Step 6: Are you in balance?

You should now have enough time for Choice work - the question is do you have enough Core Partnership? The variable you may not know is what percentage of clients having Choice appointments will want a Partnership appointment. But you can monitor this and find out!

CAMHS example: we find that a CAMHS CAPA team often seems to transfer to Core Partnership about 66% to 70% of Choice appointments. So the team will need to be offering 70% as many Partnerships as Choice.

The transfer % can vary! And there can be loads of reasons…

  • Non CAPA services often transfer a much higher percentage as they may not be as strengths based and are often weaker in their collaborative shared decision making- with decisions being made in the multidisciplinary team rather than with the clients
  • Services with sparse community agencies may feel under great pressure to transfer more
  • Anxiety in the system around risk may do the same
  • Trying to do Choice after a long waiting list can mean the service users are very reluctant not to get a service.

OK so now you know, for each individual and for the team:

  • The number of accepted referrals per week
  • The number of Choice appointments offered
  • The number of New Core Partnerships that can be offered per quarter.

You are likely to be broadly in balance if you have 8-9 times as many New Core Partnerships per quarter as you accept referrals per week. Assuming you flex your choice capacity to meet the referral demand.

You may be out of balance because you are not providing enough Core clinical capacity (i.e. Choice and Core Partnership). We find that teams can offer between 30 and 40% as core work. Much more than that has too little Specific and other work etc. 35% Core work can be hard to deliver if all the CAPA components are not in place, especially good leadership and full sign up from staff. In practice, most teams can deliver 30% of their capacity as Core work and up to 40% if all the CAPA components are enthusiastically in place.

Caution: these are broad guidelines!! These percentages may vary depending on whether the Big Admin has been included, the helpfulness of the IT system, travel times etc.