The current appointment-based outpatient model is at a breaking point, with elective care waiting lists having tripled since 2010, currently sitting at 7.5 million. We need a fundamental shift in how outpatient services deliver care to get on top of the backlog. Without this, there is little chance of achieving the target for 92% of patients to wait no longer than 18 weeks from referral to treatment by March 2029.
Rethinking the current outpatient model
In our previous blog, 'Outpatients: the case for change', we introduced The Clean Clinic Model for outpatients, covering three core principles:
- Empower patients to request care only when they need it
- Triage requests and only allocate appointments that are needed
- Convert appointments to asynchronous communication wherever possible
This model represents a radical change from the current outpatient model: follow-up appointments are no longer allocated by default, patients can easily get in touch with their service when they need support, and where possible, care is delivered asynchronously, i.e. via two-way messaging, rather than through face-to-face or telephone appointments.
Based on our work with partner NHS trusts, we are confident that adopting The Clean Clinic Model, enabled by Accurx technology, will release up to 20% outpatient capacity by moving away from an appointment-first model. In this blog, we practically explain how the model can be delivered.
How trusts can deliver the Clean Clinic Model
Empower patients
To deliver scalable results quickly, let’s begin by focusing on the principle to empower all patients to request care only when they need it. With this principle, we ensure that patients have a reliable way of contacting the service when they need support, and start to shift healthcare from ‘high barriers to access, everyone needs an appointment’ to ‘low barriers to access, everyone needs to be triaged’.
How is it done? Every follow-up patient is given a digital link to a web form through which they can request support as needed without any app requirements. The form can be customised with service-specific questions, and the link can be distributed via multiple channels, including text messages, appointment reminders, clinic letters, the trust website, and the patient portal.
A simple example of how this can release capacity is that patients with an upcoming appointment can easily cancel it if they don’t feel they need it, knowing that they will be able to access support if their situation changes.
Empowering patients in action: The Thoracic Medicine team at a large acute trust previously scheduled follow-up appointments for all patients by default. Recognising that some of these appointments may no longer be needed, they empowered patients to let the service know if they preferred to cancel the appointment, and to use the patient triage link should they need support in the coming months. In the first month of implementation, this approach released 22% of scheduled appointments, freeing up capacity for patients who needed care the most.
Triage requests
This takes us onto the next step of moving away from the appointment first model, and our second principle to triage requests and only allocate appointments that are clinically needed.
How is it done? All team members will have access to a collaborative Accurx team inbox, where incoming patient requests are automatically organised into medical and administrative folders. This ensures that the right staff are notified promptly of requests, allowing them to review and triage requests efficiently. Based on the information provided, healthcare professionals can determine the most appropriate next steps, whether that’s offering reassurance, providing advice, adjusting medication, or scheduling an appointment (only when necessary).
Triage in action: A large acute trust IBD team previously relied on a telephone nurse helpline, which was limited to 30 patient calls per day. This meant that many patients struggled to get through when experiencing a flare-up, often leading them to seek help in A&E. Now, IBD patients have access to a digital patient triage link, allowing them to submit requests via a structured online form. Staff can review, triage, and respond digitally through their shared Accurx inbox, often resolving issues without the need for a phone call or appointment. Since implementing this system, the team has seen a 50% increase in monthly patient interactions managed (600 to 900), and have estimated avoiding up to 180 A&E attendances per month.
Once healthcare teams are confident that patients will request support when needed, and they have the processes in place to manage incoming demand, they can also begin to rely more heavily on Patient-Initiated Follow-Up (PIFU), eliminating follow-up appointments for suitable pathways that can be driven safely by patient demand instead.
Convert appointments
Now that appointments are no longer the default and services are operating in a triage-first manner, the final step to releasing remaining capacity is to streamline activity where reviews do need to take place, and to convert remaining appointments to asynchronous communication wherever possible. In many cases, in person review is not required, and digital assessment forms and relevant investigation results can be used to guide decisions without the patient present.
How is it done? Staff can send structured digital assessment forms to patients via text, and book them in for required investigations. Where responses and/or investigation results are satisfactory and the patient is stable, then decisions and next steps can be communicated via simple messaging, eliminating the need for an appointment.
Converting appointments in action: One acute trust’s spinal team previously booked patients in for follow-up appointments 8 weeks post nerve root block procedures. Now, instead of a routine appointment, patients receive a digital form asking them to indicate if their pain has improved. This allows their care team to assess next steps without the need for an appointment. This approach has resulted in ~55% of post-injection telephone follow-ups being avoided, freeing up clinical time while ensuring patients receive appropriate care based on their needs.
The above examples show how implementing the Clean Clinic Model principles can increase productivity and improve patient access and experience. If the model can be scaled across all outpatient services, we have a chance of getting on top of the backlog and meeting the rising demand.
Get in touch
If you want to discuss more about how the Clean Clinic Model can be implemented in your Trust, email partnerships@accurx.com to speak to a member of the team.