Problem 3: ADHD

There are long waits to initial psychiatric assessment for ADHD.

A very common problem! As in the previous examples its about using demand and capacity to "think out of the box". It always feels like just too much demand and not enough time but solutions can be in surprising places.

A recent example from my own ADHD service (Steve) is that I was busy with moderate waits for initial adhd assessment. It was a joint clinic with paediatricians but we decided to move our clinic and another site in a local hospital. I found with the added clinic support (admin and clinic nurse for weighing etc) and no going up and down stairs to collect them, I could (and my colleagues) see about 20-30% more patients in a morning. The waits have massively fallen. This is a good example of extending capacity by moving tasks - freeing up the medical bottleneck.

Handle Demand
Eligibility Criteria Does a GP referral mentioning ADHD symptoms go straight to ADHD assessment or are they seen first for general Choice appointment?
Diversion Criteria Are other ADHD services available such as parenting to divert away from routine ADHD follow-ups?
Full Booking Are there a set number available and booked to?
Screen Referrals Are screening rating scales used before an ADHD appointment is offered?
Extend Capacity
Know Capacity Is there a set number that will be taken on?
Does ADHD have enough time in the team diary?
Follow-up focus Do you work alone? Working with another clinician and sharing some supervision can make it easier to discharge or amend treatment plans. Especially in a multi-disciplinary way.
Extend Clinical Roles Are any of the Choice team capable of carrying out an initial ADHD screening?
Who can prescribe?
Monitor Activity How are DNA’s handled? Another appointment routinely sent or a non-attendance review form that needs completing before an appointment is sent?
How long and how often do the follow-up visits have to be?
What are they actually for? (A good audit project).
Let go of Families
Closing Case Variation Does your service do all the follow-ups – what’s the role of paediatrics or GP’s or nurse led clinics or school nurses..?
Care Plans Are Care Plans reviewed with the multiagency network to ensure their effective involvement?
Process Mapping
Process Mapping What steps do service users go through to get to ADHD assessment? Do they all add value?
Does using an ADHD framework enhance the work or divert from more important psychosocial issues?
Flow Management
Something to do Can service users access parenting groups/advice without a diagnosis?