Demand and capacity management in Primary Care

Introduction

Demand & capacity management is what GP practices already do. The question is: how can it be improved?

We know from experience that operational staff and rota managers are already doing a form of demand & capacity management.

Practices therefore already have the people who can do demand & capacity management – they just haven’t had the right tools to do it – yet

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Demand & capacity is a term that you see being increasingly used in Primary Care. Recently NHS England has begun releasing webinars on the subject, accompanied by diagrams and data. The language used has started to be around using ‘demand & capacity planning tools’. Whilst this is progress, at the same time, it makes it sounds like practices need to ‘add’ something new to their operational management and gain some ‘higher’ level of understanding. We don’t think thats necessarily true and we don’t think it would take very much to get to what NHS England calls ‘demand and capacity management‘ – as we will show.

Tempo is a demand & capacity planning tool (and much more), but with one very important caveat:

The Tempo interface makes it easy

Tempo simply takes the operational things that you already do, brings them together in one place, crunches the data and places everything into a live time-line. This instantly provides real-time demand & capacity intelligence, at your finger tips. Then Tempo helps you do something beneficial with that.

In other words, all practices are already doing a form of demand & capacity management. Tempo just takes that to a level that allows a practice to realise the benefits of demand & capacity management. In this sense, Tempo allows practices to take back control and achieve an NHS England standard for Demand & capacity management. 🙂

In this post, we will take a look at the four questions we’ve needed to answer in order to be able to design and build Tempo and why Tempo is the solution that practices are looking for.

• What is demand & capacity management in Primary Care?
• How do we see and measure our demand & capacity in a Practice?
• What is the nature of demand & capacity in Primary Care?
• How do we model our demand & capacity for Primary Care operations?

Demand & capacity management as the solution to our problems

It’s widely believed that demand & capacity management is the way to solve the difficulties experienced by Primary Care – namely: not enough clinicians, not enough appointments, providing on the day access, providing continuity of care. In other words, coming up with the best models of practice operation to meet the demand of the patient population, with the workforce capacity and resources that are available. This basically means managing staff leave and designing rotas.

Including time

The missing part of that idea is, of course, time. It would be relatively easy to model demand & capacity as a snapshot. In fact, this is how many practices are forced to manage it, because there has been no tools available to allow the operational model to be ‘dynamically‘ managed over time.  Time is the key dimension that has been missing from our models, because time increases the complexity of managing demand & capacity exponentially.

To answer the question: what is demand & capacity management in Primary Care?

Tempo was created because, as a large practice, we could see that there was nothing available to us to help manage demand & capacity over time. In a reduced form, this can be thought of as managing staff work plans, leave and rostering, together, in a joined up way.

Our breakthrough has been not just to create the first properly working version of this solution but also to realise that demand & capacity management is not a NEW type of management. Its the same forms of management, done in a new way, with better tools. This then led us to incorporate much more into in our core solution, such as appointments and finance.

Tempo was designed to be the first user-friendly digital toolset to transform day-to-day practice operational management into demand & capacity management. The Tempo solution is therefore built upon the daily, weekly and monthly management of rota design, appointments, staff, leave, sickness and teams, with finance added on top as an optional additional layer of data, bringing additional insight and planning.

Advanced management does not have to be difficult

As stated above, most practices manage demand & capacity to some extent. But the difference between managing demand & capacity as a snapshot or even as a series of snapshots and modelling demand & capacity over time is where Tempo really provides value to a practice. With Tempo, you will quickly get to managing demand & capacity in a sophisticated way, without changing what you do – just changing how you do it. With our support at every step, you will simply be migrating your work into Tempo.

This will deliver an added bonus of making that work quicker and easier to manage. It can also help to standardise what you do and drives equity.

By this approach, your normal operational events generate a new data set that is the key to taking control of the elusive nature of demand & capacity. Its only when you have this data easily to hand and visualised on screen, that you can model it and start to control it.

The Tempo answer to this is simply to run your operations inside Tempo. This will capture your demand & capacity data, measure and count it and provide a range of tools beyond that, that use your data.

But, what is demand & capacity?

As stated above, practices already know what they are, because they are what you are doing . What is really meant by the question is:

• What is the nature of demand & capacity?
• What does it look like in your system?
• How do you manage it?

What is capacity?

In many ways, far simpler than demand and already very well know, capacity is, initially, who you have, what they can do and when they can work.

This, alone, is pretty hard to model, especially over longer time-frames. However, there are other dimensions to capacity that provide opportunities for better demand & capacity modelling and if those can also be captured and modelled, outcomes can be better for everyone.

• Building / Rooms / desks
• Additional roles
• Teams & services

In the simplest form, capacity is a counting exercise. However, once again, when time is introduced, it becomes more complex.  In Tempo, capacity is counted for any of its dimensions, at any moment. This ‘nailing down‘ of capacity into what we call the ‘capacity engine‘ and the useful segmentation of it, for different purposes, is a key part of the overall demand & capacity capability of Tempo. This is particularly true when you want to examine your capacity for services, teams and how they can relate to budgets.

