During Covid-19, Sally Cruse and Hassan Daji from NECS Consultancy worked on the London Outpatient Transformation Programme providing support to the Ophthalmology and Video Consultation workstreams. Here, they provide their views on a holistic approach to reducing the quantity, and improving the quality, of outpatient appointments.
The London Outpatient Transformation Programme started in December 2019 with an aim to reduce the number of face to face outpatient appointments by a third over five years. This would be achieved by harnessing digital solutions and removing unnecessary new and follow up appointments. However, the immediate impact of the Covid-19 pandemic meant the programme needed to change its strategic direction and re-prioritise its resources. This led to the sped up national procurement of a digital consultation platform, Attend Anywhere, to ensure patients could keep necessary appointments. The platform also enables a multi-disciplinary service by a wider group of clinicians being able to join a consultation.
Digital consultations are part of a bigger picture to improve the outpatient experience. The rate of video and telephone consultations nationwide has increased significantly since the pandemic began and, whilst the long-term impacts haven’t been recognised yet, we expect to see a reduction in DNA rates, travel time and financial costs. However, the quick shift in medium over the past three months has not yet tackled the underlying questions surrounding clinical triage: whether the first or follow up outpatient appointments are necessary, if a digital solution is appropriate for a specific clinical setting, or if care/advice could be offered in a primary or community setting.
Another way to improve the patient experience is through increased use of patient-initiated follow-up appointments (PIFU). PIFUs were highlighted in the Long-Term Plan and by The Royal College of Physicians as being essential to changing and reducing outpatient appointments.1 PIFUs can help by significantly reducing unnecessary appointments and shifting responsibilities; patients need to take responsibility to self-manage and clinicians must empower patients to do this whilst also ensuring other patients, such as those with multiple comorbidities, do not fall through the cracks because of poor management of patient lists.
Ultimately, each Trust needs to work with their communities to understand how their local arrangements can reduce face to face outpatient appointments within agreed clinical pathways. Local challenges may include: the quality/compatibility of their (digital) systems, the sheer size of patient lists that cause patients to be missed, or competing financial pressures. As we move towards a more provider-led model of care, ICSs need to embrace the opportunities available and ensure that old ways of working do not slowly re-emerge. Above all, the changes need to be led by clinical teams and identified local champions to drive a culture of change.Partnerships between the different levels of care will also be a major boost to how patients experience outpatient care. Building these partnerships will allow for more efficient and effective use of the limited capacity within the system and embrace a whole of system approach. This will include primary and community providers supporting patients in the management of some comorbidities. To facilitate these relationships, national tariffs need to be reviewed to ensure the new ways of working are not penalised.
Considerable progress has been achieved during COVID-19 to implement digital consultations across all trusts in England. However, video and telephone conferences are only part of the solution to transform outpatient services. The next stage will be for ICSs to establish their local clinically led programmes. These programmes need to develop and embed sustainable solutions that meet the needs of both patients and clinicians whilst addressing health inequalities.
Contact NECS Consultancy to understand how we have supported clients to strategise, plan and improve their integrated and digital systems. Find out more here: NECS Consultancy
- Royal College of Physicians. Outpatients: the future – adding value through sustainability. [Online]. Available from URL: https://www.rcplondon.ac.uk/projects/outputs/outpatients-future-adding-value-through-sustainability