The modern outpatient: a collaborative approach 2017-2020

4. National Context

4.1 This paper has been written for stakeholders, for clinicians and managers and for service providers. Its main purpose is to herald a change in approach that is both necessary and inevitable. It is therefore essential that we understand, plan and design a service that is fit for The Modern Outpatient. At present this is not in place; in three years' time, we aim to have established a robust and reliable infrastructure that will be set to truly deliver a modern outpatient service.

4.2 The Scottish Government has published a number of documents that set out the policy framework for NHSScotland. Over the course of the next few months we will also develop an overarching strategic plan that will identify the way forward for the next five to ten years. The 'Modern Outpatient: A Collaborative Approach programme' will play a crucial role in the delivery of these ambitions over the next three years.

4.3 The most significant policy drivers for this work include the 'National Clinical Strategy for Scotland' which sets out the challenges facing healthcare and some of the principles surrounding our approach. The strategy was produced following extensive consultation with clinical and other stakeholder groups before publication in 2015. NHSScotland has led the world with its work on quality and safety in acute settings, and this programme will contribute to furthering one of its quality aims in this area, namely that:

'Services will be based around supporting people rather than single disease pathways, with a solid foundation of integrated health and social care services based on new models of community-based provision.'

4.4 The Chief Medical Officer's Annual Report for 2014/15, 'Realistic Medicine', has been welcomed as a bold, new vision for healthcare in Scotland. Amongst its guiding principles, the commitment that we must deliver value in NHSScotland is significant for this programme. The report sets this out clearly saying:

'We must deliver healthcare that focuses on true value for the patient. Waste in healthcare should be assessed not in terms of what might be thrown away, but in interventions that don't add value for patients. This includes avoiding unwarranted variation in clinical practice and resultant outcomes.'

4.5 The Joint Integration Boards and Integration Partnerships will play a pivotal role in commissioning services which deliver better outcomes for the population they serve, with particular recourse to population health and the wider determinants of health, both preventative and anticipatory and meeting the needs of people with multiple, complex, long-term conditions. The existence of large social and geographical inequalities in mortality and increasing co-morbidity will require of the Programme evidence that new ways of working encourage access to outpatient care by making it more user-friendly and accessible, and ensuring no patients 'slip through the net'. Tests of change or new ways of delivering outpatient interactions will ensure that any mismatch of available resource, be it skills, staffing numbers or skill mix, are remedied. This will require clinicians and managers in primary, secondary and social care to work together to ensure joined up strategies for new workfare models.

4.6 From 2017 onwards GP practices and GP clusters will have oversight and direct involvementin improving the quality of health and social care services, including the current chronic disease management programme and use of secondary care services. This work explicitly acknowledges the pressure faced by GPs and so recognises the imperative to ensure the balance of care is appropriate, equitable and focused on the care delivered where it needs to be, and not about displacing workload. It is envisaged that the 'ground up' and national collaborative approaches to improving access and quality will be complementary rather than conflicting. The Programme outputs and deliverables will be revisited and refined as GP clusters evolve and new ways of improving access and quality emerge.

To ensure this equitable and balanced approach the development of this work will support the delivery of the recommendations of the GP Improving Practice Sustainability Short Life Working Group, established by the Cabinet Secretary for Health and Sport in Spring 2016. As included in those recommendations, we would expect to see robust local structures at the primary/secondary care interface to underpin local collaboration. This should build on good practice supported by the Royal College of General Practitioners and promoted in the recent joint statement with Royal College of Nursing and other Professions.

4.7 'The Modern Outpatient Programme' will contribute to the delivery of these ambitions by supporting greater patient self-management, shifting the provision of services and resource into the community. And this will improve the value of interventions in secondary care services where they are required to the individuals who need them.

4.8 New ways of managing outpatient services will have a positive impact on reducing the workload of GPs and Consultants, thus releasing their time to see patients with more complex needs and ensure they see patients who need to be reviewed on time.