Reducing demand. Step 2 - Match supply to demand
Having worked out how much capacity you need each day you match supply to demand.
(a) Open Access mixed appointment system – doing today’s work today.
Many practices have a duty doctor or other ways of giving everyone an appointment on the day they want it – the key is to do “todays work today” and not ask anyone to call back or book them in later in the week because you have “run out” of appointments.
The best way to match supply to demand is through an open access system, otherwise you’ll still end up sending people away when your variation exceeds supply, or you find when and as you see more and more complex people so your appointments get longer.
Example Tower Hamlets CCG
As an example, on Monday 10th July there was a spike in demand across the whole system. Unpredicted and unexplainable: 38% higher than predicted demand, and the highest attendance in history at Royal London A&E. Special cause variation. The cause? Unknown. But if we had a closed, demand-matched system, we’d now be in bottleneck mode. So this works when people are prepared to pull extra hours in case of occasional surges. And these do happen.
We also know that if people know they can get an appointment with the practice, they manage their own demand better. They don’t get anxious about getting into the practice and will wait, sometimes realising they don’t need the appointment. A walk-in option generates better demand management, and it appears has the potential to reduce demand.
Example: A walk in service reduced demand in Robin Lane Health and Wellbeing Centre.
Their research showed that:
Guaranteed consultation and type of accessibility offered reduced patient anxieties regarding access
Attention given to patient education during attendance enables patients to try alternatives in order to self-manage in future
Improved efficiencies by facilitating a teamwork environment where clinicians draw on collective experience at point of patient attendance.
The walk-in service was introduced in 2012 and this was the impact.
Matching supply to demand also requires a mixed appointment system with a range of appointment types, and at best an open access on the day walk-in service.
(b) GP variation
It helps to know average throughput per GP, and length of time each GP spends with each patient, partly because when one goes on leave, you can lose 13 or 27 slots depending on who that GP is. There are reasons for this, and variation can be reduced to standardise consultations, but only to a certain extent. What works here is a lot of transparency around throughput, and high trust that everyone is working to their best abilities, even when there is large variation in output. Overall knowing this variation helps professional peer review and improves everyone’s practice.
Here is an example of the variation in one practice, a histogram of time taken for face to face appointemnts by GP. Often GPs don’t know how they vary in relation to their peers. This starts important discussion.s
