Creating a single point of access to psychology services

Best Practice: Creating single point of access triaging in psychology services to provide an effective and responsive service for adults with learning disabilities in Birmingham

Who did it: Dr Sunny Kalsy-Lillico, Consultant Clinical Psychologist, Birmingham Community Health Care Trust

We have developed psychology single point of access (SPA) triaging to provide an effective and responsive service for adults with learning disabilities (LD) in Birmingham. This is in the context of adopting lean ways of working, avoiding duplication and managing the capacity demands that were (and are) being placed on statutory services with decreasing resources.  

As a service, prior to the psychology SPA we had at least eight different routes into the psychology service, with each referral being processed in different ways depending on the receiving psychology team.

This meant that there was significant difference in timescale, approach and even the types of referrals that were accepted by the various psychology teams.  Furthermore, we did not easily and reliably know how many referrals were coming into the city-wide psychology service as a whole nor did we have a reasonable way of identifying which psychologist was working with which service user.

At best we had duplication, at worst we had some parts of the service being over-run with referrals and holding long waiting lists, whilst others part of the service had capacity and no waiting lists.

We knew that we needed to have a well governed way of providing psychological input, with clear processes of managing referrals to our service, including clear timescales, communications and outcomes.

This was against a backdrop of fewer staff and cost efficiency measures which meant that recruitment was significantly reduced whilst the demand for psychological support for people with learning disabilities remained high.

Furthermore, the wider LD health service had also adopted an SPA across Birmingham in order to manage the needs of service users referred to the service with equity, avoiding duplication in a quality and responsive way. 

It took 12 months to develop the psychology SPA as a viable option to meet the need to provide a high quality service for people with LD in Birmingham.

There were concerns relating to fears of reducing clinical autonomy however the need to change process given the context of austerity was significant.  The SPA is managed by myself with support from our psychology administrator to develop clinical and IT (patient administration) systems to process all referrals to the psychology service, allocate to staff (qualified psychologist, trainee doctoral psychologists and assistant psychologists) and then record clinical contacts ensuring that we are responding well within the national standard of 18 weeks.

We have also developed a semi-standardised screening assessment that enables the assessor to make a preliminary formulation based on the presenting needs of the individual and determine one of the ten service outcomes following screening assessment.

Through this process, we can now reliably provide a number of service outputs as required by management (numbers of referrals, time to first contact etc) as well as share the demand of referrals across the service as whole, so that no single area is overwhelmed.

We have been able to centralise core information relating to clinical referrals, standardise psychology clinical files and also reduce waiting times whilst increasing clinical contacts.  We have also been able to target interventions as the central processing of referrals has quickly highlighted trends and patterns of referrals.