12. Redesign and Extend Clinical Roles

Do users see the right person with the right skills or does the intervention they get depend on the skills and preference of the person they happen to see?

Do the clinicians in your team have a wide range of skills so that families and young people see as few clinicians as possible and have to wait as short as time as possible for the interventions they need?

Do you have bottlenecks that are due to a shortage of specific skills e.g. Cognitive Behaviour Therapy (CBT)?

Do you know how many clinicians in your service have those specific skills? Make sure you think skills not profession- your family therapist may have CBT skills and your psychoanalytic psychotherapist may have systemic skills.

Do you know which families and young people need to see those clinicians with the highest level of those specialist skills? E.g. who absolutely needs to see the psychologist for schema based CBT and who could see the family therapist for diary monitoring, activity scheduling and identification of negative automatic thoughts?

Can more staff do initial family therapy rather than automatically referring to the Family Therapist?

Change your focus from 'profession' to 'skills'


If clinical roles are rigidly defined then the demand on that role has to match the capacity exactly for an imbalance not to occur. It is more likely that either waiting lists or under usage will occur. Extending roles and increasing flexibility makes it easier to match demand and capacity across a clinical team. Added Bonus: adds quality for the user who sees a professional with wide ranging skills thus reducing handoffs. This is fundamental in providing choice for users in terms of who they see and continuity of care.

Ideas for Action

  • Try to ensure families see the right clinician as soon as possible.
  • Identify bottlenecks that could be widened by new or extended roles e.g. ADHD assessment by non-medics.
  • You must ensure that proper training, supervision is provided.
  • Staff who extend their skills must stop doing other work.

This item will also help you with

Flow Management Process Map and Redesign Implementation of High Impact Change number 10 Our Choices in Mental Health