Major overhaul of outpatient appointments

A plan to deliver a major shift in the way outpatient care is delivered, giving patients faster and more local access to care, has been published today.

The Modern Outpatient: A Collaborative Approach 2017-2020 sets out a new strategy for responding to rising demand and aims to free up 400,000 hospital outpatient appointments by 2020.

Outpatients are those people who have been referred to hospital for a further assessment of their condition by a consultant.

Of the 4.5 million outpatient appointments delivered by the NHS in Scotland each year, 1.5 million were new appointments and 3 million were return appointments - either for follow-up care or a routine check-up.

The strategy proposes that some patients, particularly those who are waiting for a routine check-up or test results, would be seen closer to home by a team of community healthcare professionals with close links to hospital departments. The NHS will also make better use of e-consultations and action will be taken to reduce the number of unnecessary referrals.

Publishing the strategy, which healthcare staff and professional bodies will have the opportunity to give views on, Health Secretary Shona Robison said: “Our NHS must continually evolve to meet the increasing demands it faces. Today I am setting out a plan to ensure people get seen by the most appropriate health professional, often closer to home and ending many repeated, unnecessary trips to hospital.

“This plan contributes to our strategy of shifting the balance from acute to community and primary care, something that everyone agrees is vital to the future of our NHS. This will work in tandem with our commitment to increase the share of the NHS budget available for primary care to 11% – an extra £500 million over the next five years.

“However I am clear that this is not about giving more work to GPs or community nurses. Underpinning this plan is an aim for our community and hospital professionals to work more closely together, reducing unnecessary waste in the system and getting people seen by the right professional first time around.

“We recognise, though, that this plan represents a change to the way that things have been done traditionally, and that is why we will consult with staff and professional bodies to seek their views on this document and the future of outpatient care.

“There are real challenges that our outpatient services are facing right now. The performance of our hospitals in scheduled care is simply short of what we expect and that is why we’ve put in an extra £10 million this month to deliver an extra 40,000 outpatient appointments.

“There are also a number of local areas and local clinical teams that are doing some excellent work at the moment to redesign the way they provide outpatient services. It is important that this work is shared across the health service and we will be taking that forward, as well as working with boards with particular challenges to get their services back on a sustainable footing.”

Examples of service redesign already underway:

• As part of the National Ophthalmology Workstream, patients who have had a cataract operation and would normally go to hospital for a follow-up appointment are now being seen in a community setting, often by a local optometrist. Around 46,000 cataract treatments were undertaken in 2015, with approximately 26,000 follow-up appointment slots released to date.

• In NHS Lanarkshire, an ‘advice-only’ referral option was introduced in neurology services – meaning GPs can request advice for their patients from hospital clinicians rather than having to refer the patient to hospital for an appointment. This reduces waiting times for clinical advice and has the potential to reduce the number of new outpatient appointments by 5,000 in the first year of the programme if rolled out across Scotland.

• The on-going review of patients with Coeliac Disease, who have already been diagnosed, is currently managed in secondary care with an annual blood and bone health status check. Under the new care pathway designed by the National Gastroenterology Collaboration, patients will be seen by community-based dietetic services. As part of the existing Gluten Free Food Service in community pharmacies patients already have annual review undertaken by the pharmacist who reports any issues to the patient’s GP and dietician.

Edward Dunstan, Director Of Surgery, NHS Fife and Chair of the Scottish Committee for Orthopaedics and Trauma said: “With ever increasing demand, traditional ways of doing things must be challenged. Technology enabled care and the use of Allied Health Professionals are pivotal to this change of mind-set.

“The historical referral patterns need to be challenged with care closer to home. Only those patients who need to be seen in the hospital setting should be seen there.”

Dr Alan Clarke, Consultant Gastroenterologist at NHS Greater Glasgow & Clyde and Clinical Lead for the National Gastroenterology Collaboration, said: “As the National Lead for the Scottish Gastroenterology DOIT Collaboration, I have had the opportunity to work closely with colleagues nationally across the clinical spectrum to design clinical models of care for gastroenterology patients that will be responsive to their needs, safe, sustainable and to the highest clinical standards.

“These models of care will only be deliverable however if we foster a culture of national, regional and local clinical leadership, engagement and cooperation between our clinical staff.”