FutureNHS Outpatient Transformation Platform

Outpatient Transformation Platform
FutureNHS [registration required]

• “Our long term ambition is to redesign outpatient services so we can avoid up to 30 million face to face appointments every year. We will do this in a number of ways including:
• Embracing technology and offering flexible, timely care via remote consultations.
• Offering earlier interventions and delivering outpatient care closer to home, such as providing First Contact Practitioners in GP surgeries.
• Empowering patients and putting them in control of their follow-up care, monitoring their own condition and choosing when to see a specialist.”
• Includes a collection of Patient Initiated Follow Up (PIFU) resources by specialty

Classifying Outpatient Activity by Function

Classifying Outpatient Activity by Function
The Strategy Unit 14 October 2021

• A new tool to support service reform and enhance analyses of outpatient care. This report details the development of a set of rules that categorise outpatient attendances according to their implied function. The report goes on to examine the types of question that such a system can help address.

Re-examining the model of outpatients and specialist referrals

Re-examining the model of outpatients and specialist referrals
BMJ 29 March 2021

• Nigel Edwards (Nuffield Trust) examines the different models linking primary and secondary care and lessons which can be learnt from the COVPDI-19 pandemic.

Elective care community of practice

Elective Care Community of Practice
FutureNHS platform [registration required] 

• Guidance and tools to support whole system transformation across specialities and interventions.

The evidence base of interventions to improve planned care.

The evidence base of interventions to improve planned care.
NHS Midlands Decision Support Centre (DSC) November 2019

Transforming Outpatients (230pp), November 2019

• A directory of interventions, covering eight main interventions for transforming outpatient appointments, including: One-stop clinics; community-based clinics; alternatives to consultant-led care; virtual consultations; and, virtual follow-up clinics.

Self-Management November 2019

• A directory of interventions exploring the following themes: self-management; and, shared decision-making.

Rethinking Referrals November 2019

• A directory of interventions, and explores the following themes: advice and guidance; triage and clinical review; standard referral pathways and structured templates; and, shared learning opportunities.

Advice and Guidance guides

Advice and Guidance: high impact intervention guides
NHS England 16 September 2020

• A series of short guides are designed to help teams get the most from Advice and Guidance services setting out practical advice, key actions and information. These services provide non-face-to-face support delivered by consultant-led services. The aim is to ensure that patient care is managed in the most appropriate setting, to strengthen shared decision making and avoid unnecessary outpatient activity.
• Includes Guidance for system leaders, guidance for general practice.

Near Me at Home: codesigning the use of video consultations for outpatient appointments in patients’ homes

Near Me at Home: codesigning the use of video consultations for outpatient appointments in patients’ homes
BMJ Open Quality 2020;9:e001035. doi: 10.1136/bmjoq-2020-001035

• This project, based in the largest Island in the Inner Hebrides of Scotland, describes the use of a codesign model to improve the NHS Near Me video consulting platform for delivery of outpatient appointments in the patient’s home.

Third phase of NHS response to COVID-19 and implementation guidance

Third phase of NHS response to COVID-19
NHS England 31 July 2020
Update on the latest Covid national alert level; priorities for the rest of 2020/21; and an outline of financial arrangements heading into Autumn as agreed with Government.

• A: Accelerating the return of non-Covid health services, making full use of the capacity available in the window of opportunity between now and winter
• A1. Restore full operation of all cancer services.
• A2. Recover the maximum elective activity possible between now and winter
• A3. Restore service delivery in primary care and community services.
• A4. Expand and improve mental health services and services for people with learning disability and/or autism
• B: Preparation for winter alongside possible Covid resurgence
• C: Doing the above in a way that takes account of lessons learned during the first Covid peak; locks in beneficial changes; and explicitly tackles fundamental challenges including support for our staff, action on inequalities and prevention.
• C1. Workforce
• C2. Health inequalities and prevention.
• Financial arrangements and system working 
• Financial arrangements for CCGs and trusts set out in Annex Two.

Implementing phase 3 of the NHS response to the COVID-19 pandemic
DHSC 7 August 2020
1. Urgent actions to address inequalities in NHS provision and outcomes

• 8 actions
• Details of Task and finish group on accelerating NHS progress on tackling health inequalities during the next stage of COVID-19 recovery

2 Mental health planning

• Focus – IAPT services, community mental health teams, children & young people, support for NHS staff.

3. Restoration of adult and older people’s community health services

• Supersedes the prioritisation guidance for community health services first published on 20 March 2020 and updated on 2 April 2020,

4. Using patient initiated follow-ups as part of the NHS COVID-19 recovery.

• “Individual services should develop their own guidance, criteria and protocols on when to use PIFUs. PIFU pathways can be used for patients of any age, provided the patient and their clinician agree that it is right for them.” Includes example implementation checklist adapted from work by Somerset CCG and other case studies.

5. 2020/21 Phase 3 planning submission guidance
6. COVID-19 data collections: changes to weekend collections .

Rebuilding the NHS - Resetting outpatient services for the 21st century in the context of COVID-19

Rebuilding the NHS - Resetting outpatient services for the 21st century in the context of COVID-19
RCP, RCGP 6 July 2020

• Principles and recommendations for the reset of outpatient services ie how patients can be best supported by primary and secondary care working collaboratively.
• In summary, we recommend that services should:
• make sure that all relevant organisations, patients and carers are involved in the production and implementation of reset plans
• systematically consider the impact of their reset plans on inequality
• work towards a system in which patient records are available to everyone involved in decision making and provision of care
• design new clinical processes to maximise the benefit of new technology to patients, carers and clinicians
• make sure that everyone involved has access to the education, training and support they need to adapt to and use new systems.

