This article was first published in Health Management.
The COVID-19 pandemic is putting global healthcare systems under immense pressure and outpatient services are not excluded. The need to transform and reduce outpatients has never been greater. If we can reduce outpatient numbers, this would allow clinicians to focus on the sickest patients and reduce face-to-face contact without limiting access to acute clinical decision-making. Whilst the NHS Long Term Plan (NHS 2019) established the need for outpatients to transform over the next five years, COVID-19 has become the burning platform to realise this change in a matter of days.
While this accelerated transformation is a challenge, it is possible. Focusing on virtual consultations and other alternative outpatient delivery methods can ensure providers improve their productivity, reduce their referral-to-treatment times, and overall demand. A previous redesign programme we conducted of referral pathways for a large NHS Trust converted 2,500 appointments from face-to-face to virtual, releasing capacity for more than 900 extra appointments per year. In the context of COVID-19 demand, such improvements have a significant impact on freeing up vital resources.
In the short-term, guiding patients to the right care setting from the start is key to reducing the pressure on outpatient departments. There are three core principles to ensuring this:
Think virtual first for low-risk patients
Delay measures that focus on reducing or eliminating face-to-face contact, and therefore demand, are particularly challenging because outpatient appointments are typically deli- vered face-to-face. In 2018/19, NHS figures show less than 3% of first, and 4% of follow-up, appointments were ‘virtual’, with over 53.9 million patients waiting over two weeks for an appointment over the same period (NHS 2019a). So, even before COVID-19, there was a clear need to modernise the model of care in outpatients, including embracing digital to create a more patient-centric and efficient service.
But first you need to decide in which care settings to see patients. A risk stratification approach that separates low and high-risk patients is best for both patients and staff.
Optimise across available delivery channels
Virtual consultations are a great alternative to face-to-face appointments, and yet they are still not widely adopted, missing opportunities for providers to create more productive services. In addition to a digital offer, providers have five other delivery channels available to optimise care and minimise face-to-face interaction:
Keep patients informed
In some instances, such as an antenatal appointment, a two-week wait cancer appointment or an urgent referral, there will be a clinical need to see patients face-to-face despite the pandemic. In those cases, providers will need to consider how they ensure the safety of patients and staff and keep them separate from others. For example, they could use different entrances or alternative sites to maintain appropriate infection control processes.
To make any new arrangements work, you need to effectively communicate with patients. Actively engaging with them through SMS, email, social media and automated calls will ensure they understand new arrangements and requirements as the pandemic evolves.
More communication that outlines a wider choice of delivery channels will also encourage patients to cancel appointments that become unnecessary and therefore reduce the demand further. This will give clinicians a more accurate view for scheduling and avoids did not attends, which the NHS National Benchmarking Network Report for Outpatients (NHS 2019b) says cost the NHS around £1 billion a year.
Maintaining momentum from COVID-19 to create legacy
By implementing alternative delivery channels to cope with the immediate crisis, providers need to acknowledge that a transformational step-change is being achieved. But in doing so, they must challenge themselves to ensure any change is truly maintained. Otherwise, behaviours will slip back to the old way of delivering outpatients – those which prompted the NHS Long Term Plan in the first place. Now is a better time than ever to create and maintain a legacy in outpatient service delivery that will help support demand challenges faced once the pandemic is over. There are three key points on how to ensure the changes made are successful:
The effect of this crisis cannot be underestimated. Clinician and patient behaviour will be forever changed as a result of COVID-19, especially those patients with chronic conditions who have been safely managed remotely both in acute and community settings. Through implementing alternative delivery methods, more productive clinics and reductions in unnecessary attendances can be achieved, to help manage the demand mid-pandemic and when it returns to business as usual across the NHS. The effective triage, vetting, management and discharge of patients have been cornerstones of the revised models of care that have been achieved in a very short space of time. It will be integral to review and redesign the traditional clinical pathways to optimise the patient journey and sustain the disruptive innovation achieved as a result of COVID-19.