Constantly having to replace staff and recruit new ones. This is time consuming.
  • Some services have a lack of supervision capacity, e.g. for High Intensity Therapists, therefore are unable to recruit new HITs.
  • To address this recruitment challenge, many IAPT services use alternative provision (e.g. Xyla) to provide digital Step 2 and step 3 treatments to help manage waiting times and reach access targets.


  • Funding of staff – some services have to employ PWPs / HITs on a lower banding than other services due to lower level of funding by CCG relative to targets. This negatively impacts on recruitment and retention.
  • Would be helpful for trainees to be put onto permanent contracts. Currently many services are unable to offer trainees permanent contracts; some services have lost three cohorts of trainees due to not being able to offer permanent contracts (due to lack of funding). This has led to a significant loss of experience within team, and it is harder to then support new trainees.
  • Some services would rather be funded for qualified staff rather than for trainees, to improve the stability and experience within the workforce.

Time for outreach

  • No space (or funding) for outreach or engagement work within IAPT model – dependent on commissioners being willing/ able to fund it. Increasingly challenging with increased access targets. Hard to balance staff time spent on clearing waiting lists and seeing patients versus doing engagement work – meaningful outreach work needs dedicated time. If staff spend a lot of time on outreach work, this can reduce achievement of access targets, so services are not incentivised to do this.


  • Quality of interpreting, and cost, raised as big issues by some IAPT services in North Central London.