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ABSTRACT - Capacity and demand theory suggests that the presence of a queue is not necessarily an indication of a shortage of capacity in a system. It is much more likely that either there is a demand and capacity variation that creates queues or there is a delay designed into the system. A shortage of capacity is only really indicated where a backlog is not stable and continues to grow. In this article, data are taken from one NHS trust that provides evidence for a continually growing backlog for follow-up outpatient services. It is believed that these data are representative of most locations within the NHS in England and therefore suggest an immediate shortage in effective follow-up capacity. To avoid compromise to patient care, the problem will have to be addressed before the situation becomes unmanageable. The paper highlights options to reduce or deflect demand or to increase effective capacity.
KEY WORDS: capacity planning, clinics, demand, queues
Introduction
In two previous articles the challenges concerning the management of bed capacity were highlighted.1,2 It was asserted that the data did not indicate a real shortage of bed capacity in most NHS trusts because most of the problems associated with bed availability can be explained by the presence of demand and capacity variation. In the case of bed management, better availability can be achieved through a combination of actions to reduce demand and capacity variability and by the identification of the true capacity constraint. In many situations, increasing the number of beds can perversely make the situation worse.
Every system usually has one stage in the process that acts as the capacity constraint, and it is essential for effective capacity management of a system to know where this bottleneck exists.3 In this article the demand and capacity balance for outpatient follow-up clinics is assessed, to identify if this is the part of the patient journey when flow is most likely to be delayed or where capacity is at its lowest. In particular, there are concerns that priorities and targets set by government have conditioned behaviour such that systems are now designed to minimise the waiting time for patients' treatment to start, but the system is not balanced. A potentially false logic is that any delay...