An Introductory Guide
For Clinicians & Service Managers
CAPACITY
FOR PSYCHOLOGICAL
THERAPIES SERVICES
By The Mental Health Collaborative
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Introduction
This guide provides a basic
introduction to capacity and
ways to ensure services make
the best use of their current
resources. It is part of a
series of introductory guides
for psychological therapies
services. These guides cover
four areas: Demand, Capacity,
Goal Setting/Case Review and
Clinical Administration. There
is also an introductory guide
called ‘Start Here’ that looks at
how to implement change in
the midst of uncertainty about
what will work.
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This is a beginners guide to capacity theory as
it applies to psychological therapy services. The
intention is that it will plant a few seeds of interest
and hope to help you with your own service.
For the purposes of this guide, a Psychological
Therapy Service is any local service providing
psychological therapies. Examples might include:
Primary Care Mental Health Teams, Community
Mental Health Teams, Clinical Psychology Service
and Psychological Therapies Services.
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What is capacity?
Capacity is the total resource you have available to
do the work. It includes staff and any equipment
needed (such as rooms). Not all of the clinical
staff time will be available for direct service
user contact. This is because time will be spent
travelling, on leave, at meetings etc. It is important
to take this into account when looking at your
service capacity.
For this guide we will focus on available clinical
hours. This is not determined solely by the number
of Whole Time Equivalent (W.T.E.) staff you have.
Your service capacity is the total number of clinical
hours you have available and will primarily be
limited by current job plans. If you don’t yet have
job plans, don’t worry, we will come to that.
Why work on service capacity?
There are a number of good reasons for working
on service capacity:
• Highlights opportunities for releasing more time
for patient care.
Working on service capacity is not about getting
people to work longer or harder. It is about
ensuring time is used appropriately. If you ask
them, most clinicians would rather spend less
time looking for patient records, booking care
reviews or going to badly chaired and focused
meetings. They would prefer to use the time
they save for clinically related activities.
• Creates a better working environment
The feedback from clinical services
who do this work is that most clinicians
are happier afterwards as their
working lives are more in control.
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• Enables analysis of whether the service has
enough staff to meet the demand.
If you have also worked on demand,
then doing work on capacity means you
can analyse whether you have enough
resource in place to meet your demand.
• Helps you make effective bids for additional
resources.
Can you demonstrate to the organisation
that you are using your current capacity as
efficiently as you can? Are you effectively
managing demand? If the answer to these
two questions is yes and you still don’t have
enough staff to do the work, you will have a
really strong case for additional resources.
• More efficient than more staff.
If your team only spend 50% of their time on
clinical work (not unusual for a CMHT) – then
every additional hour you can redirect to clinical
work is the equivalent of 2 hours if you bought
it in as new staff time. Why is that? Well, lets
say you’ve worked out that your team needs
20 hours more clinical time. You couldn’t just
employ someone part time for 20 hours as
you know that 50% of a staff member’s time is
spent on non clinical work; so you would have
to employ 40 hours more time to get the 20
hours of clinical work. But if you can create
that 20 hours by stopping doing something
else, then you only need to find 20 hours.
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What is our service capacity?
Okay, so you understand that capacity is the total
hours you have available. Now you need to know
how to break this down so it is meaningful and can
be matched to demand.
Step 1
Write down a list of all your clinical staff and how
many hours they work.
Name
Professional
Hours
Harry
CPN
37.5
Sally
Psychologist
18.5
Step 2
Ask each member to keep a record of their work
for two weeks. Use this to work out the amount of
time (in hours) spent on direct clinical work. Also
record: meeting time, clinical admin, supervision,
CPD/training, travelling and any other relevant
categories (for instance if you spend a couple of
hours a week doing a piece of improvement work).
For example, Harry, who is contracted to a 37.5
hour week, spends two weeks keeping a record of
what he does. He allocates hours spent to a few
main categories as follows:
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Harry’s record of work
Hours
(2 weeks)
Average hours
spent per week
Direct clinical work
40
20
Clinical admin
12
6
Training/CPD
4
2
Supervision
2
1
Referral meeting
4
2
Team meeting
3
1.5
Travel
10
5
Totals
75
37.5
Step 3
Adding it all together to get the teams capacity
The following table shows the results of all team
members’ record of their average weekly time
allocation.
