In General Practice (and other parts of the Health Service) there is a natural circle of Need and Capacity. When there is unmet need it shows up as Demand and this is what usually drives increases in Capacity.
However, there is a delay while capacity meets the need and politically it may be tempting to use Demand Control to reduce Demand directly without sorting out the unmet Need.
The problem with Demand Control is that it produces a short-term improvement in Visible Demand while doing nothing to improve long term Capacity.
Demand Control may in fact make things worse by taking clinicians away from providing Capacity and by storing up unmet Need which then comes back into the pool of Demand after a delay.
If this is not recognised, then it can result in repeated short-term fixes which look good temporarily but then fail while the underlying problem gets worse.
So what can we do to improve things without any extra funding?
We need to learn what works for us and our staff and that means listening to everyone we work with and empowering them to adjust how they work to help patients better. Happiness and fulfilment for all of us is necessary for long term growth. One of the more damaging and frequently used quick fixes is to improve short term Capacity at the expense of the health of our clinicians.
Our communities also have a role in improving their own health. Many of the underlying problems are not in our control but we can help patients be more self-sufficient and use continuity and partnership with them to improve their care.
Every change we make needs to be reviewed to see if it builds long-term Capacity (and if not, it should be abandoned)
At Milton we are doing some of these things to increase our Capacity (This is not an advert. We are not recruiting.). However, some things are better when we work together, and we also need to join with our friends and colleagues at the CCG and in secondary care to build long term improvements.