suggestions for service innovation

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suggestions for service innovation

Postby bigbearbailie » Thu Aug 10, 2017 9:14 am

Hi all, just thought i'd look for a bit of inspiration.

I work in an adult psychology service. its for non-psychosis clusters so plenty of anxiety and depression, PTSD, survivors of abuse, OCD etc.

We're having a think at the moment about the way the service operates and if there's anything else we can do to improve things. Our waiting list has grown more recently from about 50 weeks to somewhere close to 90. There are the equivalent of 3 fte psychologists at differing bands and we aim to have 3-4 clinical contacts per day seeing people for up to 30 sessions as this is what we're commissioned for.

The service assesses individuals and places on a waiting list, as soon as someone has space they're picked up by an available clinician according to length of wait. If we think a client would benefit from a specific model and a clinician that works more in that area we'll try to tailor who they get. Military veterans get prioritised to the top of the waiting list in keeping with the military covenant and we seem to be getting more and more referrals as the specialist trauma centre in the area is overwhelmed and short staffed.

We have had some forays into group work but struggled to help people move on with this. we try to link in with the local CMHT and non-statutory services where we can but the options are quite limited and we're a little isolated having a separate base and little regular contact.

I wondered what other's experiences of similar services was and any suggestions on ways in which other services may try things that are different. I'm loath to accept that this is just the way it is and want to do my best to help make the service as effective and efficient as possible.

any thoughts would be gratefully received
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Re: suggestions for service innovation

Postby elkie » Thu Aug 10, 2017 11:41 am

Are there any ways that you can generate/access extra money to take on more clinicians? In an NHS service that I used to work in there was talk of renting out the therapy rooms to private therapists in the evenings - it didn't happen but it was interesting to know that its a possibility. Also, I seem to remember hearing about how one of the big NHS Eating Disorder service takes on foreign patients and charges significant fees as part of a way of funding their NHS service - I don't know if any secondary care psychology services have done anything similar to this. If generating extra income is out of the question is it possible to take on more trainees or honorary clinicians who are going through the BPS conversion process?
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Re: suggestions for service innovation

Postby bigbearbailie » Tue Aug 15, 2017 10:05 am

Thanks for your response Elkie.

I'm not sure about the logistics of income generation if i'm honest. I know other services run training and teaching nationally and we do our part, particularly with the local training course but i think it would have to be a significant culture change and business model for that to make a dent i think.

In terms of taking on private patients my inner ethics alarm is ringing. I know this is something that happens more in physical health.

i had hoped for a few more responses but perhaps this reflects the sense of stuckness and perhaps even hopelessness lots of us are feeling.

any other thoughts or ideas would be really welcome
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Re: suggestions for service innovation

Postby ell » Tue Aug 15, 2017 11:13 pm

When you assess people for therapy, what kind of proportion turn into actual intervention cases? I suppose I'm wondering about the suitability of your referrals, and if you get lots of referrals where the client doesn't want to engage, or there are other reasons therapy isn't suitable for them. If that proportion is high, is there any work to be done around educating referrers, or assessing sooner (then having a wait list for intervention)?
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Re: suggestions for service innovation

Postby bigbearbailie » Mon Aug 21, 2017 3:39 pm

Hi Ell,

its an interesting question about those that get referred. It feels as though we accept a large proportion of people of those referred once they actually get to assessment. Our clinical lead I think does a great job of passing inappropriate referrals back or signposting on to alternative services but the sheer volume of referrals she has to manage is perhaps taking its toll. i'm not sure if others have had similar experiences but where other services have been able to tighten their belts with regards to their entry criteria i think there is a general sense of this being the last saloon for lots of people referred with few options as alternatives especially for those that are chronic and complex in their presentation.

I think a difficulty i certainly face is people end up at our service who have been bounced around through various teams who are unable and unwilling to work with them. I try to find ways to work with people within the envelope we offer but I am beginning to wonder if compassion in these cases overrides my clinical judgement.

I think there is a great deal of difference in those who may be suitable when originally referred vs those who end up waiting for 12-18 months and then attend but whose circumstances then change or emotional health gets worse which means that later on they are less appropriate or even inappropriate. We try to manage this with reviews whilst people are on the waiting list but sadly as the waiting list grows so does the number of reviews and our capacity to take on new clients. it all feels rather cyclical
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Re: suggestions for service innovation

Postby elkie » Wed Aug 30, 2017 8:17 am

What kinds of groups have you tried? I know of a step 4 psychology service that is in a similar situation to yours and they've been reporting good outcomes for schema therapy groups that they've been running.
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