Unlike recent years, for 2024/25 NHS England has not asked trusts to increase elective activity. Instead, it has asked trusts to focus on improving the productivity of elective services.
There are many ways services can approach productivity improvements. From well-trodden initiatives to reduce Did Not Attends (DNAs) or On the Day Cancellations (OTDCs) and backfill empty slots, to more recent pushes to cut unnecessary appointments through waiting list validation, direct-to-diagnostic pathways and patient-initiated follow-up (PIFU), to name but a few.
Inefficient communication hinders progress
For many colleagues in the NHS, identifying opportunities to improve service productivity is the easy part. Successfully implementing the required change is much harder.
From spending time with colleagues on the frontline, we see that one of the biggest barriers to staff successfully implementing these initiatives is the inability to quickly and efficiently communicate with their patients, their colleagues and other care settings.
It's a simple need, with a simple solution. The 164,000 NHS staff that use Accurx every week have told us loud and clear that having one communications system, that actually works, is transformative for productivity.
What’s possible when everyone can communicate
98% of GP practices use Accurx to communicate with or about their patients. Over the last five years, our platform has enabled practices to deliver more care asynchronously by assessing and resolving patients’ needs outside of traditional appointments.
In our annual user survey, 83% of the over 2,000 respondents agreed or strongly agreed that Accurx significantly increases the number of patients their practice can manage each day.
Practices tell us they can now resolve up to 40% of patient requests without the need for a traditional synchronous appointment and these ‘online consultations’ often take less time than a typical appointment. This activity is recognised and recorded as appointments, so we can see the productivity gains evidenced in NHS statistical publications. The percentage growth in monthly GP appointments since 2019 has been double that of the GP workforce.
Harnessing digital questionnaires to deliver productivity gains
A powerful and popular feature in Accurx that enables NHS staff in any care setting to be more productive is digital patient questionnaires. By quickly and easily collecting structured data from patients, services can progress patient care asynchronously, review patients remotely and make better use of appointment capacity.
With waiting lists continuing to grow, we believe more elective services could and should be harnessing digital questionnaires to deliver productivity gains. Here are five of my favourite ways you can use digital patient questionnaires in your service:
1. Validation of waiting lists for first and follow-up appointments
With long waiting lists and follow-up backlogs, one of the simplest, yet most impactful ways to use digital patient questionnaires is to validate your waiting lists. Asking patients whether they still require an appointment and, if not, why not, ensures appointment capacity is focused on the patients that need it.
University Hospitals of Leicester (UHL) now uses Accurx to validate its waiting lists every nine weeks. Since initiating this work less than 18 months ago, more than 22,000 patients have been removed from their waiting list. This contributed to a 15% reduction of their waiting list overall - bucking the upward national trend.
2. Direct to diagnostics pathways
Identifying patients that could or should be triaged straight to diagnostics before a first appointment can significantly reduce first:follow-up appointment ratios. Digital patient questionnaires can capture data on both clinical suitability and patient preference for direct to diagnostics pathways.
The Upper GI Cancer team at a large east London trust has used an Accurx questionnaire to improve the efficiency of its two week wait pathway. The digital questionnaire finds out more information about the patient’s symptoms, enables the team to prioritise initial investigations and prevents unnecessary scans and outpatient appointments. They’ve found that patients who complete the questionnaire are almost 10% less likely to require further investigations and 30% more likely to be discharged than those who did not complete it at the first MDT review.
3. Screening patients waiting for surgery
Screening patients early in the surgical pathway to identify long-term conditions or risk factors for poor health outcomes can help to optimise perioperative resources. For patients requiring health optimisation, this allows it to begin as soon as possible and reduces the likelihood of an OTDC due to the patient being clinically unfit for surgery. For low complexity patients, their pathways can be streamlined, for example, by routing to high volume low complexity hubs or listing as available at short notice.
We’ve worked with Guy’s and St Thomas’ to develop a digital perioperative complexity tool that combines a digital patient questionnaire with the ability to view a summary of patients’ GP records through Accurx. In a three month pilot, the tool demonstrated the ability to create significant efficiency gains. On average it took 3.8 days between patients being sent the digital questionnaire to the point the Clinical Nurse Specialist had validated their complexity. This compares to 3-4 weeks under the current pathway. The time saved can be redirected to supporting health optimisation. Moreover, 45% of patients were assessed to be low complexity and therefore suitable for fast tracking.
4. Pre-procedure checks
OTDCs (including DNAs) negatively impact theatre utilisation rates and productivity. Using a digital questionnaire to carry out a pre-procedure check can remind patients of their upcoming procedure, prompt them to stop any medications (if required) and check for any changes to their health since the pre-assessment. With this information, a service has the opportunity to respond to any potential issues before the patient arrives for their procedure, thereby reducing the risk of theatre slots going unused.
15% of OTDCs for the General Surgery Service at UHL were due to patients being unfit for their procedure due to changes to their medical status since their pre-op assessment. To address this, we worked with the service to develop a pre-procedure questionnaire to send to patients a week before their surgery. It confirms attendance and asks about any health changes since their pre-op assessment. This allows for procedures to be rescheduled if necessary and has contributed to an increase in theatre utilisation from 68% to 76%.
5. Eliminating low value follow-ups
Whether it be follow-up from a procedure, long-term monitoring of cancer patients or implementing patient-initiated follow-up pathways, digital questionnaires can help ensure clinical capacity is prioritised for patients that require it.
The Haematology Service at UHL has reduced the number of follow-up appointments needed by a third. They have replaced routine three monthly telephone follow-ups of their Chronic Myeloid Leukaemia patients with a digital questionnaire. The patient reported outcomes captured in the questionnaire are reviewed alongside a blood test and together inform whether a follow-up appointment is necessary.
We’re here to support your service
Need support implementing key changes to improve your service’s productivity? Or, want to understand more about how Accurx can support your trust? Sign up today for a free, tailored trial here.