We will start this section with information that might be helpful before/ during training, specifically on possible types of placement you will be getting in Year 1. We collated this segment based on feedback obtained from current trainees. Then we will end with something that most trainees who have not worked in the UK prior to training easily feel confused about.
What is the NHS?
The National Health Service (NHS) is the umbrella term for the publicly funded health care system in the United Kingdom.
Three Core Principles of the NHS
It meets the needs of everyone.
It is free at the point of delivery.
It is based on clinical need, not ability to pay.
How does this link with Mental Health?
Mental health services are free within the NHS, in some cases service users will need a referral from their GP or other healthcare professionals to access specialised services. Primary care services (see Figure 1) tend to accept service users who self-refer.
Figure 1. An explanation of the stepped care model, Reprinted from Student health and wellbeing slide show by Reynolds, S. from http://slideplayer.com/.2018
As a Trainee Clinical Psychologist, where will my placement be?
(Your placement will vary depending on the region and universities you will be studying at. For example, University of Exeter may have a Child and Adolescent Mental Health placement instead of an adult mental health service).
We tend to be in adult mental health services for our first year of training, then we will move on to either older adult, physical health, or child and adolescents’ services in second year. For the purpose of this guide, we will only highlight possible services you will be in in the first year. The course will provide you with more information on your induction day and throughout your training. The course will provide you with more information on your induction day and throughout the training. Also, feel free to have conversations with peers you’ll meet in the course as they will be able to share more insights and experiences working in different services.
Primary Mental Health typically offer short term therapy (1-16 sessions) and operate 9am-6pm on weekdays. Such services normally only consist of Psychological Wellbeing Practitioners (PWP), Clinical Psychologists, and Assistant Psychologists (AP). They normally do not work with service users who have higher risk (e.g. at risk to self or others or risk from others) who need an input from psychiatrists or other allied health professionals (other health and social care professionals working within and without the NHS). Your work may involve working with Step 1-3 or 4 (see Figure 1) for adults depending on the service’s remit.
Improving Access to Psychological Therapies (IAPT)
IAPT was launched in 2008 to provide evidence-based treatments for
people with anxiety and depression, using the Stepped Care approach in Figure 1. The main therapeutic modality is Cognitive Behavioral Therapy (CBT). Within IAPT, there are LI and HI therapists.
What is LI and HI?
Low Intensity (LI) CBT therapy is normally provided by Psychological Wellbeing Practitioners (PWP). They provide therapy at Step 2 level, sometimes also known as Guided Self Help (GSH). High Intensity (HI) CBT therapists have completed a year-long intensive training on CBT approaches. They tend to provide Step 3 interventions. There are other therapies such as offered at different IAPT and primary care services too.
Secondary Care Services or Community Mental Health Teams (CMHTs) usually support people aged 18 to 65 with longer term needs e.g. bipolar, psychosis, personality disorders (debated term, use sensitively). These services tend to have a Multi-disciplinary team (MDT) structure (doctors, nurses, social workers, OT*, SLT*, Physiotherapists etc). Similarly, Older Adult Mental Health Team (OAMHT) work with families and adults 65+ who need help with problems related to old age like dementia.
Early intervention in Psychosis (EIP)is an integrated service for people aged 14 – 65 presenting with a first episode of psychosis. Depending on your placement, some EIP services are embedded within CMHT services.
High support / Integrated care teamsprovide support to people over 18 who have mental health with physical health conditions living at home, in a hospice or in a nursing home.
Community Learning Difficulties Services (CLDS)help people with Learning or intellectual difficulties to be as independent as possible by offering advice, therapy and practical support.
Your role may involve liaising with carers and working with other special needs services.
Rehabilitation services - for people who’ve undergone a recent change in mental and/or physical functioning (e.g. as a result of acquired brain injury or traumatic brain injury or stroke). You will gain cognitive assessment competencies here. Home Treatment Teams (HTT) for adults aged 16-65 with mental health crisis (e.g., unable to keep themselves safe) but are not in hospital.
Forensic Inpatient Unit- They provide treatment and care for people who have experienced the Criminal Justice System and may demonstrate challenging behaviours in the context of serious mental health difficulties, usually with complex co-morbidities.
What are NHS pay bands / banding?
Many trainees feedback that there were confused by conversations surrounding banding when they started their training. So what is banding?
NHS wage banding ensures transparent rates of pay for all staff across the healthcare system and allows employees to move up NHS pay scales through training and development. Staff are paid at certain bands based on their professional background and years of service with the NHS. Managerial staff and team / service leads are higher on the banding system, and hence earn more. Knowing a staff member’s pay band gives insight into their seniority in the team, and conversations about banding commonly occur within teams as a demonstration of hierarchical power and influence in the system.
Bands range from 1 to 9, with 1 being the lowest paid and 9 the highest. Gradations within bands denote the number of years a person has worked at that band level i.e. each year staff members move up a gradation (essentially a ‘pay rise’).
Where were other home trainees before Band 6?
Most assistant psychologists can be Band 3/4/5
PWP or LI can be Band 5 (at start), Band 6/7 with managerial positions.
HI at a Band 7
As a trainee where do I fit?
Band 6 (No we don’t get paid, but this is where we would be if we were).
Which band will I be once I qualified?
We start at Band 7 but can apply for a band 8 position after 2 years in some cases even 1 year.
You can read more about banding here: https://www.healthcareers.nhs.uk/working-health/working-nhs/nhs-pay-and-benefits/agenda-change-pay-rates
How to navigate conversations about banding?
“Most of the home fees trainees worked so hard at Band 3/4/5 for years before getting into the course so their hard work is definitely worth some acknowledgement and celebration. However, international trainees need to be mindful that in some services, we are expected to be “professional people at Band 6 level” or uphold some sort of seniority level. This honestly, does not mean anything to an international trainee.
As international trainees, some of us join the program thinking that we are students and therefore placements are more of a place where we can gain clinical experience than a place where we are paid to work from 9-5. As most of us are paying more than £26,000 per annum for the clinical training, a lot of international trainees tend to view clinical training as part of a university course rather than a job; thus there could be different positions and perspectives taken by us and home fees trainees."
- An international trainee from KCL shared their thoughts on this matter.
We hope that the information on banding brings some insight to the different perspectives taken by international vs. NHS funded trainees. Based on our International Trainee Experiences survey, international trainees reported that they do not understand the purpose of conversations surrounding banding (e.g., naming their bands, or talking about “band 6 salary”). Sometimes knowing what to expect and getting some perspectives can go a long way to helping a fellow trainee find their own way in these conversations.