Outpatient care: a model for the future

Across the NHS, millions of patients are waiting for outpatient care. The experience can be passive: waiting for letters and appointments in a system that is yet to seize the opportunity to enable patients to actively participate in their care

Remodelling the outpatient experience – time to modernise.

Outpatient care – a cornerstone of NHS activity – continues to operate within a model conceived before widespread adoption of the internet. The appointment-first structure was built for a time when the only way to access care was physically to be in front of a clinician.  This way of working has remained largely untouched for several decades.

Countless more modern services have been designed on top of this structure, but it appears that the foundation on which they operate remains outdated. Building an innovative digital infrastructure solution is essential but we should also consider how to address the design flaw inherent in the appointment-first approach.

General practice and the art of the possible

General practice has adapted to rising demand (1), with many practices rethinking how access is managed by moving to a “total triage” model.

With total triage, patients request care online or by phone. Each request is then triaged before the most relevant type of appointment is booked. Many requests are resolved with asynchronous communications – patients receiving text messages or accessing secure messaging platforms, without needing to make an appointment.

Total triage has brought not only convenience, but also measurable impact. In primary care up to 40% of patient requests are now resolved without an appointment (2), freeing up capacity to support those patients who are in most need of face-to-face care. Adopting this way of working can help clinics run more smoothly. Patients who need an appointment can be seen sooner and their confidence in the health and care system is bolstered. With total tirage patients increasingly trust that they can ask for help when they need it and that they will be heard. Simultaneously, clinicians trust that they aren’t booking non-essential appointments.

It’s possible for outpatient care to replicate what general practice has achieved

Undoubtedly, primary care and secondary care operate in different ways, with different purposes – an exact solution from one cannot be cut and paste onto the other. However, Accurx have worked with early-adopting NHS trusts to apply the principles underpinning the triage-first approach, evidencing that they are transferable to outpatient care.

Patients may not always need an appointment – some issues can be resolved in minutes. A safe and reliable system for patients to contact their care team is needed in order to  triage requests and identify the appropriate course of action.

Primary care has demonstrated the opportunity for adapting models of care and introducing alternatives to the in-person appointment model. With more avenues now available for managing patient requests, clinicians no longer need to be constrained by an inflexible set-up

Clinicians want to be able to access more methods for delivering effective care. Shifting the model that until now has dominated outpatient care has potential to decrease appointment wait lists and in doing so mitigate some of the risks of patients’ conditions deteriorating

Towards modern outpatient care

Accurx are working to adapt and translate the triage-first model from general practice for outpatient teams. The company calls this Clean Clinic Model, which built on three core principles:

1. Enabling the most direct course of action. For example, on receipt of an enquiry from a patient, referring the patient straight to a test and then following up as needed, without a precursor appointment.
2. Converting appointments to messaging, where appropriate. Some face-to-face and telephone appointments can be resolved asynchronously, using two-way messaging or patient questionnaires.
3. Streamlining the appointments that are needed. When appointments are required, make the most of the time by empowering staff with tools designed to aid their productivity.

At its heart, a revised outpatient model is far less about plugging in a new platform and much more about rethinking the purpose of each clinical interaction and matching the system response to the patient need. That’s what modern outpatient care can be.

Bold leadership will drive change

In general practice, the shifts towards the model of patient triage and appointments were often bottom-up and staff driven. In secondary care, given organisational size and operational complexity, something different is needed: co-production, enabled by leadership committed to new ways of working and resourcing in support of change management.

1. Much recent high-level policy discussion is focused on elective recovery and waitlists, however this conversation should also address the core mechanics of how patients access care. Using technology to give patients a meaningful way to interact with their care team is a prime example of putting the principle of patient engagement into practice.