‘One size fits all’ outpatient care no longer fit for purpose says RCP

A new approach to outpatient care is needed if it is to meet growing demand and reduce disruption to patients’ lives, according to a new report from the Royal College of Physicians.

Outpatients: The future - Adding value through sustainability 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 report also 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 technology already available.

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.

Professor Stephen Powis, NHS England medical director

NHS England medical director Professor Stephen Powis backed the RCP’s recommendations in a foreword for Outpatients: The future - Adding value through sustainability, acknowledging that 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. He says:

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.

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.

Dr Toby Hillman, clinical lead, RCP Sustainability Programme

For co-author Dr Toby Hillman, clinical lead for the RCP Sustainability Programme and a consultant respiratory physician, what began as an exploration of hot-spots of resource use and waste in the NHS ended up as a re-examination of the whole concept of outpatient care: 

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.

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