A Child and Adolescent Mental Health (CAMHS) department sitting within the Children and Young People Directorate providing outpatient community-based psychiatric services to the local population, within a borough.

The department comprises of three sub-teams: Generic CAMHS, Adolescent Mental Health and Leaning Disability and Neurodevelopment. The department provides outpatient services in general CAMHS, Neurodevelopment, Neurodisability, Attention Deficit Hyperactivity Disorder including Medication, and services for Looked After Children and Schools.

Consultant doctors across the Directorate are also responsible for providing Trust wide out-of-hours Consultant cover.

The CAMHS department faced several key challenges, including:

• Assessing the demand for their services to understand workload requirements.
• Allocating appropriate resources to meet service demands.
• Ensuring that staff job plans were aligned with the actual workload.
• Determining if existing capacity was sufficient to effectively meet service demands

• Establishing Demand: The CAMHS department used SARD’s Team Job Planning Toolkit to assess demand. All new referrals are initially managed by non-medical practitioners, and complex or acute cases are referred to doctors for psychiatric assessment. They used the toolkit to determine how many patient appointments per week were required from the Consultant team, including associated administration. The toolkit provided summaries of current scheduling and compared it to annual demand.
• MDT Provision: Demand for Multidisciplinary Team (MDT) work was determined based on the activities in job plans. This included case conferences, referrals, and triage.
• Clinical Administration: Administration time was allocated based on the equivalency to assessment time. For instance, a 1.5- hour assessment would require 1.5 hours of administration time to document outcomes and carry out follow-up work.
• Clinical Supervision: Some Consultants had structured Clinical Supervision sessions with training grade doctors to ensure quality care.
• Core SPA: A specific amount of time per week was allocated for Supporting Professional Activities (SPA) for each Consultant, Associate Specialist, and Speciality Doctor.
• Other Non-Clinical PAs: Demand for postgraduate and undergraduate activities, as well as additional NHS Responsibilities and External Duties, are determined using current allocations in job plans.
• Team Objectives: The Clinical Director summarised directorate objectives in the system to support the development of service based objectives required in individual job plans.
• Caseload: The toolkit allowed for plotting each doctor’s caseload at two points in time to determine changes and distribution.

By employing strategic workforce planning, we addressed key challenges within the CAMHS department:

• Addressing Capacity and Demand Gaps: The department faced a significant capacity shortfall of 8.34 PAs, representing an 8.7% gap in meeting service demand. Clinical Administration was notably under-resourced, with only 11.5 PAs allocated against a demand of 22 PAs, creating a gap of 10.5 PAs. To bridge this gap, we recommended fully recognising the administrative demand by allocating an additional 10.5 PAs across doctors to ensure that assessment and administration activities are adequately covered.
• Optimising Outpatient Services: Outpatient services demonstrated a close alignment between capacity (22.23 PAs) and demand (21.99 PAs). This balance indicates effective resource allocation for outpatient care, which we aimed to maintain.
• Aligning Direct Clinical Care (DCC) Activities: Other DCC activities, including MDTs and “DCC Other,” were well-aligned with demand. However, Core SPAs were misaligned due to SPA tariffs being set at 1.5 PAs per Consultant, which aligns with the Trust’s future goals once the new job planning policy is formally implemented.
• Standardising Core SPA Allocations: Some Consultants had more than 1.5 Core SPAs in their job plans, leading to inconsistencies. We worked to standardise these allocations to ensure equitable distribution of non-clinical responsibilities among staff, aligning them with the Trust’s aspirations.
• Enhancing Non-Clinical Activity Management: Capacity was aligned with demand for other non-clinical activities, such as additional responsibilities and Medical School activities, ensuring that these areas were managed effectively.
• Conclusion and Recommendations: The CAMHS department needed to allocate additional resources to meet the demand for clinical administration and review Core SPA allocations to ensure fairness. By aligning these resources with demand through careful planning, the department could significantly enhance service delivery and improve overall operational efficiency.