Balancing demand and capacity

Below are the change ideas that can be tested to enable services to balance their demand and their capacity. To ensure they can offer care sustainably during COVID-19, elective care services will need to reassess their capacity and capability as they adjust to new circumstances.

Appointment demand
- Use Telephone clinics and enhanced vetting to reduce appointment demand
To continue delivering care whilst unable to see patients face-to-face, colorectal consultants at NHS Tayside introduced enhanced vetting and a new telephone clinic and reduced their demand by 50%.
- Using online health and care video library can increase service capacity
To both inform patients prior to any scheduled procedures, and to reduce the need for follow-up appointments, the Health and Care Video Library was created by Health and Care Innovations (HCI), a partnership between Rocklands Media Limited and Torbay and South Devon NHS Foundation Trust. The library includes over 600 videos developed by NHS clinicians to be used within care pathways.
- Creation of new referral guides and information guides can help reduce appointment demand
The Care Home Dietetic team in NHS Greater Glasgow and Clyde anticipated that referrals would rise significantly during COVID-19. To manage this, they worked at pace to produce helpful guides for care home teams and avoided a spike in referrals.
Sustainable patient engagement (including appointments)
- Keeping patients informed can help maximise service capacity
NHS Greater Glasgow and Clyde have created a user-friendly patient information leaflet to ensure patients are fully prepared and feel confident about the care they will receive. Doubt, anxiety and being unprepared could cause delays, affecting service capacity.
- Relocating a clinic can help ensure services can engage with hard to reach service users
When clinic-based services were paused in response to COVID-19, a team from NHSGGC Sandyford implemented a mobile clinic to ensure patients of homeless health services could continue to be treated and supported.
- Using virtual tools can enable continuous engagement and inform care decisions
NHS Grampian Dermatology and Plastics services sought to continue their QI work at pace and used NHS Near Me appointments to interview service users virtually during COVID-19. Read more in this case study.

NHS Greater Glasgow and Clyde extended the online use of patient-reported outcome measurements (PROMs) and patient-reported experience measurements (PREMs) across multiple cancer services as delays to treatments due to COVID-19 can greatly affect patients’ wellbeing. This informs team prioritisation decisions and the identification of patients needing urgent clinical review.

A Clinical Rheumatology team at NHS Lanarkshire have successfully trialed a new registry with outpatients at Rheumatoid Arthritis Clinics. This provides the clinic staff with additional information about the patient’s specific needs and encourages shared decision-making.
Understanding capacity
- Design a Patient Initiated Follow-up Pathway to improve quality of care
To better understand their outpatient capacity against the needs of their patient, NHS Lanarkshire Rheumatology Department is currently implementing a new Patient Initiated Follow-up Pathway for selected patients with chronic inflammatory arthritis who have stable disease activity.
Understanding physical capacity
- A physical capacity tool can ensure safe, organisation-wide remobilisation
When faced with COVID-19 restrictions, services had to reduce their elective care activity. NHS Fife developed a new physical capacity tool which would allow for capacity across multiple services to be calculated simultaneously. This is now embedded in NHS Fife governance structures and it has been adapted for use in community settings.
Understanding your demand
- Understanding your pathway: The ‘Last 10 Patients’ QI tool
Using ‘Last 10 patients’ QI tool enabled the NHS Lothian’s Dermatology team to understand patient flow within their pathway to identify their longest waits.
Sustainable approaches to meeting demand
- Using pre-clinic telephone consultations to reduce clinic waiting times
Pre-clinic telephone consultations can help teams to continue to meet appointment demand. NHS Ayrshire and Arran have continued to run their postmenopausal bleeding (PMB) clinic at full capacity throughout COVID-19 and have reduced waiting times for ‘urgent suspected cancer’ cases.
Use of technology to balance demand and capacity
- Designing a remote prehabilitation programme to provide support and care
The Kent and Medway Prehabilitation Programme team have successfully provided nutritional advice, exercise, and psychological support to patients and reported a 98% compliance rate with a new prehabilitation programme. The programme also enabled them to reach more patients across the county, overcoming restrictions for face-to-face consultations.
- Using technology to connect with patients and deliver essential care
Chelsea and Westminster Hospital NHS Foundation Trust and ViiV Healthcare have designed a new app for patients. This helps patients with long-term conditions self-manage their health, and connect to staff at outpatient clinics. This can reduce the need to visit hospital for routine appointments. This providing a new and creative way to connect with patients and deliver essential care.

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