A Practical Example

One practice that carried out a more in-depth analysis of their capacity took into account a number of different factors such as;

• Skill mix – many practices want to analyse the appointments to reflect the skill of the person whom the patient sees, so they will record separately appointments with a doctor, nurse, other health professional and healthcare assistant.
• Length of consultation – most practices find that they need to plan more time for some consultations, either by booking a ‘double slot’ or by planning a number of lengthier appointments, typically reserved for periodic reviews for those with complex conditions or multiple pathologies.
• Lead time – it is always necessary to handle a number of same-day cases – sometimes these can be completed through a telephone consultation. Sometimes they will result in a same-day appointment and sometimes in a home visit. Because these cases are often handled differently, and because it is necessary to reserve capacity for them, it is recommended that these are counted separately from appointments that were planned in advance.
• Logical groupings of case types – in most practices there are logical groupings of case types for which the demand may be well understood and is sometimes highly predictable. These may include such things as baby clinic, minor illness, and routine monitoring appointments for those with long-term conditions etc.
• Type / location – another grouping that may be understood and useful for planning and capacity management in some practices is to categorise telephone consultations, home visits and face-to-face consultations in the surgery separately.

It used these to develop a range of categories in which appointments were divided:

Some of the key lessons learnt 

The example practice that has got a lot of things right:

• Many of the appointments with doctors are planned at five consultations an hour, with those for nurses at two or three an hour.
• They had already defined some longer appointments. These are for planned periodic reviews of a group of patients with complex conditions. Also identified were some patients with long-term conditions who could be routinely monitored by nurses in relatively short slots.
• The practice already uses the duty doctor to monitor same-day requests, to steer some patients towards nurses and to complete some cases with a telephone consultation.
• The role also includes some degree of management of the resources of the practice to balance workload.
• The practice is also finding that around one third of the slots for same-day patients is about right overall.

But there are some lessons too:

What is not obvious in the diagram, but was well known in the practice and obvious from comparison with the demand, is that, despite capacity being highest, Monday was still too busy. Clinical staff felt under constant pressure to keep up, while receptionists (from quite early in the day) were feeling that their job had become one of delaying patients to another day. Moving some of the ‘long’ appointments to later in the week freed up capacity, allowing the larger number of same-day patients on a Monday to be accommodated.