Demand and Capacity Framework

Basic Idea

This is about separating all the clinical work we do – Partnership – into two segmented work streams: Core and Specific Partnership work. These two streams or segments are based on two factors

  1. the clinical skills deployed and
  2. the amount of capacity service users in each stream use i.e. how many appointments / resources do they need?

Why have Core and Specific work?

There are several reasons for separating partnership work into two streams or segments. They are around

  • Making efficient use of skills by targeting them at the right people to the right level according to goals and outcomes sought
  • Using demand and capacity ideas to smooththe pathway (flow) for the client
  • Maximising capacity for different types of work

Clinical reasons

Many service users can be helped by a low intensity intervention of average duration. So rather than join a waiting list to a longer duration, higher intensity intervention that they may not need the services users that can benefit from something of lower intensity can be identified, seen and helped in a Core Partnership workstream.

The second idea is a demand and capacity one around how bottlenecks can be managed. Many services experience waits to specific high intensity interventions or assessments. The apparently commonsense solution of increasing the resource after the bottleneck is actually not very efficient.

It is much more efficient to add appropriate lower intensity resources ahead of the bottleneck so fewer service users need the specific intervention. So for example there might be long waits to see a psychiatrist for assessment of low mood. This could be managed effectively and safely by having more of the non-medical members of the clinical team able to do mental health screening and risk assessment thus preserving the psychiatric capacity for more complex challenging diagnostic issues.

Another reason is that in a service focussed entirely on deployment of advanced skills there are often queues into each individual advanced skill. We know that the more queues you have the slower the flow through the service. Core work in CAPA uses multimodal integrated skills across several domains or average duration specific modality work. This increases the clinical flexibility of any one individual clinician and means that there is smooth flow into core work and efficient use of specific partnership work when needed.

A CAPA team that separates work into delivery of Core Partnership and Specific Partnership ensures particular work is defined and protected.

Demand and Capacity reasons

This separation of clinical work into two streams is known in demand and capacity terms as segmentation. Segmentation is about separating a large group into several smaller groups based on their subgroup characteristics, attributes or needs (for more information see the 7 HELPFUL Habits section on the website www.capa.co.uk).

An example of segmentation is the separation of a swimming pool into three lanes: fast, medium, and slow swimmers. These three lanes allow swimmers to choose a lane that suits their speed and the flow in each lane will be smooth.

In CAPA the segmentation is not only based on some of the clinical skills (more of this later) but also, and importantly, on the amount of time or number of appointments to complete treatment, intervention or assessment. Knowing the amount of resource required in each stream allows us to plan much more accurately the capacity of that stream and know how much work we can do.

This is crucial in individual and team job planning and to be able to match our capacity to our team or service demand.

To see how this works see The Packing of Fruit…