The state of outpatients today
The elective waiting list in England has more than tripled since 2010, currently sitting at 7.5 million, with more than 3 million people having already waited longer than 18 weeks. It’s no surprise that public satisfaction with the NHS is at a record low.
Rising demand has been driven by population growth, ageing and increasingly complex health needs, and was significantly exacerbated by the pandemic.
NHS Confederation analysis recently found that the NHS will need to find a way to do 50% more activity by 2028/29 to meet the 18-week treatment target. While the additional two million extra appointments delivered by the new government goes some way to achieving this (about 15%), there’s still a huge uphill challenge ahead.
We believe that the way care is delivered must change if we are to have a chance of getting on top of the backlog, and reforming outpatients is a major lever that can be pulled.
Why? Because the way outpatient care is delivered hasn’t really changed since the NHS was formed, meaning the opportunity for transformation is huge.
- Patients are still referred by primary care, with many left waiting for months before being seen.
- After an appointment, procedure or test, patients may be put on a follow-up list, with appointments scheduled at a set frequency regardless of whether or not the appointment is needed.
- Many appointments require a trip to the hospital, even when a simple, virtual check-in could have been enough, leading to lost work days, long journeys, and disruption to daily life.
- If patients need help in between appointments, it’s often a struggle: endless phone calls, voicemail boxes and email inboxes that aren’t monitored, and no easy way to ask a simple question.
The result of these inefficiencies is a system at breaking point; there simply isn’t enough capacity to meet demand. Long waiting lists mean operational targets are missed. Additional clinics might be put on, but come at an extra cost. Patients who can’t access timely care turn to other parts of the system, often inappropriately, leading to overwhelm in primary, urgent and emergency care services.
Administrative staff and clinicians are simply adhering to the model we’ve always had and are doing their best to make it work, but we will never get on top of the backlog unless we find ways to work smarter, not harder. We need to radically rethink how outpatient care is delivered, now.
What’s the answer?
Based on our extensive work in primary care (where 98% of practices use Accurx) and growing work with partner NHS trusts, we believe the answer lies in replacing the traditional outpatient appointment model with a ‘total triage’ approach. A 20 minute appointment will always take 20 minutes of a clinician’s time, so to achieve the productivity gains that are required to get on top of the backlog, we need to find more efficient ways to deliver care.
There is a precedent for this in primary care. Prompted by the pandemic, many GP practices have completely transformed their model of care and now channel all patient inbound (whether on the phone, walk-in or online) into a single inbox for triage.
Practices who have implemented this model effectively have found that up to 40% of patient requests can be handled asynchronously (e.g. using two-way messaging rather than through face-to-face or telephone appointments), significantly improving the practice team’s capacity to handle demand and freeing up staff time to see the patients who most need in-person care.
We believe this model is entirely applicable to outpatients, where it is often difficult for patients to get in touch with services when they need to, yet there are many planned appointments that are not needed, and many appointments that could be replaced with a more efficient asynchronous interaction.
With this in mind, we have created the Clean Clinic Model for outpatients, which follows three core principles. By aligning to these principles, trusts can deliver the transformation needed to build a modern outpatient model that works for patients, staff and the system:
1. Empower patients to request care only when they need it
2. Triage requests and only allocate appointments that are needed
3. Convert appointments to asynchronous communication wherever possible
For more detail on how the Clean Clinic Model works in practice, read our next article here.
If you’d like to get in touch with our team to discuss implementing the Clean Clinic Model at your trust, email partnerships@accurx.com.