Outpatients: the future – adding value through sustainability

The Outpatients: the future – adding value through sustainability report seeks to re-evaluate the purpose of outpatient care and align those objectives with modern-day living and expectations

Key recommendations

  1. Quality improvement projects should report on value as a whole, recognising the population and system effects of change as well as individual clinical outcomes.
  2. Trusts should be remunerated on the basis of clinical value, not units of physical interaction or activity.
  3. National guidance for the oversight of outpatients as part of local governance structures should be developed and integrated in all trusts alongside mortality and morbidity reviews.
  4. Specialist organisations and charities should work collaboratively to oversee the development of signposting to resources that support outpatient consultations, eg patient decision aids, preventing duplication of efforts locally.
  5. NHS leaders and local government need to provide clear and structured guidance on how to build partnerships with the voluntary and community sectors. This should be created and supported by  case studies.

Summary

The traditional model of outpatient care is no longer fit for purpose, ie specialty opinion, diagnosis and disease monitoring. It places unnecessary financial and time costs on patients, clinicians, the NHS and the public purse. Growing demand and expectations cannot be, and are not being, met by the status quo. It is no longer acceptable to solely consider the cost of clinical interventions in relation to individual health outcomes.

In order to continue to deliver high-quality healthcare, we must start to think in terms of value and sustainability; identifying a balance between cost and outcomes (value) and long-term impacts (sustainability). That 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.

The time has come to re-evaluate the purpose of outpatient care and align those objectives with modern-day living and expectations. This requires trusts to be more flexible, and to allow patients more control over when and how they receive care.

A key element of the redesign process is better utilisation of the technology already available. It is up to national NHS bodies to provide guidance and support to enable this transformation. Action must be taken to ensure providers and clinicians are not penalised for introducing new models of care delivery, with the clinical value added being reflected in both commissioning and job templates. The benefits must be measured in terms of long-term value for patients, the population and the environment, not just short-term financial savings.