Effective clinical caseload management strategies from the perspective of community consultant psychiatrist: Qualitative analysis

Objective There is a lack of guidance and literature on determining a safe caseload size and how community consultant psychiatrists (CCPs) manage their caseload. This paper therefore aims at exploring effective and safe ways of clinical caseload management by gaining a qualitative understanding of caseload management (CLM) practice of CCPs. Design Cross sectional Qualitative research using semi structured interviews. Setting The participants were CCPs working in National health service in Hampshire areas of United Kingdom. Participants The target population comprised 11 CCPs working in the National Health Service (NHS) to get their view on current practice in NHS and compare past and present practices of CLM. Main Outcome Measures A qualitative research method was used to explore the topic of CLM by collecting data through observations, interviews, questionnaires and then analysing the data using the coding and emergent themes method. Results Caseload size for CCPs was higher than a manageable level and had an impact on their ability to service their other responsibilities such as strategic work; they did not have a shared view on setting a limit to their caseload. Majority of CCPs were not using CLM and did not have enough control on limiting their caseload size. Some CCPs were using time management and audit of caseload as effective CLM strategies. NWW was not being used equitably. Conclusions Although the study represents the perceptions of limited number of CCPs, the findings of this study are unique and an important addition to the slight literature that exists on this topic. The results were in line with existing research that large caseloads can have negative impact on CCPs and their ability to provide effective care to the clients. The key factors determining the caseload size were highlighted. Proactive time management and proactive caseload size management were found to be effective tools for CLM. These supported by job planning meetings, Yearly appraisal, use of electronic data system and New ways of Working could be effective in maintaining a safe caseload size for the provision of safe and effective care. The data from this study can be used for requisite quantitative studies on a larger and statistically significant number of CCPs to find effectiveness of each CLM strategy.