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Better GP/consultant relations key to improving outpatients

Experts recommend changes to one-way referral process

Adrian O'Dowd

Thursday, 30 August 2018

Growing pressures on outpatient services could be eased with better two-way exchanges between GPs and hospital consultants, according to the Nuffield Trust.

The think tank has today published a briefing paper that suggests more two-way conversations between GPs and consultants have the potential to transform outpatient services for the better.

Over the last 10 years, outpatient services in England have had the sharpest rise in activity of all hospital services. More than 110 million outpatient appointments are now scheduled each year and many sustainability and transformation partnerships (STPs) have outlined ambitious plans to cut costs by reducing outpatient activity.

For the Rethinking outpatient services briefing, the authors drew on a Nuffield Trust workshop, held in collaboration with NHS Improvement, which heard from health leaders across the country who have made significant changes to their outpatient services.

The authors say that successful and radical rethinking of outpatient services can only be achieved when clinicians are at the heart of the process.

Their paper says that what has underpinned some of the most impressive outpatient redesigns has been the transformation of relationships between consultants and GPs - who have traditionally been frustrated with the one-way referral process - and their wider clinical teams.

At the workshop, the authors heard that there were significant opportunities to improve the design of many elements of outpatient care, such as making follow-up appointments more flexible and to add most value to patients.

Developing a two-way conversation between GPs and consultants, attendees said, had the potential to treat more patients in the community and support clinicians in their decision making. It could also enable them to ask for advice, promote trust between clinicians and patients and reduce referrals.

Examples of different ways of working trialled by attendees included:

  • a child health GP hub that facilitates collaboration between primary and secondary care, including multi-disciplinary team meetings to discuss concerning cases and easy routes for GPs to ask consultants for advice, including during a patient’s GP appointment
  • innovative approaches to follow up, including using an email questionnaire to determine (with patient agreement) whether an appointment is needed, leaving the consultants to focus on the more complex cases.
Other suggestions included creating virtual follow-up clinics, using an email questionnaire to determine whether an appointment was actually needed and using data to find solutions to “did not attend” rates.

One of the paper’s authors Sophie Castle-Clarke said: “With over 110 million appointments scheduled a year in England, and nearly 24 million of those not attended, the time to rethink outpatient services is long overdue.

“The good news is that with this significant challenge comes great opportunity to do things differently. Clinicians we spoke to are already seeing the benefits of shaking up traditional models of outpatient services, with fewer missed appointments and better quality consultations.

“A clear thread running through successful changes to outpatient services was allowing clinicians to orchestrate these changes and build strong and productive working relationships.”

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