Focus on physicians: outpatients

14 Dec 2018

14 Dec 2018

There has been a large expansion in outpatient services in the NHS, with appointments almost doubling from 63.2 million in 2006–2007 to 118.6 million in 2016–2017. Despite this, many outpatient services operate as they have for decades, often to the frustration of doctors, patients and carers.

The RCP recently surveyed UK consultants about their experiences of delivering outpatient care to increase our understanding of current practice in the UK. The results helped inform our report Outpatients: the future, which includes principles for good outpatient care and recommendations for change.

The experiences of consultants show that outpatient services, like much of the NHS, are under pressure. 29% said every clinic finished later than scheduled, and 27% said that at least one clinic a week finished late. Only 6% said their clinic never finished late.

This could easily change. 22% estimated that more than 20% of new patients did not require outpatient review and 24% that more than 20% of follow-up patients did not need outpatient review.

Consultants feel demand could be reduced by using alternatives to face-to-face consultations, particularly for follow-up patients. Telephone and email consultations were most commonly suggested.

66% of consultants provide and advice service to referring clinicians to reduce referrals, mainly via an electronic services such as eRS, email or telephone. But the vast majority of email and telephone services are not commissioned and do not form part of job plans for 68% of consultants.

84% of consultants reported that referrals to outpatient services are screened by a clinician before attendance, with redirection to a more appropriate service or a change in priority commonly undertaken. 68% of consultants reported declining unsuitable referrals and 56% taking the opportunity to request more information or organise further tests.

For consultants caring for patients with long-term conditions, providing a phone helpline (92%) or email advice (90%) were common. However, only 34% had a patient support group and only 31% provided a written self-management plan in case of clinical deterioration. Disappointingly, only 36% of consultants reported offering patient advocated or ‘see on symptom’ follow-up services.

We also need to provide a better service for patients, who are often frustrated to arrive only to hear that information crucial to the consultation is not available. Only 22% of consultants reported a clinical check was made before an appointment to make sure that appropriate information was available and only 4% reported that patients were able to do this.

Despite the NHS plan recommending in 2000 that patients always receive copies of correspondence about them, only 68% of consultants send patients a copy of their clinic letter. 90% of these are a copy of the letter they sent to the GP, rather than one addressed to the patient.

Dr Nigel Trudgill, director of the RCP Medical Workforce Unit.