This paper charts the implementation and development of a referrals management system within a secondary care National Health Service (NHS) clinical psychology and counselling service over a period of approximately three years. The new system that is described has brought about dramatic reductions in numbers waiting for both assessment and therapy, as well as modest improvements in attendance rates at first assessment. Other changes have resulted from the new system, such as a more unified, transparent and collaborative approach, a move to more of a consultation model of assessment and an expansion in the breadth of clinicians' roles. The paper explores the challenge of having to continue to meet a demand that far outstrips the available resources. This raises dilemmas in clinical decision-making, in the positioning of the department in relation to referrers, and in maintaining an efficient service with minimal waiting lists without losing the depth and variety of work that are strengths of the department.

This paper charts the implementation and development of a referrals management system within a secondary care NHS clinical psychology and counselling service over a period of approximately three years. The new system that is described has brought about dramatic reductions in numbers waiting for both assessment and therapy, as well as modest improvements in attendance rates at first assessment. Other changes have resulted from the new system, such as a more unified, transparent and collaborative approach, a move to more of a consultation model of assessment and an expansion in the breadth of clinicians' roles. The paper explores the challenge of having to continue to meet a demand that far outstrips the available resources. This raises dilemmas in clinical decision-making, in the positioning of the department in relation to referrers, and in maintaining an efficient service with minimal waiting lists without losing the depth and variety of work that are strengths of the department. These issues are discussed in the context of recent governmental policy and changing ways of working for applied psychologists.