A therapist’s time and how this is allocated is frequently cited as a significant obstacle to the implementation of evidence-based practice (EBP). When therapists have heavy caseload demands, they may have little time to reflect on their practice. Newly qualified therapists may be particularly overwhelmed by the responsibility of a long waiting list, at a time when they are just developing their skills. Management of long waiting lists is often simplistic, with rationing of time allocated per child, resulting in children being discharged, regardless of outcome. In this situation, with limited time for EBP, therapists are often left with no choice but to prioritize client contact above EBP and reflective practice. This chapter describes a typical service in England, delivered in 11 community clinics in a specific primary care trust in the north-west of England. Community clinics are National Health Service (NHS) buildings where health services are delivered to the local community. A Trust is the local organization which commissions non-acute health services on behalf of the NHS. The community clinic model has been long established in the UK, usually consisting of a lone therapist providing one-to-one assessment and treatment to children referred in the local area. Newly qualified therapists frequently have at least one day of community clinic work as part of their timetable. In areas with large geographical areas to cover, and/or with limited or no speech and language therapy (SLT) coverage by the Local Education Department for nursery and school settings, the community clinic model continues to provide a much demanded service. Some areas have abandoned the traditional direct service delivery model in favour of indirect therapy models (for example, training programmes for parents and classroom staff), recognizing that even rationing therapy sessions cannot meet the demands placed upon the service.

Our community clinic service has an open referral system. In common with other NHS services, the service is free. The team provides assessment, diagnosis and therapy packages for children aged 0–18 years, although the majority of clients are aged three to seven years. Most clients live within a 10-minute walk of their local clinic. The service receives between four to five hundred referrals per annum.