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Harry
Sally
Thelma
Louise
Totals
Direct clinical
work
20
6
19
19
64
Clinical admin
6
2
6
6
20
CPD
2
2
4
2
10
Supervision
1
1
1
1
4
Supervising
0
3
0
0
3
Referral
meeting
2
2
2
2
8
Team meeting
1.5
1.5
1.5
1.5
6
Travel
5
1
4
6
16
Totals
37.5
18.5
37.5
37.5
131
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Doing Capacity Sums
Now you need to use the information you have
collected to work out how much time you have
available to see clinical work. The easy way is
to use the Mental Health Collaborative DCAQ
Tool. You put the data in, it does all the sums for
you, and gives you the answer at the other end.
Information on how to access this is available at:
www.scotland.gov.uk/topics/health/nhs-scotland/
delivery-improvement/1835/74
However, we know that some of you will want to
know how to do the sums yourselves, so we’ve
included the following example.
Application Tip
Calculating how much time you have
available to see clients
No-one works 52 weeks a year. To calculate your
capacity you first need to take into account annual
leave, sick leave and special leave. On average one
day per week is already accounted for by annual
leave and sickness. It can help to remember this
when you are thinking about your capacity: a full
time staff member is only there for an average of
4 days a week, not 5 days.
We will do all our calculations in the following
examples based on a 42 week year as we’ve made
the following capacity assumptions: 8 weeks leave
and 2 weeks sickness (4%) per annum.
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Application Tip (continued)
At its simplest, the team’s clinical capacity is the
sum of the clinical hours. So using our example
above, we have 64 clinical hours per week which
equates to 2688 a year (64 x 42) and 224 hours
a month (2688/12). If the average number of
appointments per case is 8 and each appointment
takes 1 hour then the average demand per case is
8 hours. This means we have a total team capacity
of 28 new cases a month (224/8).
HELP! That sounds complicated…
Let’s break that down then step by step
Each referral is seen an average of 8 times for one
hour a time.
• This means in total each referral has 8
hours (8 x 1) of clinical contact time.
• You’ve got 224 hours a month of staff time
available to see patients (you’ve already
adjusted for time spent doing other things).
• So to work out how many new cases you can
see a month – simply divide the total amount of
clinical time you have (224) by the total number
of clinical hours you spend with each referral (8).
This equals 28 new cases a month.
HELP! That still sounds complicated…
We’ve already mentioned the new DCAQ tool that
will help you with this, all you need to do is to enter
the data you have collected and it will do all the
sums for you.
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But there is a big difference between how
much time I spend with each referral.
That is true, but averages are fine. You may
be surprised when you work out your average
numbers. In the Borders, when they looked at
average contacts for all clinicians, they were
surprised to find that there was not as much
variation as they predicted. Most therapists who
they thought saw people for longer (including the
author), did not have significantly more contacts
per patient than those they predicted were
‘quicker’.
Ok, so I am measuring my capacity, what next?
There are two main ways you can use this
information about capacity to help you.
• You might be surprised by the data and
how much time you are spending on
non-clinical activities. The data might
indicate where there are opportunities for
redesigning how you run the service so you
can release more time for clinical work.
• If you have also completed work on your service
demand, then you can use this data to see if you
have enough resource to meet your demand.
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Increasing capacity without working harder
Releasing time for clinical work
Sometimes you can create extra capacity for
clinical work by reducing the amount of time you
spend on other activities. Looking at how your
team spends their time helps you think together
about opportunities for redirecting time to clinical
work. This is not about getting people to work
faster or harder or even longer, it is about using
your time smartly.
Neither is it about stopping the things we do that
add value, for instance, time spent in supervision is
important. However, we all know the frustration of
ending up doing things we don’t think are the best
use of our time. How often have you sat in poorly
chaired meetings that have been going over the
same ground for the last three years?
“”
Looking at how your team
spends their time helps you
think about opportunities for
redirecting time to clinical
work.
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Example of releasing time for clinical work
Doing capacity work helps teams to talk openly
about how their time is spent and whether they are
making the most effective use of it. It might lead you
to redesign some of your admin processes to release
time for clinical work or you might want to look at
how effectively your meetings are chaired so you
can release time for clinical work.
The summary of how people spend their time is
an essential starting point for looking at ways of
increasing capacity. Our staff are contracted to
work a set amount of hours, we are NOT expecting
anyone to work longer hours!
To see how this might work, let’s try a few small
changes with an example team.
