We’re aware of challenges many members working in NHS Talking Therapies services across England are facing with pay inequity; where pay banding is sometimes lower than that paid to other psychological therapists working in the same service and with service users presenting with the same clinical complexity.

This inequity in pay and conditions is wrong and not supported by NHS England or the NHS Agenda for Change payscales. 

Below are a series of resources we’ve collated that evidences why all practitioners delivering high-intensity therapy in NHS Talking Therapies services, and who meet the training and professional registration requirements set out in the NHS Talking Therapies manual, should receive the same pay and conditions. 

Included are key documents, supporting quotes and job role exemplars that may assist you in discussions with service leaders, your colleagues, unions or us as your professional body. 

Context

NHS Talking Therapies for Anxiety and Depression services are the main pathway adults in England can access psychological therapies through the NHS. 

The service is based on a stepped-care model. NICE recommended low-intensity interventions are offered for less severe cases of depression and some anxiety disorders (step 2). 

For people with less severe depression who haven’t benefited from a low-intensity intervention, they’re offered a choice from a range of high-intensity psychological interventions, including; 

  • Cognitive Behavioural Therapy (CBT) including behavioural activation
  • Person-Centred Experiential Counselling for Depression (PCE-CfD)
  • Interpersonal Psychotherapy (IPT)
  • Dynamic Interpersonal Therapy (DIT)
  • Behaviour Couple Therapy (BCT) - Couple Therapy for Depression (CTfD) 
  • Mindfulness-based Cognitive Therapy (MBCT) 

For cases of more severe depression there is a range of NICE-recommended high-intensity interventions (step 3) available, including; 

  •  Cognitive Behavioural Therapy (CBT) including behavioural activation
  • Person-Centred Experiential Counselling for Depression (PCE-CfD)
  • Dynamic Interpersonal Therapy (DIT)
  • Interpersonal Psychotherapy (IPT)

For anxiety disorders there are currently only specialised CBT interventions recommended for use at step 3. 

Nationally, NHS Talking Therapies services see over one million people a year, with service users progressing onto either a course of treatment or receiving assessment, advice and signposting onto further support, deemed suitable for them. 

Crucially NHS England states in the Talking Therapies for Anxiety and Depression manual that a good NHS Talking Therapies service offers a choice of recommended interventions to all service users, allowing them to co-create their own care plans. 

It also states that the recommended interventions for step 2 and step 3 are not recommended based on a hierarchy of effectiveness. Each intervention is equally effective, and the practitioners delivering each intervention at each step are equal to each other - client choice over the intervention they receive is recognised as a key factor in achieving successful outcomes. 

 

The case

NHS England sets out, in both the NHS Talking Therapies manual (page 31) and NHS England’s Agenda for Change payscales, that trainee High Intensity Therapists should be employed and paid at Agenda for Change band 6. Once they have completed the necessary NHS Talking Therapies service top up training and achieved the required professional registration, pay banding should be increased to Agenda for Change band 7. This applies to all practitioners delivering interventions at step 3. 

The NHS Talking Therapies manual sets out that NHS Talking Therapies services shouldn’t contract with any practitioners who have completed a recognised NHS Talking Therapies qualification and who have the required professional registrations to work unpaid, and that services should offer substantive employment avoiding contracts with practitioners that only pay them for sessions their clients attend. 

In addition, NHS England recognises that there can be variations in the processing times for professional registrations with different professional bodies, and as such band 7 uplifts should be backdated to the date of application for professional registration. 

NHS England defines a trainee High Intensity Therapist as a practitioner working towards the completion of a recognised NHS Talking Therapies high-intensity modality training and/or achieving the required professional registration for that modality (set out in the NHS Talking Therapies Manual Appendix A). 

A qualified High Intensity Therapist is defined by NHS England as a practitioner who has completed the NHS Talking Therapies high-intensity modality training for the modality they’re delivering and who has achieved the required professional registration as set out in the NHS Talking Therapies manual Appendix A. 