What is the nature of capacity?

Like demand, capacity is comprised of the known and unknown. Generally it is more known than demand but, because it does contain unknowns, it only adds to the complexity of managing demand & capacity.

What does capacity look like?

Capacity would come to you in a few forms and in units of time.

• Availability
• Roles & specialisms
• Rooms & desks
• Teams (for patient groups & services)

You may have any number of tools to capture this data. With Tempo, all your capacity is caught and maintained by the Capacity Engine of Tempo. This capacity engine ensures that your most accurate measurements of any type of capacity is available to your plans, models and rotas at all times and for any period of time in your practice year.

What does demand look like in a practice?

In simple terms, demand is what your patient population need. NHS England webinars can go to great lengths to break this down.

How is this expressed to you, at a practice?

As people asking for appointments. As appointments that the system knows must happen. So, initially demand is broken down into planned and reactive – but, in the end, its all just appointments.

These are then expressed as counts for appointment types, coming to you via the channels you have open to patients:

• Phone calls
• Online appointments
• On site
• Planned appointments
• Follow up appointments

So demand is expressed as a need for appointments. Appointments demand are then re-expressed, by a practice, as a rota. The rota is therefore a best attempt to use available capacity to create a session design that meets the demand. This is demand & capacity management. But why is it so hard to make this yield positive results for patients and for your workforce? Answer: the system is too complex and the tools used are not sophisticated enough or agile enough.

Is demand really knowable?

Yes and no.

Demand is one of those things that is very hard (almost impossible) to pin down, because of its nature. Its too complex and fluid and, most importantly, its usually in the future !

How do we anticipate demand?

Rather than ‘what is demand’, this is the key question and the one that Tempo sets out to solve.

Two things: 

• Data on demand
• Capacity planning based on data

The best way for a practice to cater for their demand is to employ a rotering and capacity learning system, running in a continual loop. This sounds fancy but what this really comes down to is to use a unified digital system to run your key operations and for that system to build in the dynamic intelligence of time, so that you transform your day to day operational work into a dynamic demand & capacity system. In other words, Tempo.

• Measure what demand appeared to be in the past
• Set targets for what you think demand will be in the future
• Design your rotas around those targets and plan your workforce capacity for those rotas
• Adjust and fine-tune your output as you approach each week / day in your rota
• Compare what your thought demand would be with what it appeared to be
• Adjust your targets
• Adjust your rotas for the future (or not)

The rota represents the best attempt to plan for both demand and capacity, whilst trying to deliver services of all types. A rota will always be a best attempt, because the real-world behaves like the weather systems that blow around it – in a somewhat predictable yet chaotic and non-deterministic way.

The question is: how well can a rota anticipate demand and capacity?

We would term rotering in Tempo as ‘demand and capacity based rotering‘ because the combined tools of Tempo are designed around being able to optimise the rota to both anticipate demand and make best use of capacity. Tempo can do this because it contains your demand and capacity data.

At any time, the nature of demand is a combination of both known and unknown. For any point in the calendar, as that moment approaches, demand usually becomes less unknown. This is the reason why practices hesitate to rota far ahead. This is also compounded by the difficulty of planning leave and accounting for sickness. So, to plan a rota in the future you need to know demand as well as possible, know what time-off looks like and build-in sickness. Why is this so hard to do? Answer: the system is too complex and the tools used are not sophisticated enough, joined up enough or agile enough.

Weather forecasting & rotering

Tackling this disparity between the complexity of what practices are trying to manage and the tools they have to to do it with has been our mission for 3 years. If demand is like the weather and rotering, therefore, like weather forecasting, accepting this elusive nature and designing solutions around it has been the key to the success of Tempo.

Sounds clever, but what does that actually equate to in a practice?

It means Tempo provides the tools to anticipate, plan and adjust for demand. Like weather forecasting tools, you can capture, crunch and visualise a lot of complex data in Tempo and its not difficult to do that – you just do what you normally do in an integrated digital space. You also get lots of useful automation to apply complex rules and speed up intensive tasks AND you get tools that reflect performance back to you. This is what taking control of demand means in Tempo. The additional effect of Tempo is to create a learning system, within which demand & capacity plays a key role.

The answer to the question: what is the nature of demand & capacity and how do you model it?

Then the Tempo learning system automatically kicks in

Apart from making it easier to manage complexity day-to-day, the point of capturing your demand & capacity data in one place is to be able to get to the point where you can visualise it and get control over it, plan and set targets and see what those designs look like over a time-line.

The Tempo learning system is self-generating inside your practice account

Just by using Tempo, a learning system is realised through your:

• Annual week planner
• Rota templates
• Teams management
• Leave management
• Rotering

These screen provide real-time, calculated demand & capacity data to you about:

• Rooms
• Appointments
• Access
• Costs
• Service lines