Supervison
Sally decides to do group supervision
– saves 2 hours a week
Travel
Thelma and Harry find a clinic room at base, and
no longer travel for one clinic – saves 0.5 hours for
Thelma and 1 hour for Harry
Louise moves a remote weekly half day clinic to a
fortnightly day long clinic – saves 2 hours driving
Meetings
The referral meeting is changed to just Louise and Sally
meeting for an hour a week to check referrals against
criteria and allocate – saves 6 hours
Sally spends half-an-hour preparing for the team
meeting and is supported in chairing the meeting more
efficiently so now all business is done in one hour –
saves Harry, Thelma and Louise 0.5 hours each.
The saved time is allocated to direct clinical work (with
some additional time for associated clinical admin).
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After the changes:
Harry
Sally
Thelma
Louise
Totals
Direct Clinical
work
23
8
22
22
75
Clinical admin
6.5
3
6
6.5
22
CPD
2
2
4
2
10
Supervision
1
1
1
1
4
Supervising
0
1
0
0
1
Referral
meeting
0
1
0
1
2
Team meeting
1
1.5
1
1
4.5
Travel
4
1
3.5
4
12.5
Totals
37.5
18.5
37.5
37.5
131
The result:
Before
After
Difference
Direct Clinical Hours
per Week
64
75
+11
Clinical Hours Per Year
2688
3150
+462
New Patients Per Year
336
394
+58
That is 58 more new patients a year, more than one
additional new referral a week. No-one is working
more hours, there are no new staff, and we have
not reduced time for CPD, supervision or clinical
admin. This is the equivalent of employing at least
another half time person for the team.
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Actually we have added more than a half-time
person to our team as we have not yet factored in
time for annual leave, travel and so on. We need to
use the assumptions we have about how clinicians
spend their time, but backwards this time. As we
lose so much of a persons time to travel, leave etc
– every hour you get to reallocate to clinical time
is usually the equivalent of employing 2 additional
hours.
Opportunities for releasing
capacity for clinical work
In the above example we’ve highlighted some
areas for consideration to release capacity for
clinical work. The following table summarises
issues you might want to think about.
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Issue
Detail
Travel Time
Some community services spend a lot
of time travelling and there may be
opportunities to reduce this. For instance:
• Is there a need to spend an hour a week
travelling to a particular meeting? Would
a telephone conference call be just as
effective and achieve the same outcome?
• Can you reduce the amount of time spent
travelling to remote locations by doing
longer clinics less frequently?
Meetings
Badly managed meetings can waste a lot of
time. Some of the most common problems
are:
• Lack of focus and clarity on the purpose of
meeting/agenda item;
• Issues being discussed at length only
to defer a decision till a later date due to
a lack of information or key people being
unavailable;
• Lots of people sitting through a discussion
that is only relevant to two people.
Allocation
Meetings
Is it necessary for the whole team to attend
the allocation meeting? Could the allocation
of referrals be done differently?
Clinical
Admin
Do your admin procedures involve
duplication such as:
• Duplicate assessments of patients;
• Typing up notes, only to have admin
retype them into a template;
• Entering the same information into two or
more systems?
• Writing notes of meetings that are then
typed up (why not take a laptop and get
someone to type the notes straight in).
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Issue
Detail
Skill Mix
Are your highly skilled/specialist staff
deployed appropriately? If not, then
reviewing your skill mix may mean you
are able to utilize existing resources more
effectively.
Absence
Rates
You will have an organisational policy for
how to manage sickness absence and this
will be based on best practice. Are you
following it?
These are just some ideas, you will probably have
a lot more. But remember, this is not about making
staff work harder; it’s about working smarter. This
is about reducing the time spent on unnecessary
activities, with all of the negative emotion that
goes with that. It’s about removing the day to day
frustrations we all experience when wasting time
fixing problems or spending time doing something
unnecessary.
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Keeping it Right - Individual Job Planning
Everyone should have a job plan which sets out the
percentage of time they are expected to spend on
the activities relating to their job. This plan should
be reviewed regularly and will be central
to personal development planning and appraisal.
All the individual job plans for team members
can be combined to form a Team Job Plan. This
will act as a summary of the capacity of the whole
service.
It allows the team to look at their total capacity, as
well as seeing clearly what the impact of changes
to the way their time is used. We’ve already
mentioned the MHC DCAQ tool. This will let you
model the potential changes to practice, so you
can see the impact of reducing the amount of time
spent in meetings or the impact of managing to
reduce time spent travelling.
The capacity to undertake levels and types of
work needs to match the demands on the service.
This should inform team and individual job
planning and personal development plans.
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We need more capacity
Your team has spent time looking at working
patterns, all your staff have job plans and
unproductive time has been greatly reduced.