Patient-initiated appointment systems: an alternative for hospital outpatient care?

Patient-initiated appointment systems: an alternative for hospital outpatient care?
PenARC Evidence Synthesis Team 23 April 2020

• Patient-initiated appointment systems (PIAS) enable patients to request a medical appointment when they feel it is needed and could reduce the number of those appointments allowing flexibility in the outpatient health care system. 
• A review of the evidence in 17 RCTs suggest that PIAS may have little or no effect on patient anxiety, depression and quality of life compared to consultant‐led appointment systems. Aspects of disease status, adverse events and patient satisfaction also appear to show little or no difference. There may also be little or no effect on service utilisation in terms of contact with health services but there is uncertainty about the impact on costs. Areas for further research include variations in the benefits and experiences of PIAS due to population characteristics and conditions.

The health commissioner perspective. 14 May 2020

Transforming care through technology – a toolkit for new models of outpatient care

Transforming care through technology – a toolkit for new models of outpatient care
The Shelford Group 9 September 2019

• This toolkit outlines examples of how Shelford Group trusts are using technology and digital innovations to transform outpatient services in the NHS.
• Case studies
• Streamlining booking and delivering virtual care
• Supporting self-management and remote care
• Implementing remote care through telemedicine
• Moving to virtual care models
• Improving efficiency through technology

Outpatients: snapshot of a year

Outpatients: snapshot of a year
John Appleby for Nuffield trust 25 July 2019

• A visualisation of outpatient figures by specialty, provider and health care professional for the year 2017/18 to understand where attendances have come from and how they have been delivered. Including attendance and DNAs, referrals and follow ups, telephone consultations.

Hospital-Acquired Complications Associated With Low-Value Care

Measuring Hospital-Acquired Complications Associated With Low-Value Care
JAMA Intern Med. 25 February 2019. doi:10.1001/jamainternmed.2018.7464

• Analysis of data around incidence of  hospital-acquired complications [HAC] following 7 "low value" procedures (n=9330) (ie those that would not be expected to require admission) in 255 hospitals (Australia) found that the most common HAC was health care–associated infection, which accounted for 83 (26.3%) of all HACs observed.  
• For all 7 low-value procedures, median length of stay for patients with an HAC was 2 times or more the median length of stay for patients without a complication.

Abstract

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report
Getting It Right First Time, 28 November 2018

• The GIRFT review into oral and maxillofacial surgery across England outlines the need to centralise services and build on existing hub and spoke networks and for a standard protocol which will reduce unwarranted variations in the number of hospital follow-up appointments after surgery. In the most straight-forward of cases, eg; dental extractions, the report suggests a target of zero follow-up appointments.

Consultant to Consultant Referrals Good Practice Guide

Consultant to Consultant Referrals Good Practice Guide
NHS England 16 November 2018

• This good practice guide has been developed to support health economies to manage the increasing number of consultant to consultant referrals in elective care. This is achievable with the transformation of outpatient services through effective use of available resources, development of new ways of working and ensuring improvements in patient pathways and patient experience.

Outpatients: the future – adding value through sustainability

Outpatients: the future – adding value through sustainability
Royal College of Physicians 8 November 2018

• This report argues that a new approach to outpatient care is needed if it is to meet growing demand and reduce disruption to patients’ lives. It describes the current ‘one-size-fits-all’ model as no longer fit for purpose and recommends replacing it with a person-centred approach that recognises that people have varying health needs, personal pressures and abilities to self-care or self-manage

Key recommendations

Outpatients app - MyCare

Outpatients app - MyCare
NHS Confederation October 2018

• A new app which enables patients to manage their outpatients appointments has been developed by Milton Keynes University Hospital NHS FT. The app allows patients to change and confirm appointments on a smartphone, tablet or computer, with outpatient letters emailed in real time.

Virtual outpatient clinic as an alternative to an actual clinic visit after surgical discharge

Virtual outpatient clinic as an alternative to an actual clinic visit after surgical discharge: a randomised controlled trial
BMJ Qual Saf 2019;28:24-31, 5 October 2018

• A randomised trial of virtual outpatient clinics (VOPC) compared to outpatient clinic (OPC) attendance for a broad range of general surgical patients following a hospital admission. 
• Follow-up indicated 78 of 82 (95%) VOPC patients were very happy with their overall experience compared with 34/61 (56%) in the actual OPC group. A significant proportion of both cohorts—68/82 (83%) in VOPC group and 41/61 (67%) in OPC group (p = 0.029)—preferred a VOPC appointment as their future follow-up of choice.

Rethinking outpatient services: Learning from an interactive workshop

Rethinking outpatient services: Learning from an interactive workshop
Nuffield Trust 30 August 2018

• This briefing, in collaboration with health leaders across the country, reveals opportunities to improve the design of outpatient services and challenges if some services should be delivered in their current form.
• The event focused on three areas: how patients are referred to outpatient services, what happens when they are there, and follow-up care.
• The following overarching principles emerged:
• Outpatient redesign works best when it is focused and led by the clinicians who are delivering it. 
• Use data to reinforce new ways of working.
• Renegotiate the tariff locally. 
• Design the service based on a thorough understanding of the tasks that need to be done.

The Potential Economic Impact of Virtual Outpatient Appointments

The Potential Economic Impact of Virtual Outpatient Appointments in the West Midlands: A scoping study
The Strategy Unit, 13 August 2018

• Analysis of the potential impact of a substantial shift towards virtual appointments in place of traditional face-to-face outpatient services for acute hospital services.