3: Handle Demand

The service ensures that referrals are appropriate e.g. using published eligibility and redirection criteria. Service users can chose an initial Choice appointment when their referral is accepted i.e. full-booking. The service flexes Choice capacity in line with referral demand to prevent a waiting list.

Eligibility criteria

CAPA is a system that improves access but you still need to have eligibility criteria that are tailored to local circumstances. It is a case of what your service ‘should do’ not what you ‘can do’.

However, we do find that it helps to be flexible over those ‘grey’ referrals. Those ones where information is not complete, or the presenting problem could be masking another (behavioural problems and depression for instance). It can be more effective to see the service user, perhaps with the referrer, to check whether your service could be useful and is wanted.

CAPA works best if you have limited priority criteria. Seeing everyone quickly, i.e. no waiting list, means that very few things become an emergency. Implementing CAPA means you will be able to fix your time to Choice - we find within 4 to 6 weeks of referral is good. But you can choose any time frame that suit you locally.

Full booking

When a referral is accepted clients are given the option of at least two Choice appointments on different days and at different times. This works if there are vacant Choice appointments in a team diary for the admin staff to offer over the phone. You need a system for vulnerable people or risky service users who may not be able or ready to call in. Make sure someone calls them or the referrer helps them to book in.


Flexing your capacity in response to your referral rates ensures the wait to initial Choice can be kept stable to about 4 weeks and certainly within 6 weeks. This means offering more Choice appointments if more referrals are accepted.

What will happen if you don’t Handle Demand?

You may see referrals who don’t need you or should be seen somewhere else. This is frustrating for service users as it wastes time and it eats up your capacity.

If you have too many priority streams (emergency, urgent, soon, routine are common ones) you will find referrers soon learn what words to use to get someone prioritised (‘this 4 year old is suicidal’)! ‘Routine’ clients may never get seen. Limiting the number of priority streams means everyone is seen more quickly by minimising multiple queues; reducing variation and smoothing flow (see the 7 HELPFUL Habits Handle Demand section of the www.capa.co.uk).

If you do not use full booking into Choice then you will find a waiting list into the service can soon develop. The lack of booked appointments often increases waits. Clients and referrers will keep phoning in to enquire when they will be seen and admin and clinical staff time will be taken up managing anxiety.

If you don’t flex your capacity service users may wait longer or shorter times according to when they are referred. The lost service capacity at low demand may not be used – increasing waits at other times.