"The outpatient system is older than the NHS and the time has come to grasp the nettle and use tech and other innovations to improve patients' experience and care."

Professor Stephen Powis, Medical Director NHSE, 2018

This presentation will describe plans for the future provision of outpatient and related diagnostic services as part of a major service and estate transformation programme, across two academic and health sciences campuses and over 50 community sites, supported by ambitious and innovative funding models. Modernisation of outpatient services will align with national and commissioner priorities by increasing one-stop access, exploiting technology to streamline care pathways and release acute site capacity.

The challenge facing healthcare providers in the NHS and worldwide is likely continued capital scarcity from traditional sources. In response, this strategy leverages maximum value from existing acute site assets for investment in flexible facilities to avoid the risks of under, over or stranded capacity at a time of unprecedented uncertainty in healthcare. Underpinning the strategy is a service modernisation programme, with outpatient care at its leading edge, targeted to deliver NHS Long Term Plan objectives –

  • Boosting out-of-hospital care and dissolving divisions between primary and community services
  • Redesigning and reducing pressure on emergency hospital services
  • Providing more personalised care and giving people more control over their own health
  • Mainstreaming digitally-enabled primary and outpatient care
  • Integrated Care Systems to improve population health

One of the most significant healthcare transformations in the last quarter-century has been in ambulatory care, with activity shifting from inpatient to day and outpatient settings. Enabled by improved anaesthesiology, diagnostics and information technology this has increased efficiency, reduced unit costs and benefitted patients in terms of accessibility and convenience. However, due to a legacy of estates and facilities which pre-date these developments their full benefits are yet to be realised for many providers.

This is illustrated by how, on many acute sites, outpatient activity is typically spread across multiple locations. This fragmentation results in poor utilisation of space and equipment, workforce inefficiencies and inconvenience for patients. The disaggregated distribution of outpatient and diagnostic facilities makes it more difficult to provide one-stop services with patients having to traverse a busy site and/or attend on several occasions. To address these issues the provider has developed an outpatient care model in which around 20% of outpatient activity would be consolidated with diagnostic support in new, purpose-built accommodation away from the acute site. The process through which the model has been developed, its underpinning principles and benefits are described below.

A modelling exercise has identified the activity and facilities required for outpatient services which could be located close to, but off the acute campus in an innovation hub, with early estimates indicating around 200,000 attendances by adults and children in 2027 – 28. Estimated facility and space requirements, reflect the resource efficiencies accruing to a consolidated outpatient model, a shift from face to face to virtual and patient-initiated encounters and digitally-enabled streamlining of care pathways.

Key components of the new unit will include –

  • Outpatient consulting and examination suites
  • Virtual consulting and telemedicine hub
  • Imaging
  • Medical day case
  • Phlebotomy
  • Pharmacy

The plan provides the opportunity to pilot and embed new ways of working. For outpatient care, this is reflected in a set of key principles from international evidence-based best practice –

  • Out of hospital care where clinically appropriate
  • Centralisation to create critical mass and optimise resource efficiency
  • Standardisation to reduce waste and errors
  • Technology-enabled – smart scheduling, remote consulting and monitoring and patient-initiated appointments
  • Improved flow management to balance demand and supply and reduce non-productive downtime for both staff and patients

The new outpatient model will deliver a range of benefits - to the provider, its patients and the health system partners including -

  • An off-site location symbolising commitment to out of hospital care building a bridge to population health initiatives
  • Improvements in resource efficiency within a dedicated planned outpatient environment
  • Improved access, convenience and empowerment for patients through one-stop services, reduction in unnecessary hospital attendances and roll out of initiatives such as phone apps and virtual consultations
  • Reduced logistical complexity and released acute capacity
  • Freedom from legacy constraints to develop proven new models of care such as on stage/off stage consulting, examination and treatment
  • Management of uncertainty and increased resilience and flexibility substituting scaleable digital solutions for best-guess fixed capacity
  • Environmental sustainability by reducing journeys, traffic and pollution