The director of the national Elective Care Transformation Programme explains why and how the NHS is working to reduce unnecessary face-to-face outpatient appointments.
The NHS Long Term Plan commits to reducing face-to-face outpatient appointments by up to a third over the next five years.
This will be a game-changer for many patients. Far less need to struggle with public transport, road congestion, or parking; to arrange for time off work or to be accompanied by a relative or friend; or to travel for hours just to have a brief exchange in an outpatient clinic and little time for questions.
Transforming the approach will not just save patients time and money, it will allow staff to work in the most efficient and satisfying way, reduce pollution from road travel, and save the NHS more than £1 billion a year.
It is a big change to the way the NHS traditionally works – and that’s where the Elective Care Transformation Programme’s expertise comes in.
Over the last two years, we have successfully led rapid testing and implementation of innovative approaches to transform outpatient services in 14 high-volume elective specialties.
Some of the initiatives we have tested include:
- follow-ups over the phone, or by Skype, with a specialist nurse: 100 per cent of post-operative prostate patients in Dudley offered telephone follow-ups preferred these to travelling to hospital for their appointment.
- open invitations for patients to contact their clinic after surgery or for a long term condition, with clear guidance about how and why they should get in touch, as an alternative to routine follow-ups for all. All patients offered open access in Great Preston, Chorley and South Ribble as they recovered from gynaecology surgery rated their care as good or very good, including the 87 per cent who did not require a follow-up.
- ‘one stop’ clinics which people attend for multiple aspects of their care, potentially including scans or X-rays: in Lincolnshire, one stop pre-assessment clinics for general surgery reduced non-attendance rates from 9 per cent to 4 per cent.
Throughout this time we have developed, gathered and shared best practice on how to do transformation well. This learning is at the heart of our new transforming outpatient services workstream, which is focusing initially on ophthalmology services through our ground-breaking EyesWise project.
EyesWise is supporting local systems to ensure that people who need to see an ophthalmology specialist get care as quickly and easily as possible, saving sight and improving lives.
Practical information and ‘how to’ solutions from our work so far are gathered in our handbooks, which bring together information about different approaches, evidence of impact, and the experience of frontline teams.
For those who are embarking on the journey, this is what our experience shows is essential to successful transformation of outpatient elective care services:
- strong support from the leadership team across organisations: they need to absolutely understand and back the change, invest money and staff time in planning and implementation, be there to unblock barriers if there are any, give teams permission to get on with it, and ensure it is an urgent priority for all involved, with a clear timescale for delivery.
- whole system working: it’s about re-thinking the way services work, what they do, and who does what. This will only achieve the desired results if the team includes the right people from across the organisations involved, along with patients or patient representatives, and others who don’t yet provide aspects of the service but potentially could – such as community pharmacists. A new way of working for many, it requires new approaches to team communication and support, including coaching. This may be face-to-face or remote. For instance, Advice and Guidance – specialist support to GPs in primary care often provided through the NHS e-Referral Service – is a key component of our work to transform outpatient services.
- measurable goals, supported by real-time data and evaluation, so teams can see what is working, and revise or expand their approach to ensure delivery.
We have found that with these in place, change is led from the front and owned by those involved, which results in sustained and embedded improvement.
The Elective Care Transformation Programme works nationally with expert clinicians and key stakeholders to develop, co-ordinate and share resources (including alternative outpatient service models and associated technology) that support local transformation of outpatient services and improve elective care. We also co-ordinate collaboration to address barriers to implementation, such as challenges with interoperability and tariff.