You’ve done everything you can think of to reduce
your demand BUT it still exceeds capacity.
Now what?
Clearly, if by analysing demand your team can see
that 30% of clinical time is needed for guided selfhelp, then the team capacity for guided self-help
must match this. If the hours you have for guided
self-help are less than the demand, capacity for
self-help will need to increase. Otherwise your
waiting lists will just continue to grow. If after
increasing capacity by the methods outlined
above, there is still a shortfall, then more staff need
to undertake self-help. Is this where we ask for
more staff?
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Not quite yet. First you need to make sure there
aren’t resources that could be moved from other
parts of the system. So, if there are staff elsewhere
who are not working to capacity (and yes this does
sometimes happen, one set of staff running around
like headless chickens and another set of staff
with not enough work to do) then you will need to
move resources around. This may mean you have
to provide additional training. Alternatively, you
may also have some staff working very hard, but
at the wrong thing (i.e. delivering a therapy that is
not evidence based, or doing work that someone
at a much lower grade could do). This is another
opportunity for moving resources around.
You do all of this and there is still not enough
capacity to meet the demand, now what?
Well now you have an excellent case to put
forward for additional resources. You will be able
to prove that you have done everything you can
to manage the problem within existing resources;
and you will have the data to show that, without
additional resources, the waiting lists will continue
to grow.
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Summary
The following checklist will help you decide
whether you are making effective use of your
current capacity. Rather than a simple yes/no
choice you can select ‘partly’, as we recognise
that most services will be in the process of looking
more closely at what they are doing.
If you can answer yes to every question in this
checklist, then you are probably doing everything
you can to make the most effective use of your
current capacity. If you answer no or partly to
questions, then this indicates an area where you
could do further work.
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Yes
Partly
No
Do you know how team members
currently spend their time – and
how much of this is on clinical work
and how much on other activities?
Do you know what your team’s
capacity is in terms of number
of new referrals you can see and
number of interventions you can
provide?
Do you manage sickness
effectively?
Are community visits well
organised so they minimise time
spent travelling between places?
Are you certain you have the right
people doing the right things?
(or do you have highly skilled /
specialist staff spending lots of
time on work that other staff could
do just as effectively?)
Are your staff appropriately trained
so they have the skills needed to do
the work that presents?
Are your meetings well run so they
are an effective use of time?
Have you removed all duplication
and unnecessary steps from your
clinical admin procedures?
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Summary of Data to Measure Capacity
A number of times in this guide we have
referred to the DCAQ tool. This is a spreadsheet
based application. To use this tool for capacity
analysis, you will need to know certain pieces of
information. These are described in more detail in
the MHC DCAQ Tool guide at:
www.scotland.gov.uk/topics/health/nhs-scotland/
delivery-improvement/1835.74
This guide also tells you why you need this
information. The following table summarises the
data that the DCAQ tool will need.
Data needed for CAPACITY analysis
Currently
Collect
Number of staff in each professional category.
Annual Leave (average days per person)
Special Leave (percentage)
(Special leave covers leave such as carer’s
leave, parental leave and compassionate
leave.)
Sickness Absence (percentage)
Time spent travelling per week (average hours
per staff member)
Hours spent on training per week (average
hours per staff member)
Hours spent at meetings per week (average
hours per staff member)
Hours spent in supervision per week (average
hours per staff member)
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Capacity and Demand
– two sides of the same coin
Looking at your capacity is only one side of the
coin, you also need to look at how you manage
your demand. You might find you have more
control over it than you realised. See Demand
for Psychological Therapies Services for more
information on this.
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© Crown Copyright 2010
These booklets have been produced by the Scottish Mental Health
Collaborative. For further information about the work of the Scottish Mental
Health Collaborative please visit its website:
www.scotland.gov.uk/PsychologicalTherapiesServicesIntroductoryGuides/
Capacity
These booklets are a series of five. These are listed below:
•
•
•
•
•
Improving Access to Psychological Therapies Services
Capacity for Psychological Therapies Services
Demand for Psychological Therapies Services
Clinical Administration for Psychological Therapies Services
Goal Setting & Case Review for Psychological Therapies Services
PDF copies of these booklets can be assessed at the
Scottish Government website: www.scotland.gov.uk
APS Group Scotland
DPPAS10060 05/10
ISBN: 978-0-7559-9343-7
Further copies are available from:
BookSource
50 Cambuslang Road
Cambuslang Investment Park
Glasgow G32 8NB
Telephone: 0845-370-0067
Fax: 0845-370-0068
Email: [email protected]
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