Idea 2: Core and Specific Partnership Work

This idea is about separating the clinical work we do into two segmented work streams / pathways: Core and Specific work.

Segmentation is separating a large group into smaller groups based on similar needs, characteristics, or processes. This reduces bottlenecks and smoothes flow (for more information see the 7 HELPFUL Habits section on the website www. capa.co.uk).

Core Partnership Work

In CAPA, Core work is a large part of what we do most of the time.

It has an average duration in CAMHS of 7.5 appointments we know this from audits) and is work that uses a range of skills, involving liaison with the system and other psychosocial interventions. It requires clinicians to have extended clinical skills in key areas, at a core level of competence. All professions can do Core work if they have a range of core level, extended clinical skills.

Although Core Partnership work is the majority of the work, it isn’t, and shouldn’t be seen as, the least skilled area. Core Partnership clinicians are highly flexible and experienced. This is the clinical domain where good, widely skilled clinicians work.

Specific Partnership Work

This is work segmented from the Core Partnership because it has significantly shorter or longer duration.

The specific segment is separated from Core Partnership because we know it takes shorter or longer and so a segmented pathway is needed to make the flow work and to balance clinicians individual capacity.

The specific segmentation may contain a particular assessment, technique or therapy skill, to complement Core work. It may be of short duration e.g. psychometric assessment, or longer term, more intensive work e.g. systemic family therapy teams, intensive CBT or psychodynamic psychotherapy. Clinicians working in this way may have done higher-level training and would be able to supervise someone else in that skill. A client accesses these Advanced skills by the Core worker asking another clinician to join the Core work to add in a specific assessment, technique or therapy skill. It is an adjunct to the Core Partnership work.

Why have these two types of work?

  1. Many people can be helped by core level work = fast access to something that will help
  2. Extended Core Partnership skills reduce bottlenecks to Specific Partnership work which reserves higher intensity skills for when they are needed = no waits to needed Specific interventions
  3. Extended Core Partnership skills increase clinical flexibility = fewer queues / waiting lists to see a particular clinician
  4. It allows us to identify AND PROTECT team and individual capacity for Specific Partner- ship work = need for range of advanced skills in the team is formally recognised. In other words, it allows people to quickly access help to work on issues that matter to them by seeing clinicians with extended Core skills that can help with their problem. It reserves Specific Partnership work of many types for those who need a more intensive, or non-average duration intervention.

What is the challenge of defining Core and Specific Partnership Work?

Core Partnership work

Most of the team are expected to do Core Partnership work for some part of their week. This may create anxiety about learning new skills. Of course, this is also a benefit as it creates a learning culture with time.

Specialist roles

Initially, in a team that is new to these concepts, there may be some debate about seeming to reduce Specialist roles. Some can feel that to be a professional they need to be doing work that they may see as more ‘specialist’.

Our view is that the Core Partnership work needs Specific Partnership work to support it. This Specific Partnership time has their advanced skills within it. Thus defining clinicians’ Specific Partner- ship time promotes and preserves the specialist role and skills. The shift is that this time allocation in their job plans should come about through transparent team job planning (the 4th Big Idea!) rather than decided by individuals or professional line management.