Step 2: Adding Choice Appointments

The first thing to know is the accepted referral rate for the team. This will be, on average, so many referrals per week. You will need to provide that many Choice appointments per week.

There are many methods to do this. First work out your average accepted referrals per week. Although the rate of accepted referrals per week is going to vary somewhat week to week, it just needs to be near enough. When you get really confident with CAPA you can start to flex your capacity (see later for how). Now, how to decide how to find enough Choice appointments:

Two suggestions:

1. Weekly

With this method you decide who in the team will do a Choice every week and who will do one fortnightly or some other frequency. This number will be reduced in practice by leave and other events that will end up taking precedence, reducing it be about 10%. But that’s fine - just make sure the team total is enough and monitor how it goes.

In East Herts at the moment, due to referral volume, we have full-timers doing 2 a week and all others one.

Example: you have a team of 10 staff: 4 full time and 6 part time giving a FTE of 7.6. This team accepts 6 referrals per week. If each full timer does 1 per week and each part-timer one every other week. This is 4 x 1 Choice + 6 x 0.5 Choice= 7 Choice appointments across the team. Reduce by 10% that leaves just over 6 Choice. As 6 referrals were accepted this would be place to start. The team would need to monitor the need to flex Choice capacity if referral numbers vary a lot.

2. Quota

Here you and the team decide how many Choice appointments are needed over a thirteen week period and then an actual number of Choice appointments is allocated to each clinician [this is what we do in Richmond. Ann]. They then choose when they do their allocated number and write these in the Choice diary. What is different in this model is that if staff are away then they have to choose when they do the required Choice. The number doesn’t reduce.

Practice Point: there is no CAPA “rule” about how many Choice appointments staff do. It could be that everyone does 1 per week what- ever their FTE. Or some may prefer not to do Choice appointments – or not have the skills- it’s up to you and the team!

Example: using the same team above – 7 referrals accepted per week over a 13 week period means that they need to find 91 Choice. Staff member A, who is full time, agrees to do say 15. He will choose 15 slots to offer a Choice appointment in the next quarter and write these in the Choice diary.

The plus of this method is that is more accurate. The minus is that it makes the job planning more technical. This is because each staff member needs to create the right amount of time in his weekly capacity plan for Choice work.

Example: let’s say it is agreed that a Choice appointment takes 3 hours (1.5 hours clinical and 1.5 hours admin). Staff member A completes 15 Choice appointments over 13 weeks = 3 hours x 15 / 13 = 3.5 hours in his weekly capacity job plan.

Whichever method the time for the Choice work needs to be added to each capacity plan. Something might need reducing at this stage to make room.

Skills needed for Choice

  • Excellent engagement skills, particularly with the service and the concept of change. So enough engagement with the Choice clinician to be useful, but not to impede transfer to the Core Partnership clinician
  • Ability and comfort with working in a range of therapeutic modalities. Comfortable with stance of facilitator with expertise rather than expert with power
  • Core Assessment skills
  • Ability to formulate with the service user
  • Ability to collaboratively develop goals
  • Ability to develop pre-Partnership work
  • Ability to undertake risk assessment
  • Outcome focused (includes use of routine outcome measures)
  • Sound knowledge of local services
  • Sound knowledge of practice-based evidence and ability to communicate this clearly to people and their families.