Churn may occur when a system has too many priority criteria and so the new referrals that fit those criteria swim to the front. This churn leaves those behind everyone else as “the sediment”.

The more people that churn to the front the fewer of those waiting their turn (the sediment) are processed.

The man in the illustration is waiting in the departure lounge at the airport. He becomes the sediment after families with young children and those in wheelchairs board first (which is a good use of priority criteria) but what if those thinking of a having a family, those whose children have left home, those feeling a little poorly etc are also prioritised?

In CAMHS, everyone wants us to prioritise their referrals. The danger is that the crowd goes to the front of the queue and the rest never get seen. Sound familiar?

The same can apply post initial assessment or Choice - if you have an internal waiting list the pressure to see "this family soon" can be strong. For the system to work and be fair everyone must wait their turn. Hence you need full booking, defined slots in Partnership (treatment) dairies etc