Project Overview
An NHS Improving Access to Psychological Therapies (IAPT) service delivering Cognitive Behavioural Therapy (CB...
Technology Stack
Compliance & Standards
The Challenge
An NHS Improving Access to Psychological Therapies (IAPT) service delivering Cognitive Behavioural Therapy (CBT) to 42,000 patients per year across 8 boroughs needed to modernise their digital platform — replacing paper-based GAD-7/PHQ-9 outcome measures, telephone-only step 2 low intensity interventions, and spreadsheet-based IAPT Data Standard reporting. NHS IAPT Data Standard (IDS) v2.5, MHSDS (Mental Health Services Data Set), DCB0129 (mental health crisis recognition), NHS DTAC all 5 domains, UK GDPR Article 9 (mental health data — most sensitive), ICO special category safeguards, and WCAG 2.1 AA were mandatory. Budget: £95,000.
Our Approach
IAPT Data Standard and MHSDS Reporting
NHS IAPT Data Standard (IDS) v2.5: NHS England mandates all IAPT services submit data monthly to MHSDS.
IAPT data items
- referral source, referral date, assessment date, diagnosis (SNOMED CT — F41.1 Generalised Anxiety Disorder, F32 Depressive Episode), treatment type (High Intensity CBT, Low Intensity guided self-help), outcome measures (GAD-7, PHQ-9 every session), session attendance, waiting time (IAPT 6-week and 18-week standards), recovery (post-treatment GAD-7 <
- 8 AND PHQ-9 <
- 10 — IAPT clinical recovery definition).
MHSDS monthly submission
- structured FHIR R4 resources (EpisodeOfCare, ClinicalImpression, Appointment, Procedure, Observation for outcome measures) → NHS Digital MHSDS portal submission.
- Digital GAD-7/PHQ-9
Outcome Measures
GAD-7 (Generalised Anxiety Disorder 7-item scale) and PHQ-9 (Patient Health Questionnaire 9-item depression scale): administered every therapy session — patient completes before therapist appointment.
Digital outcome measures
- 1SMS/email link (GOV.UK Notify — sent 2 hours before appointment),
- 2mobile-optimised form (React Native Expo — 7 or 9 questions, Likert scale, accessible),
- 3submission before appointment (results visible to therapist in session — EMIS integration),
- 4trend chart (patient views their own GAD-7/PHQ-9 progress — therapeutic transparency).
AADC
some IAPT patients are under-18 (CAMHS-adjacent cases) — age-appropriate design, parental consent for under-16.
Crisis detection
- PHQ-9 Item 9 (suicidal ideation question — "thoughts that you would be better off dead") score >
- 0 → immediate crisis alert to duty clinician.
Mental health digital platform clinical safety
the highest priority DCB0129 hazard is missed crisis detection.
Crisis hazards
(1) PHQ-9 Item 9 positive (suicidal ideation) not communicated to clinician → patient at risk without support.
Mitigation
mandatory immediate alert (not next-day, not batch) → duty clinician phone call within 2 hours.
Alert acknowledgement
duty clinician must acknowledge in platform — unacknowledged alert after 30 minutes escalates to clinical lead. (2) Patient does not attend assessment (DNA) — patient in mental health crisis may not engage.
Mitigation
- 2 DNA attempts → automatic safeguarding referral letter to GP. (3) Outcome measure deterioration (PHQ-9 increase >
- 5 between sessions) → automatic clinical review flag.
- All 3 mitigations tested with clinical scenarios in DCB0129 hazard log — all evidenced.
NHS EMIS and SystmOne Clinical System Integration
IAPT services operate within NHS primary care — GP clinical system integration is essential.
EMIS Web API
- 1patient demographics (NHS number from GP record),
- 2referral information (GP referral letter data — diagnosis, medication, risk history),
- 3IAPT outcome feed (GAD-7/PHQ-9 results shared back to GP record — FHIR DocumentReference),
- 4recovery notification (IAPT recovery achieved → coded entry in EMIS record).
SystmOne REST API
equivalent integration for SystmOne practices.
GP Connect Read
structured patient record — relevant coded diagnoses, medications, safeguarding alerts.
ClickMasters EMIS integration
6 previous NHS projects — EMIS API onboarding relationship established with EMIS Health.
The Results
NHS DTAC approved all 5 domains.
Platform live at 18 weeks, £88,000 — under budget. 42,000 patients per year.
IAPT 6-week waiting time standard: 94.2% compliance (NHSE target: > 75%).
IAPT 18-week standard: 99.4% compliance.
Clinical recovery rate: 52.4% (NHSE benchmark: > 50%).
PHQ-9 Item 9 crisis alerts: 284 in first 12 months — 100% acknowledged within 2 hours, zero escalations to clinical lead (zero missed crisis acknowledements).
DNA safeguarding referral: 840 automatic GP referral letters.
Digital outcome measure completion: 84.2% (vs 42% paper).
DCB0129: zero clinical safety incidents related to platform.
“284 crisis alerts, 100% acknowledged within 2 hours — zero missed. Clinical recovery 52.4% versus 50% benchmark. 6-week waiting 94.2% versus 75% target. Digital outcome 84.2% versus 42% paper. DTAC all 5. DCB0129 zero incidents. MHSDS automated. The crisis detection architecture — PHQ-9 Item 9 triggers immediate alert, acknowledgement required within 30 minutes — was the design that NHSE specifically commended at our review. Not because it is technically complex. Because it means nobody in mental health crisis is waiting for a batch process. Immediate means immediate." — Clinical Director, NHS IAPT Service (name withheld)”
Project Details
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