Step-by-Step Guide: Demand versus capacity

1. Count appointments for a typical week 

What is it that needs counting?

The aim is to count all of the routine appointments available for the week, including same-day appointments, slots put aside for pre-bookable appointments and pre-planned telephone consultations (but not cases such as clinics). You can split these by different health professionals, but to make quick, ball park comparisons with levels of demand, it may be easier to total only doctor appointments, or doctor and nurse.

Factors to consider

So far you have looked at the appointments you offer in a typical week. The chances are that this will be a time when few, if any, staff are on holiday or away. You will probably not have included a bank holiday, nor considered the impact of trainees and how they can contribute more over time, or looked at the impact of local support schemes.

By understanding the impact of these variations you may feel you need to adjust the average number of appointments offered over a given week.

• What happens when clinical staff are away on holiday? Are there occasions when some of the doctors or other staff have commitments which reduce their availability to see patients? Are fewer appointments available in those weeks? How many weeks in the year does this cover?
• What happens in a week with a bank holiday Monday? Are more appointments planned for the Tuesday after the bank holiday?
• What happens when GP trainees work in the practice (if they do)? Does this increase the capacity and free up doctor time or does it reduce the capacity at certain times?
• Do you have a ‘duty doctor’ and have you included the patients that are seen by him/her in the count of capacity?
• When a GP is on holiday, for small and personal list sizes, practices may experience greater demand on his/her return.
• Is there a local scheme to improve access that allows you to refer patients you can’t see quickly elsewhere? Does this increase the capacity available?

Important

Does this mean that the capacity for a typical week should be adjusted?

Once you have the total number of appointments, enter them into the relevant boxes of the ‘total tally sheet’ from the previous section. If you are unable to differentiate between those appointments you hold for same-day and pre-bookable, then simply enter the total figure.

2. Compare with demand from patients

This is about comparing available capacity in your practice (that is the total number of appointment slots) with the demand from patients (your analysis of same-day and pre-bookable requests). Each practice will differ but it is sometimes helpful to compare with a national average. Or you might compare yourself with another local practice.

Comparison with your demand measurement

Look at the analysis of your appointment requests against your analysis of current capacity (that is, available appointments).

• Are there days of the week where there is a much greater demand than the appointments you have available?
• Does the number of appointment requests significantly outnumber your total appointment supply?
• Are you holding too many same-day appointments back so that a lot of patients can’t pre-book an appointment? Do you need to adjust the ratio between the same-day/pre-bookable split? Some practices find it easier to have two thirds of their appointments (including nursing capacity, telephone consultations) available to book in advance. That leaves one third for on-the-day cases, though the mix will vary to take into account the characteristics of different patients, or to reflect the greater demand for same-day requests on a Monday.