Technology Could Modernise England's 'Outdated' Outpatient System

Nicky Broyd

November 09, 2018

A new Royal College of Physicians (RCP) report says the traditional model of outpatient care is no longer fit for purpose and a new approach is needed.

'Outpatients: The future - Adding value through sustainability ' recommends looking beyond just the financial cost to the NHS of outpatient appointments and instead taking into consideration the cost to patients of travel, lost time at work or school, and things like childcare along with the impact of transport and pollution on public health. 

Co-author of the report Dr Toby Hillman, clinical lead for the RCP Sustainability Programme and a consultant respiratory physician, said in a press statement: "Having re-evaluated the purpose of outpatient care and aligned its objectives with modern-day living and expectations, we must ensure that the benefits are measured in terms of long-term value for patients, the population and the environment, not just short-term financial savings."

Traditional Model

According to the report the current 'one-size-fits-all' model for outpatient care, consisting of specialty opinion, diagnosis and disease monitoring, with a heavy reliance on traditional face-to-face consultations, is no longer fit for purpose. 

It says it places unnecessary financial and time costs on patients, clinicians, the NHS, and the public purse.

In his foreword to the RCP report, NHS England medical director, Professor Stephen Powis, said it’s time to ‘grasp the nettle’ to help reduce some of the 118 million outpatient appointments every year – many of which aren't necessary. 

The report says 25% of doctors in a recent survey said 10–20% of their new patients didn’t need to attend an outpatient clinic, and 28% of doctors said 10–20% of their follow-up patients could have been seen using an alternative to face-to-face consultation.

The NHS believes ending unnecessary appointments will free up clinical specialists to spend more time with complex patients where they can make the biggest difference.
 

Report Recommendations

The report calls for a person-centred approach which recognises people's varying health needs, and their abilities to self-care. It says there should be a clear health benefit when asking people to take time off work and school to travel to appointments.

In an NHS media statement Prof Powis said: "For many people, care can be delivered more timely and conveniently closer to home, by specialists at the GP surgery or by using technology in new and exciting ways. 

"This report shows a snapshot of exciting new models already working successfully through apps, Skype, text messaging and remote monitoring systems that are changing the shape of care; we need to bottle and spread those examples building a new consensus for the future based on the views of clinicians and patients."

Health Secretary Matt Hancock took to Twitter to endorse the findings, saying: "This is exactly where the NHS needs to go - using technology to improve patients’ and clinicians’ lives. Love it."

The RCP report says an updated outpatient system will also require a change to the way hospital care is funded. Currently hospitals are paid per patient seen but in future it says this should be based be on clinical value, not units of physical interaction.

Pollution

The report says as well as improving convenience for patients, alternative consultation methods could have an impact on health by reducing NHS-related travel. 

It says on any one day NHS-related traffic in England accounts for 5% of vehicles on the road, reducing air quality, contributing to busy roads and traffic accidents and so affecting health.

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