Anywhere CAMHS and Flow Management

23. Identify Bottlenecks

  • Make a list of all the places people wait (bottlenecks)
  • Process- map your most problematic bottleneck (i.e. your biggest waiting list) so that you REALLY understand what is going on
  • Clarify whether due to a CURRENT or HISTORICAL demand and capacity imbalance, such as maternity leave that was not covered
  • Decide whether you need to reduce the demand or increase capacity .

Anywhere CAMHS found they had long waits at one of the outreach clinics. Though they had staff there, there was not enough room space to see people. So they investigated locally and started to offer appointments in a local school. This was a double bonus - more appointments and more choice of venue for users.

24. Daily referral screening

  • Do you think your referrals meeting works?
  • As a team, decide on the best way to attend to referrals daily
  • Use clear eligibility, threshold and priority criteria
  • Use a system for allocation rather than just putting accepted referrals on a waiting list.

Anywhere CAMHS has a daily rota of two staff who screen for priority and appropriateness, using agreed criteria. Accepted cases are written to within 24 hours, inviting them to phone and book an appointment.

25. Reduce the number of queues

  • Have a single referral point to ensure only one stream coming into your service
  • Reduce priority streams to two (emergency and routine)
  • On acceptance of the referral, offer families the next available appointment of their choice
  • Avoid internal waiting lists by ensuring most families can be helped by most clinicians (extend clinical skills and roles) and that highly specialist capacity matches demand.

After referrals were accepted, families sent to Anywhere CAMHS went onto separate waiting lists according to whether they were considered emergencies, urgent, quite soon, soon or routine. All these queues were of different lengths. Analysis of the cases after they were seen showed that it was rarely possible to judge from a referral letter how urgent things were. So they changed to two priority streams only, emergency and routine. They found that everyone was seen more quickly, with families being offered the next available appointment.

26. Segmented clinics are useful

  • Consider segmented specialist clinics for OCD, Eating Disorders, ASD assessment.

Anywhere CAMHS runs an ADHD assessment and medication clinic. Other interventions are offered in different segmented clinics e.g. a parenting clinic.

27. Have dedicated admin/networking time

  • As a team, decide on how much admin/liaison time is appropriate and then allow staff to choose whether they take carved out time daily or weekly
  • Some roles need more admin time than others- tailor to the individual and audit regularly
  • Move to standard formats for letters, reports and Care Plans to save time.

Anywhere CAMHS allows full-time clinicians one session a week of admin/liaison time in their job plan, in addition to admin time at the end of each session to write up notes.

28. No internal waiting lists

  • Where is your longest internal wait? Why? Any alternatives?
  • Discuss in the team how to organise bookable appointments that families can chose from
  • Use this system throughout the service to avoid internal waiting lists.

Anywhere CAMHS has a separate assessment session and then an intervention clinic. If the clinician and the family agree they should return for more work then the assessing clinician finds the intervention clinic book and offers a convenient appointment with an appropriate treating therapist. No waiting list = Full Booking.

29. Give families that are waiting something to do

  • Gather a pack of resources that referrers can give families about things they can do to help themselves
  • Start giving families something to work on between appointments
  • Make good use of written and visual psycho- educational materials.

Anywhere CAMHS did a team audit - How often do you ask, as a clinician, what the family are going to do for themselves between now and the next session? They realised they did this surprisingly rarely and changed their practice, finding that it enhanced the effectiveness of their interventions.