The modern outpatient: a collaborative approach 2017-2020

1. Executive Summary

We currently see 4.5 million Outpatients in a Secondary Care/hospital based setting. Some specialties have seen the numbers of patients doubling since 2008/9.

There is evidence already in existence that shows the Outpatient Service in Scotland can transform to be more responsive, with less inappropriate visits to hospital and with patients signposted to the right clinician at the right time and right place.

Transforming the patient experience will rely more than ever on closer integration, planning and co-ordination of services across a spectrum of clinical settings at national, regional and local level.

Better access to clinical decision making support and specialist advice will make a significant impact on patients getting the right treatment and removing unnecessary steps from their journey.

Maximising the roles of the wider multidisciplinary team will be crucial to ensuring the patient has access to the right clinician first time and in removing unnecessary delays to their journey. Whilst some new roles have been adopted or extended this has not been at scale.

Extending the range of training and development opportunities will be essential in delivering a modern workforce which ensures the extended multidisciplinary teams have the skills, confidence and capacity to work to the full range of their competencies.

Reducing the need for face-to-face consultant appointments by, for example, optimising e-health and digital solutions such as supporting self-management, managing patients more remotely or reviewing patients in the comfort of their own home using online tools, will be essential to providing care closer to the patients' home.

There are many examples of 'redesign in action' contained in this document. Taken together across the entire range of outpatient services up to 400,000 Outpatient appointments have the potential to be redesigned into a more appropriate and sustainable model of care.

One of the key objectives of any transformation programme must be to ensure that precious clinical time is used wisely and effectively both in Secondary and Primary Care. This is not about simply moving workload from one part of the Service to another. We expect that the aims of forthcoming report on 'Improving Practice Sustainability' will be closely aligned with the work on transforming Outpatients.

The Modern Outpatient: Core Principles

• Strengthening knowledge exchange and self-management in the community with the patient at the centre;
• Accessing decision support, care planning and care services in the community wherever safe and appropriate;
• Emphasising competency-based roles in secondary care, to focus Consultant resource on more complex patients, and recognising the role of the GP as the 'expert clinical generalist' and raising the profile and enhancing the role of the wider multidisciplinary team of community-based practitioners;
• Optimising e-Health and digital opportunities at the primary/secondary care interface as the norm;
• Reducing widespread variation in secondary care return appointments and review processes, wherever clinically appropriate.