Outpatient services transformation programme work streams (2017–2021)
| Work streams | Contents | Specialties involved | Benefits |
|---|---|---|---|
| Referral streaming, and advice and guidance | Monitoring 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 specialties | 20% 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. |
| PIFU | Patients initiate their own follow-up appointments when clinically indicated with capacity freed up from reduction in regular follow-ups. | Rheumatology Dermatology ENT Audiology Urology Paediatrics Gastroenterology Pain management (including long COVID) Orthopaedics Respiratory 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 consultations | Increased provision of telephone and video clinics and reviews. | All specialties | 30% of clinic appointments conducted virtually reduced congestion, footfall and overheads in clinics and improved parking on site. |
| Care closer to home | Moving 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 monitoring | IT systems to monitor test results and alert clinicians of any abnormalities that may trigger an early review. | Haematology Renal Anti-coagulation Gastroenterology Rheumatology Respiratory Neurology | 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 delivery | Establishing 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 specialties | Improved 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.