The modern outpatient: a collaborative approach 2017-2020

Foreword

Each year, NHSScotland delivers around 4.5 million outpatient appointments of which around a third are new and two thirds are return appointments. It is vitally important that people get fast access to advice and support, self-management information, and, where needed, get to see the right health professional as quickly as possible to ensure care is delivered in as responsive and person-centred a manner as possible, and, critically, as close to home as possible. We have also seen significant growth in Outpatient numbers - over 140,000 extra patients now being seen on an annual basis compared to 2009.

'A Plan for Scotland' sets out our clear commitment to shifting the balance of care to ensure that people get the right support from the right professional as close to home as possible. We are supporting this with a transformational shift in how we fund healthcare: by 2020/21 more of the NHS budget (£500m extra) will be spent in the community than in hospitals. We are investing significantly to build capacity in community healthcare - general practice and wider multidisciplinary teams - to deliver our vision. This collaborative programme for the modern outpatient fits with this vision.

'The National Clinical Strategy' and 'Realistic Medicine' set out our approach to ensuring we make best use of all the resources available to us in NHSScotland in the delivery of world class healthcare; importantly this includes all members of our multidisciplinary teams. This is particularly important in the face of rising demand for, and growing expectations of, what healthcare can do to resolve health challenges. Examples of where our pathways have been redesigned to manage this demand, and ensure people get to see the health professional best suited to their needs, are set out in this document. Our national Musculoskeletal and Orthopaedic programme is one such example of this approach as the largest outpatient service in Scotland. Patients can access immediate advice and support via NHS24 and are seen by an Allied Health Professional if needed, such as a physiotherapist or podiatrist in the community. This has freed up secondary care appointments for individuals needing a surgical opinion and effectively managed growing demand for orthopaedic appointments towards the correct health professional.

Looking to the future our approach must fit with our wider plans for transformation, in particular transformation of general practice, primary care and community health services. Our approach must not be about transfer of workload from hospital to community but about promoting collaboration between clinical teams in both primary and secondary care to develop solutions that best meet the needs of the local population and at the same time appropriately managing workload across the system, valuing the contribution of all staff. To ensure genuine collaboration we will need to focus our attention on the local interface between primary and secondary care, bringing local decision makers together to promote innovation and the solutions that best meet local needs.

'The Modern Outpatient Programme' will be progressed over a three-year time span starting with consultation in December 2016 and will build on the direction set within the 'Primary Care Transformation Programme' and 'National Clinical Strategy'. Science and Technology changes are moving at pace - we particularly need to harness digital technology to provide a more responsive service in the future. For example some Boards (as exemplified in this document) have already started to embrace new ways of working - if all Boards operated at the level of the best in managing return patients 150,000 Outpatient slots could be released with the potential to increase that to 400,000 when we consider the wider gains that could be made in reducing Do Not Attend rates and spreading the best practice examples in this document on a Scotland-wide basis.

We would like to know what you think - particularly if the ambitions and proposals within this programme are the right ones and to get your thoughts on how we can redesign services for the future benefit of patients.

Shona Robison MSP,
Cabinet Secretary for Health and Sport