Selected items from the NHS England long term plan Part 4

[holyshedballs]

AS Endocrinologist consultations take palce as outpatient appointments these paragraphs are important to us

1.45. Outpatient services will be fundamentally redesigned. While GPs have been highly successful in constraining referral growth for new outpatients over the past two years (with referral growth flat), hospital outpatient visits have nearly doubled over the past decade from 54 to 94 million, at a cost of £8 billion a year.

1.46. Outpatients traditionally serve at least three purposes, and in each case there are opportunities for redesign. An outpatient appointment can provide: advice and diagnosis for a patient and their GP; follow-up review after a hospital procedure; and ongoing specialist input into a long-term condition. Technology means an outpatient appointment is often no longer the fastest or most accurate way of providing specialist advice on diagnosis or ongoing patient care. The Royal College of Physicians has rightly argued that outpatients needs a radical overhaul18.

1.47. In some hospitals patients are already benefitting from the redesign of outpatient services. These include better support to GPs to avoid the need for a hospital referral, online booking systems, appointments closer to home, alternatives to traditional appointments where appropriate including digital appointments and avoiding patients having to travel to unnecessary appointments. This is better for patients, supports more productive use of consultant time and enables the capacity of outpatient clinics to be used more efficiently.

1.48. In short, the traditional model of outpatients is outdated and unsustainable. We will therefore redesign services so that over the next five years patients will be able to avoid up to a third of face-to-face outpatient visits, removing the need for up to 30 million outpatient visits a year. This will save patients time and inconvenience, will free up significant medical and nursing time, will allow current outpatient teams to work differently, and will avoid spending an extra £1.1 billion a year on additional outpatient visits were current trends simply to continue. These resources will instead be used to invest in faster, modern diagnostics and other needed capacity.

[SilverAvocado]

I wonder if this will be translated into something I always notice - doctors, both GPs and consultants are extremely willing to waste their own and patient's time.

The classic 'come in for an appointment in hospital, tests are ordered, and then if they find nothing noteworthy (usually), a second appointment to discuss that'. Then do the same thing in 18 months time if the GP is still concerned. I don't feel like I need to see a consultant at all to accomplish any of that. And as a disabled person making two trips out to hospital means I'm effectively using up a week or more of my capacity to go out and do activities.

It's a constant bugbear of mine that doctors feel no obligation to 'add value' when you see them. Very often you're in exactly the same position walking out of the clinic as you were walking in, with no extra information and no closer to getting the treatment you need.

What I would really love is if there were communication experts employed in the system, hopefully paid less than consultants, who you'd meet with and they'd explain the condition you were being investigated for and the tests and treatments, they could deliver letters or reports prepared by doctors, except do a good job of it. And because they're not medical specialists they could also discuss other things, like referring you on to other services. For example I was disabled for years before I first got a carer, and I don't understand why doctors didn't have ANY responsibility to set me up with that and make sure I was able to get meals, wash myself, etc.

But my suspicion is that this section will be interpreted more in terms of refusing patient's services, rather than actually reducing wasted appointments.

[holyshedballs in reply to SilverAvocado]

In some respects, I think that is what they are trying to move towards with having the various sectors under one roof.

On an aside, I think that the Montgomery case has fired a shot across the medical profession bow. in their judgement, the Supreme Court said that the days of medical paternalism are over. i can see this in the draft Consent from the GMC, and the way that the long term plan is taking (some) "power" away from doctors. The NHS is clear that the NHS is for patients, but the medical profession thinks that the NHS is for them. Hence the struggles patients face and the sometimes awful attitude of some doctors.

We still have out part to play in the NHS. We are not empty vessels waiting to be filled by the doctors grace.