The modern outpatient: a collaborative approach 2017-2020

6. Optimising the Role of Existing National Programmes

6.1 Organisationally, 'The Modern Outpatient Programme' will draw on existing Scottish Government programmes of work, namely the Delivering Outpatient Integration Together ( DOIT) Programme's Dermatology and Gastroenterology collaborations, and outpatient aspects of the highly successful Orthopaedic and Ophthalmology Access Programmes, examples of which are highlighted throughout this document.

6.2 Beyond this the Programme will work to deliver on the reduction of 400,000 outpatient appointments strategically with:

6.2.1 The Technology Enabled Care Programme to extend the scope of Home and Mobile Health Monitoring. The use of video consultations presents opportunities across multiple specialties and opportunities to fully utilise and further develop technological solutions to support outpatient transformation.

6.2.2 Existing Scottish Government innovation bodies who can harness and accelerate the process of developing new technology at pace and provide leverage and funding which builds on the potential benefits of digital transformation in outpatient services.

Examples include The CAN DO Innovation Forum (Programme for Government and Scotland's Economic Strategy) and the CivTech® pilot (Digital Scotland Strategy).

6.2.3 NHS24 and NHSInform regarding the potential expansion of telephone triage services and healthcare information and self-care advice.

6.2.4 The Primary Care Directorate with recourse to the opportunities presented in the new GP Contract, General Ophthalmology Services Contract and Pharmacy Contracts.

6.2.5 The Mental Health Access Improvement Programme delivered by Healthcare Improvement Scotland in partnership with Information Services Division of National Services Scotland. Further support is available to Boards for the development of the mental health workforce to enhance supply and training of workforce to deliver evidence-based therapies, delivered by NHS Education for Scotland (see Annex 6).

6.2.6 The Primary Care Outcome Framework's (see Annex 3) aspirations provide an excellent platform to work collaboratively on workforce issues and solutions, be more integrated and better co-ordinated with community and secondary care services as part of the 'virtual' network of care provision for those patients who have complex needs, those who require to be managed by clinicians other than consultants and GPs and patients who are kept informed through supported self-management. The primary care digital transformation and GP IT re-provisioning, alongside the development of the Patient Portal will open up further opportunities to integrate patient journeys.

6.3 Through ' Making it Easy: A Health Literacy Plan for Scotland', the Scottish Government has recognised the need to address the impact that low health literacy has on the ability to access, understand, engage and participate in our health and social care system. By systematically addressing health literacy as a priority in our efforts to improve health and reduce health inequalities, there is an opportunity to impact on the volume of primary care interactions regarding potential referrals, maximise the appropriateness of referrals and where appropriate reduce the overall volume of referrals to outpatient services.

6.4 The new programme will work more effectively with primary care to realise the benefits of supporting patients with low health literacy more effectively with a view to reducing demand in both primary and secondary care.

6.5 In addition, working with independent contractors such as optometrists and pharmacists, further shifts of care into local settings, managed by a wider healthcare team, will be a key part of the Programme. For example, the ambitions of ' Prescription for Excellence: A Vision and Action Plan for the Right Pharmaceutical Care in Scotland' include the increased use of community and other pharmacists to help patients and carers self-manage their conditions.

6.6 Health Improvement Scotland already provide an extensive range of improvement support to NHS Boards and Health and Social Care Partnerships which include new and practical approaches to supporting primary care to improve the quality of care, GP Out-of-Hours and GP quality clusters.

6.7 The Scottish Health Council's 'Gathering Public Views' approach will be pivotal to ensuring on-going engagement of the public with particular recourse to the use of modern technologies and new ways of delivering services and general public awareness and patient education.

6.8 The Chief Nursing Officer - Transforming Nursing Roles will be pivotal in delivering reform in the wider community nursing workforce and ensuring the role of nurses as co-ordinators of care with a focus on anticipatory care, prevention and early intervention.

Redesign in action: Managing return patients differently

As part of the National Ophthalmology Workstream, a high proportion of post cataract return appointments are now undertaken in a community setting, in some cases by 'high street' optometrists. Further roll-out continues, with a small proportion of complex cases still requiring review by hospital eye services.

The Community Eye Services Review is underway and it is expected that other eye conditions will be subject to appointments in the community via shared care schemes with long-term conditions. Approximately 46,000 cataract treatments were undertaken in NHSScotland in 2015 - approximately 26,000 return slots have been released to date.