The modern outpatient: a collaborative approach 2017-2020

13. Agile Delivery

13.1 An incremental, iterative and collaborative approach to delivery is essential in ensuring adequate preparation and readiness of whole-system change.

The Integrated Programme Board will define the route planner for the next three years to ensure the strategic alignment, intent and sequencing of other national transformation programmes. This will ensure an iterative process for selecting the right projects, optimising benefits, investments and appropriate resource allocation and safe guard against an unmanageable volume of change and adverse impact on services and inter-Programme dependencies across 2018/19 and 2019/20.

13.2 However, following the period of consultation a focus on secondary care process and secondary and primary care interface challenges will be addressed in 2017 as a set of immediate activities.

In 2017 we will:

Initiate a review of unwarranted variation in return appointments generated in and by secondary care. Working with pathfinder specialties we will identify opportunities to reduce the number of return appointments which may not always add benefit to the management of the patient care.

Work collaboratively with the Primary Care Directorate on actions pertaining to the outpatient and primary care interface challenges outlined within the Improving Practice Sustainability Report. This will include actions to reduce avoidable re-referrals by GPs, onward referral post diagnosis to alternative clinicians which avoids GP where appropriate and improving consultant to consultant referrals.

Work collaboratively with National Education Scotland to deliver proof of concept testing of integrative clinical decision support which enables effective referral management, management of multi-morbidity and supported self-management.

Fund pathfinder NHS Boards to implement national redesign pathways which divert patients from consultant-led services and reduce avoidable demand on GPs ie AHP/nurse/other primary care provider led services (in high volume specialties Dermatology. Gastroenterology, Ophthalmology and orthopaedic redesign).

Establish National/local Redesign Collaborations in Respiratory Medicine, Cardiology and Rheumatology which take account of whole system challenges and synergies.

Implement proof of concept for Smart booking systems which enables patient-initiated review, reduces planned return appointments and Did Not Attends. A wider review of booking practices will also be undertaken.

Implement a roll-out programme for 'Attend Anywhere' which will offer patients virtual consultations at home and avoid unnecessary expense and inconvenience to patient.