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One-size-fits-all outpatient care no longer fit for purpose says royal college

A new approach to outpatient care is needed if the NHS is to meet growing demand and reduce disruption to patients’ lives, claims a report.

The RCP report, called Outpatients: The future – Adding value through sustainabilityargues that the current approach has high ‘costs’ for patients and the nation’s public health.

Not only are patients frustrated by poor communication and long waiting times, they have to spend time and money on things like childcare and travel when attending appointments, it says.

Transport to and from outpatient clinics has an impact on the environment and in turn on public health. Some 5% of UK traffic each day is NHS-related.

The report 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 manage.

It calls for patients to be at the centre of a redesign process that better utilises the available technology.

Outpatient appointments account for 85% of all hospital-based activity, excluding A&E, and demand for appointments is rising.

In England, outpatient appointments have doubled over the last decade to 118 million per year. However, one in five potential appointments in England is cancelled or reported as ‘did not attend’ – and the majority of cancellations are instigated by the hospital.

According to a survey of doctors carried out by the RCP, 57% of outpatient clinics finish late at least once a week, some every time. A quarter of doctors responding to the survey said that 10-20% of their new patients didn’t need to come to outpatients at all.

Current barriers to innovative practice – including healthcare providers being forced to strike a balance between financial remuneration and achieving targets, and delivering a service that meets the needs of patients – need to be removed.

The report recommends the adoption of new models of outpatient care, some using technology, and highlights examples from around England and Wales with data that demonstrate environmental, financial and social benefits as well as improved patient outcomes.

Professor Stephen Powis, NHS England medical director, agreed with the report’s findings that outpatient visits have been designed in clinicians’ interests rather than the patient’s.

He said: “The outpatient system is older than the NHS and the time has come to grasp the nettle and use tech and other innovations to improve patients’ experience and care.

“As part of the long term plan for the NHS, it’s right we look at ways to cut unnecessary appointments, save thousands of journeys, reduce traffic and pollution and make the NHS more efficient.”

Co-author of the report, Dr Toby Hillman, Clinical Lead for the RCP Sustainability Programme and a consultant respiratory physician, said: “We must recognise the public as individuals with varying health needs, personal pressures and ability to manage their own treatment, and give them more control over when and how they receive care.

“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.”

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