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'Grasping the nettle': how we can transform outpatient care

Following the publication of Outpatients: the future – adding value through sustainability, Professor Stephen Powis argues that the traditional model of outpatient care is no longer fit for purpose.

From its inception 70 years ago, the NHS has had to evolve and innovate to meet the changing needs of the patients it serves. 

As clinicians, we have all witnessed that change over the course of our careers – whether it’s the nature of the conditions with which our patients present, the increasing complexity and number of comorbidities we deal with, or the technology and knowledge available to us and to our patients. It’s therefore crucial we are prepared to make changes in the way we interact with patients to ensure we are always providing optimally effective and efficient care.

The vast majority of patient interactions with secondary care are through outpatient clinics.

While we know that patient satisfaction with clinicians remains high, it is also true that the various parts of the outpatient journey don’t always deliver the best experience – the too-often uninformative appointment letters; the wait for the appointment; the journey, often at inconvenient times, which can be a major source of stress for older patients; the waiting around in clinic; and, in some cases, the repetition of the entire process when the referral was misplaced or a visit to another specialty is required.

It’s hard to imagine there is no room for improvement.

[Outpatients: the future – adding value through sustainability] states that the traditional model of outpatient care is no longer fit for purpose.

Professor Stephen Powis, national medical director of NHS England

It might sometimes appear to patients that the outpatient visit has been designed in clinicians’ interests rather than their own. But as the Outpatients: the future – adding value through sustainability report sets out, clinicians are often just as frustrated with antiquated processes in their own clinics. And yet that is the kind of system that many of us find ourselves working in for much of our careers – sometimes for no better reason than ‘that’s how it’s always been done’.

The report states that the traditional model of outpatient care is no longer fit for purpose.

It’s the correct diagnosis, and the principles and recommendations suggested are the right prescription. But they mean nothing unless all of us, as a healthcare system, commit to embarking on and seeing through the course of treatment. While potentially painful, uncomfortable or disruptive, addressing this challenge is absolutely vital.

As we embark on a long-term plan for the NHS, setting out our ambitions for the next 10 years and our plans for tangible progress over the 5 years of the recently announced financial settlement, our patients and colleagues will not thank us if we collectively fail to bring outpatient care into the 21st century.

The time has come to grasp this nettle.

Doing so will mean honest conversations within our local health communities – with patients, with colleagues in primary care and community services, and with professionals across different specialties and providers – to ensure that reforms are in the interests of all concerned and sustainable in the long term.

This report provides an excellent basis on which to base those conversations, and on which to build the consensus for change.

Professor Stephen Powis is the national medical director of NHS England and Professor of Renal Medicine at University College London.