Using case studies and feedback from physicians, the RCP has responded to the Senedd Public Accounts Committee inquiry into the management of follow up outpatients across Wales.
The RCP recognises that the management of follow up outpatients in Wales poses a major clinical risk and we welcome the Wales Audit Office report and its recommendations. We agree that reform of the outpatient system is needed – while those with genuine problems need to be seen, many follow up appointments are unnecessary and take up clinical time which could be spent helping other patients. The system is also affected by widespread vacancies, rota gaps and a shortage of clinical staff. Technology could be used more widely and much more effectively, but its development has been slow.
The recent RCP report - Outpatients: the future – adding value through sustainability - found that the traditional model of outpatient care is no longer fit for purpose. It places unnecessary financial and time costs on patients, clinicians, the NHS and the public purse. Its findings align with those of the Wales Audit Office (WAO) in their 2018 report, Management of follow up outpatients across Wales.
We know that the traditional one-model-fits-all approach to outpatient care is not able to keep up with growing demand and fails to minimise disruption to patient lives. Clinicians are increasingly frustrated with, and fatigued by, growing pressures from waiting lists and overbooked clinics. Patients are frustrated by poor communication and long waiting times.
Health boards need to think differently about how they provide healthcare – for example, identifying the balance between cost and outcomes (value) and the long-term impact of the way they work (sustainability). This means taking into account all the costs related to an intervention, including loss of income to a patient attending an appointment and the impact of transport on public health.
The time has come to re-evaluate the purpose of outpatient care and align those objectives with modern-day living and expectations. This will require health boards to be more flexible, and allow patients more control over when and how they receive care. A key element of the redesign process is better use of the technology already available. It is up to the Welsh government to provide clear guidance and support to enable this transformation.