Working together to improve outpatient services

NHS Shropshire, Telford and Wrekin is working with people, carers, health professionals and local service providers to improve outpatient services.

Outpatients are when someone has an appointment in a hospital or clinic but does not need to stay overnight.

COVID-19 had a significant impact on the amount of planned care the NHS across the country has been able to provide. It is estimated that over ten million people in England did not come forward for treatment when they might have needed it. This has led to more people on our waiting lists resulting in increased waiting times for appointments.

Andy Elves, Clinical Lead for the Outpatients Programme, said: “To address these challenges and ensure our services are set-up for the future, we are looking at developing closer working between services, making better use of new ways of accessing and delivering care, and more joined up pathways for patients.

“This will ensure our local population receive the best possible care, at the right time, from the right person, in the right place.

“We want to improve the experience of patients, carers and families, GPs, and staff working in outpatient services by looking at the way people access care, how they manage their condition, and how services work together and share information.”

To do this well we must listen to our communities, so we have looked at what patients, and their carers, have already told us through our Patient Liaison and Advice Service and community engagement, as well as through our partners like Healthwatch. We have also started having conversations with people who work in and access our outpatient services to find out what works well now and what we could improve.

This is just the start of seeking out and listening to people’s experiences and views, but it has already given us some early insight to help shape the programme, for example, we have heard:

• where the use of electronic patient notes and early diagnostic testing is already in place, it is often working well

• GP access to advice and guidance from consultants in secondary care is inconsistent across services
• good communication about referrals, waiting times and appointments, between providers and with patients and their carers, is really important, and this could be improved
• health professionals need more support and guidance to make the best use of current opportunities, such as virtual consultations and enabling some patients to be able to book their own appointments, when it is right option for them and their individual condition
• people’s experience of accessing services is different depending on the outpatient service or where they live in Shropshire, Telford and Wrekin
• ‘one-stop clinics’ are valued by both health professionals and patients.

We will be providing more opportunities for members of the public and health professionals to get involved in shaping this work. We will soon be launching a public survey where we will be asking people to tell us about their experiences and views of the opportunities we are looking to build on, including:

• video and telephone appointments, where it is right for the person. This would help to make appointments more convenient for some patients, allowing them to see or speak to a health professional from anywhere, reduce unnecessary trips to hospital and the time and cost of travelling.
• enabling and empowering patients to book their own follow-up appointment (also known as patient-initiated follow-ups), when they need it and when it is appropriate, with the agreement of their health professional. This would give patients shared decision making with their health professional, greater control over their appointments, easier access to information about their appointment, and ensure the time between their appointments is based on their individual need, symptoms and circumstances.
• advice and guidance for GPs. This would ensure that GPs have more direct access to advice and guidance from specialist consultants enabling them to discuss the right care for a patient to avoid the need for an onward referral where possible
• diagnostic tests for some patients ahead of their outpatient appointment. For example, providing diagnostics in the community where possible, or using ‘one-stop clinics’, to ensure as much information as possible is available in advance of an outpatient appointment. This would provide consultants with additional information to help speed up diagnosis.

As we develop this programme, we will keep asking for feedback to review the impact on staff, patients and carers, and provide regular updates.

If you know or are part of a group who would like to be involved by sharing experiences and views about outpatient services, please get in touch with us by emailing stw.communications@nhs.net