Additionally, NHS England has set out that senior and lead clinical roles should be developed in every service for both Psychological Wellbeing Practitioners (PWPs) delivering low-intensity interventions (Agenda for Change band 6+), and for High Intensity Therapists across all modalities paid at Agenda for Change band 8a+. 

These senior roles are intended to support career development and retention within services, and should include expert clinical delivery and leadership, not just management responsibilities. 

Dr Adrian Whittington, National Clinical Lead for Psychological Professions at NHS England, has provided support for and clarification of this being the case from NHS England. He says: 

“We [NHS England] support that all high-intensity practitioners working within NHS Talking Therapy Services who have completed a NHS Talking Therapies qualification (PCE-CfD, IPT, DIT, CBT etc) should be paid at band 7 – irrespective of the high-intensity modality they practise, and that those who are working towards an IAPT qualification and don’t yet meet all the requirements of practitioners set out in the IAPT manual are paid at band 6.” 

[supporting information provided by Dr Whittington specifically for this briefing addressing pay equity in NHS Talking Therapies services, June 2023]. 

In addition, the current Psychotherapeutic Counselling NHS Training Pathway pilot has established a clear precedent for non-CBT practitioners working in NHS Talking Therapies services to be paid in line with their CBT colleagues. The pilot provides a core psychotherapeutic counselling training with an embedded NHS Talking Therapies qualification in either person- centred experiential counselling for depression, dynamic interpersonal therapy or couples’ counselling for depression. 

To further support achieving pay equity across all NHS Talking Therapies services, NHS England has published job description exemplars for both band 7 High Intensity Therapist roles and band 8a senior or lead clinical roles within NHS Talking Therapies services. These exemplar job descriptions are linked to in the resource section below and available through the NHS Talking Therapies workspace on the NHS Futures Platform. 

Workforce expansion and retention are recognised as being vital to the continued success of NHS Talking Therapies services moving forward, and the NHS Talking Therapies Manual recognises that, as well as a focus on bringing new trainees into services, there needs to be a focus on opportunities to bring in already qualified staff and ensuring existing workforce retention rates are maximised. This is an important recognition as it both supports the idea that practitioners may arrive in the workforce having followed different training routes but also that retention is key – getting pay right is an important way of making staff feel valued and keeping them and their experience in the service. 

How we can support 

Please get in touch, via matthew.smith-lilley@bacp.co.uk, to ask any further questions about the guidance and support that we are able to offer. We are often able to provide information and support to counsellors and psychotherapists affected by pay inequity where it impacts the profession more broadly within the service and where pay inequity could reasonably be seen to pose a risk to the level of continuing counselling and psychotherapy provision for the public. 

This includes making resources like this support pack available to members, seeking further clarification from NHS England on questions raised by members or contacting NHS Trusts on behalf of the profession. You may also wish to contact the BACP ethics team (ethics@bacp.co.uk) to be put in touch with our legal support service that can answer some questions you might have 

However, as a charity there are limitations to the support we’re able to offer where it relates solely to an individual’s employment circumstances. 

In these cases, we’d encourage practitioners to get in touch with trade union representatives, where available, to discuss your personal case and get tailored support for your individual circumstances. We’re happy to provide information and resources about national policy and practice to unions and union representatives to help them best support you. 

 

Quote from Dr Adrian Whittington

Dr Adrian Whittington, National Clinical Lead for Psychological Professions at NHS England, has provided support and clarification to this being the case from NHS England. He says:

"We [NHS England] support that all high intensity practitioners working within NHS Talking Therapy Services who have completed a NHS Talking Therapies qualification (PCE-CfD, IPT, DIT, CBT etc) should be paid at a Band 7 – irrespective of the high intensity modality they practice and that those who are working towards an IAPT qualification and don’t yet meet all the requirements of practitioners set out in the IAPT manual are paid at Band 6."

[supporting information provided by Dr Whittington specifically for this briefing addressing pay equity in NHS Talking Therapies services, June 2023].

Find out more