Dr Kavita Aggarwal: What does the future look like for planned specialist care delivery?

There are around 125 million outpatient appointments a year in the NHS. Whilst most of these used to be face-to-face appointments, the Covid pandemic has accelerated adoption of digital innovations including remote consultations and use of telemedicine for specialist care services. Our response to new technology is just one thing that will help shape the future of planned specialist care delivery; there are many others. We must explore these opportunities and decide together what future we are aiming for. To do that, we have joined up with the Royal College of Physicians to develop a new strategy for outpatient care, engaging widely with those who have a stake in any changes and looking for inspiration from the other healthcare systems across the world.

Whilst seeking to better understand how other healthcare systems are addressing current challenges we have found that the term ‘outpatients’ is not used elsewhere to describe planned specialist care. Internationally, in places such as Norway, Switzerland and Belgium what we describe as ‘outpatient services’ are referred to as ambulatory care services, specialist services or polyclinics. What is universal is a recognition that patients having access to multiple specialists in one appointment in a community setting could help integrate care for patients, increase clinical efficiency and reduce follow up appointments. The use of technology to help bring these specialists together is also seen as a promising development. Could this be something we should be aiming for in England and if so, how do we make it a reality for our patients?

In England, general practitioners are typically the main gatekeepers of specialist care referrals. Germany and Austria have adopted a self-referral system into outpatient and specialist services. In Norway, referrals to outpatient polyclinics are done through doctors, chiropractors or manual therapists. This means that patients are not required to be referred via their primary care practitioners if they wish to access specialist services. In the UK there are some specialist services patients can access differently including national screening programmes where patients are referred directly from the community into secondary care, referral to musculoskeletal services which can come directly from physiotherapists and in sexual health clinics where patients self-refer. Is this something we should consider expanding to other specialist services in the future? What would that practically mean for patients and services, and would it help address some of the current challenges? Something else we must consider together as we explore what the new strategy could look like.

In all healthcare systems there seems universal agreement that patients prefer to be treated in their own homes or close to their homes where possible. Many patients choose to have a homebirth or to receive end of life care in their own homes. The NHS is already working to increase delivery of care in the community, through virtual wards and utilising workforce to the top of their licence. Countries like Switzerland are limiting inpatient expenditures through tariff cuts and providing incentives for ambulatory services. Is there something for us to consider around financial incentives that encourage delivery of care closer to patient homes or would patient experience be improved if they accessed care from providers with shorter waits even if that requires travelling a bit further? Another question to work through together as part of this strategy development.

There are many more questions than those posed here, and we’re keen to get views, ideas and insights from as many people as possible to feed into the new strategy. The possibilities are phenomenal and we are excited to talk to our patients and staff to see what you think might work. To find out more and share your ideas, please complete our engagement survey