Table 1.

Outpatient services transformation programme work streams (2017–2021)

Work streamsContentsSpecialties involvedBenefits
Referral streaming, and advice and guidanceMonitoring all referrals into outpatient clinics to ensure they are streamed to the most appropriate clinic. Advice given to referrers on management and care plan.All specialties20% of referrals were returned to the referrer with clinical advice given to manage the patient's condition. This freed up capacity in the clinic to see patients with reduced waiting times.
PIFUPatients initiate their own follow-up appointments when clinically indicated with capacity freed up from reduction in regular follow-ups.Rheumatology
Pain management (including long COVID)
Haematology (lymphoma)
Breast cancer
With 5% PIFU, it is expected to save up to 15,000 clinic appointments and freeing up capacity in clinic to see patients with reduced waiting times.
Virtual consultationsIncreased provision of telephone and video clinics and reviews.All specialties30% of clinic appointments conducted virtually reduced congestion, footfall and overheads in clinics and improved parking on site.
Care closer to homeMoving care closer to people's homes through engagement with specialties supported by analysis of post-code data. Provide more clinical services out of the hospital so patients receive care closer to home.All specialties
ENT hub
20% of clinic appointments conducted closer to patients' homes, increasing convenience and reducing congestion on the acute site. Space freed up in the acute site to house the acute ambulatory unit.
Remote monitoringIT systems to monitor test results and alert clinicians of any abnormalities that may trigger an early review.Haematology
Reduced frequency and need to attend clinics in person by 50% while maintaining safety for patients on long-term immunosuppressive medications. Six-fold reduction in DNAs for blood test monitoring.
Improving operational deliveryEstablishing a central outpatients function that has a strategic overview of outpatient delivery. This includes a consistent, online way to book clinic rooms, measure room utilisation, reduce DNAs and standardise core processes.All specialtiesImproved skill mix to operate outpatients, increase efficiency and room utilisation on all sites. Reduced DNAs and improved patient experience.
  • DNA = did not attend; ENT = ear, nose and throat; IT = information technology; PIFU = patient-initiated follow-up.