The Modern Outpatient: A Collaborative Approach 2017-2020

10. Engagement

10.1 The Programme will drive a major cultural and operational shift in the understanding of what an 'outpatient' actually is across the health and social care landscape in Scotland. Accordingly, the engagement and consultation process must ensure that all relevant stakeholders have an opportunity to contribute to and shape the approach.

10.2 The document will be widely communicated to and discussed with stakeholders between December 2016 and February 2017. To allow sufficient time for broader stakeholder engagement and refinement to the Programme, a range of methods for engagement, consultation and collaborative input will be used prior to a formal launch in April 2017.

10.3 The engagement process will be used to:

• Test the assumption that change is necessary, develop solutions that are collaborative and ensure that outcomes will be beneficial.
• Ensure that the principles of patient safety and clinical decision-making fit with the model.
• Understand implications and interfaces with other national programmes of work, with particular regard to sequencing and timeframes for delivery.
• Identify any emerging concerns which need to be addressed in the short term.
• Identify any major risks or issues which may impact on the Programme in the mid to long term.

10.4 Engaging the wider network of stakeholders, as part of an iterative process, will be required to ensure a reflective, critical and collaborative approach to the design, implementation, and measurement of the Programme.

10.5 Key stakeholders will include:

• Patients, carers and service users
• Primary Care clinicians
• Chief Executives
• Joint Integrated Boards
• Medical directors and lead clinicians
• Nurse directors
• BMA
• Royal Colleges eHealth and other technological innovators
• Scottish Health Council (to assist with patient engagement)
• The Alliance (to ensure Third Sector engagement).

10.6 There has been significant clinical engagement in all of the Programmes and projects that are given as examples in this document. Clinical colleagues have been and will continue to be the key to driving change forward locally. This engagement and enthusiasm will continue to be built upon. The following are comments from clinicians:

'With ever increasing demand and financial stress, traditional ways of doing things must be challenged. Technology enabled care and the use of Allied Health Professionals are pivotal to this change of mind-set. The historical referral patterns need to be challenged with care closer to home. Only those patients who need to be seen in the hospital setting should be seen there.'

Mr Edward Dunstan, Director Of Surgery, NHS Fife and Chair: Scottish Committee for Orthopaedics and Trauma

'The National Ophthalmology Workstream has been a massive step forward for Scottish Ophthalmology. The focus on review (as well as new) patients marks a sea change in thinking that is directly benefiting ophthalmic patients.

'The national peer review visits have generated a new focus on eye departments and shone a light into the difficulties created by the necessary growth in new treatments. This has helped in moving forward with innovations and efficiencies in the current systems of care and highlighted the need for governmental support with the ongoing challenges.'

Dr Graham Cormack - consultant ophthalmologist, NHS Tayside

'The National Ophthalmology Workstream has identified clinician based concerns and Scottish Government has worked with clinicians to identify solutions. The thrust has been on sharing good practice between peers across the country with the focus firmly on patient focussed models of care.'

Professor Carrie MacEwen - President of the Royal College of Ophthalmologists

'I have had the fantastic opportunity to work alongside colleagues in Scottish Government as the National Lead for the Scottish Gastroenterology DOIT Collaboration. This has given me the opportunity to work closely with colleagues nationally across the clinical spectrum to design clinical models of care for gastroenterology patients that will be responsive to their needs, safe, sustainable and to the highest clinical standards. These models of care will only be deliverable however if we foster a culture of national, regional and local clinical leadership, engagement and cooperation between our clinical staff.

'Historically, there has been a perception within the NHS that "changing anything is too difficult" due to the complexities of the organisation, limitations of budget making service change difficult, clinical pressures preventing protected service development time and the development of an "us and them" culture i.e. clinical staff not seeing themselves as being able to influence their clinical environment so it is therefore "not their problem. My hope is that through the Collaboration we can start to implement some of the required service changes identified in our supported working groups and this tangible outcome will encourage further engagement amongst colleagues who have not yet participated in our quality improvement programme. The implementation of such change will need strong leadership at all levels and all disciplines to drive this change forwards.'

Dr Alan Clarke - Consultant Gastroenterologist, NHS GG&C, Clinical Lead National Gastroenterology Collaboration