3. Handle Demand
The service ensures that:
All referrals are appropriate i.e. using eligibility criteria
Families’ initial Choice appointment is ‘fully-booked’ and
The initial Choice capacity is flexed in response to referral demand.
Eligibility criteria
CAPA is a system that improves access but you still need to have eligibility criteria that are tailored to local circumstances. It is a case of what CAMHS ‘should do’ not what CAMHS ‘can do’.
However, we do find that it helps to be flexible over those ‘grey’ referrals. Those ones where information is not complete, or the presenting problem could be masking another (behavioural problems and depression for instance). It can be more effective to see families, perhaps with the referrer, to check whether CAMHS could be useful and is wanted.
CAPA works best if you have limited priority criteria. Seeing everyone quickly, i.e. no waiting list, means that very few things become an emergency. Implementing CAPA means you will be able to fix your time to Choice - we find within 4 - 6 weeks of referral is good.
Full booking
When a referral is accepted families are given the option of at least two Choice appointments on different days and at different times. This works most easily if there are vacant Choice appointments in a team diary for the admin staff to offer families over the phone. You need a system for vulnerable families or risky adolescents who may not be able or ready to call in. Make sure someone calls them or the referrer helps them to book in.
Flexing
Flexing your capacity in response to your referral rates ensures the wait to initial Choice can be kept stable to about 4 weeks and certainly within 6 weeks. This means offering more Choice appointments if more referrals are accepted e.g. due to seasonal variation (most of us get more referrals before the summer school holidays).
What will happen if you don’t Handle Demand?
You may see referrals who don’t need you or should be seen somewhere else. This is frustrating for families as it wastes time and it eats up your capacity.
If you have too many priority streams (emergency, urgent, soon, routine are common ones, but we have heard of services who have more) you will find referrers soon learn what words to use to get someone prioritised (‘this 4 year old is suicidal’)! ‘Routine’ families may never get seen. Limiting the number of priority streams means everyone is seen more quickly by minimising multiple queues; reducing variation and smoothing flow (see the 7 HELPFUL Habits section of this book and Handle Demand component of the 7 HELPFUL Habits).
If you do not use full booking into Choice then you will find a waiting list into the service can soon develop. The lack of booked appointments increases variability and often increases waits. Families and referrers will keep phoning in to enquire when they will be seen and admin and clinical staff time will be taken up managing anxiety.
If you don’t flex your capacity there may be little impact if there is not much variation in your demand (referral rates) or capacity (e.g. annual leave such as staff all going off in the summer). But if there is, families will wait longer or shorter times according to when they are referred. The lost CAMHS capacity at low demand may not be used – increasing waits at other times.