One size fits all outpatient care is ‘unfit for purpose’

The ‘one size fits all,’ approach to outpatient care is no longer fit for purpose.

This is the message from the Royal College of Physicians. In a new report Outpatients: The future – Adding value through sustainability, published today, NHS England medical director, Professor Stephen Powis, says it’s time to ‘grasp the nettle’ to help reduce some of the 118 million outpatient appointments every year – many of which are unnecessary.

The report argues that the cost to patients and public health of the current approach must be considered alongside the financial cost to the NHS. 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.

The RCP in its report, says the ‘one size fits all’ model should be replaced 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 technology already available, and says patient centred care means there should be a clear health benefit when asking people to travel to appointments, taking time off work and school.

In the foreword, Professor Powis who backs the RCP’s recommendations, says it might sometimes appear to patients that the outpatient visit has been designed in clinicians’ interests rather than their own, whereas clinicians are often just as frustrated with antiquated processes in their own clinics.

“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 Dr Toby Hillman, clinical lead for the RCP Sustainability Programme and a consultant respiratory physician, said: “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.”

In calling on the NHS to enlist the power of technology and innovation, Professor 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.”

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