25. Reducing queues and generic clinics

Think of every example where you put a family on a waiting list – could this be fully booked?

Every time you allocate or something specific - could this have been to something generic?

If refers as for a "psychiatric opinion" does this really mean a mental health assessment (a generic skill)

Do you have any clinicians that can do extended core skills CBT who are NOT a psychologist?

Make a list of all the queues your team has.

This is about Core Partnership work...

Rationale

Some CAMHS still have a system of allocating referrals to specific clinicians who then keep their own waiting list. Or referrals may be put into queues according to priority (e.g. separate waiting lists for urgent, soon and routine) and then allocated to similarly named appointment types.

Every queue increases variability and makes it harder to match capacity to the demand in that queue. More variability leads to less and less efficiency. Carve out like this leads to inequitable waiting list management! By minimising queues everyone is seen sooner.

Ideas for Action

  • Minimise carve out into specialised clinics or appointment types. Only have carved out clinics if the specialist resource is not available at other times (e.g. the psychiatrist only works on Mondays and so everyone who needs the doctor has to come on Monday mornings).
  • Manage most cases in generic clinics by generic clinicians with extended clinical skills. Ensure cases are allocated chronologically.
  • Don’t have separate waiting lists for emergency, urgent, soon, and routine categories.
28. No internal or external waiting lists

Do you flex your initial Choice capacity or first appointment numbers if not dong CAPA?

If there is a long wait for a specific intervention are you 1) doing core level treatment as well in the interim and

2) do the young person and family have something to do?

No-one should go on a waiting list!

Rationale

Having no internal treatment or assessment waiting lists can be achieved by the use of full booking to the next step, which smoothes flow. Booking allows patients choice of appointments and fulfils National Booking requirements. Families have chosen when they will be seen and by whom and this increases engagement. To have full booking you must have a set number of new and treatment appointments generally organised in clinic structures.

Ideas for Action

  • Ensure full booking to first and second appointments to ensure no waiting list for treatment after assessment. E.g. if use a type of triage or assessment clinic as first appointment, book family in for treatment or complex assessment from that first session.
  • For these systems to work clinicians must commit to vacant appointments to be booked in to or to commit to phone family to arrange to meet. Choice and Partnership is such a system.
  • Any time there is a handoff (change of clinician) there must be a bookable appointment system.
  • If a particular treatment involves a significant delay an alternative should be offered in the meantime. This could mean support from the referrer, or use of self-help materials.