Agenda item

This report updates the Committee on improving the outpatient services across Medway and Swale. This is in line with the Medway Model and community service redesign which will enable care to be delivered closer to people’s homes. The improvement programme will be bringing services together, this will enable health and care staff to work more closely together and develop services that focus on the needs of the patients.

 Discussion

The Committee was informed that good outcomes were being achieved in relation to the early stages of the Outpatient Improvement Programme. Clinical Pathways were being redesigned to ensure alignment with best practice, with significant public communication and engagement having been undertaken. A Consult and Connect System was being rolled out to GPs. This enabled GPs to talk to a consultant while the patient was present in the GP surgery. This could be used as an alternative to referring a patient to a consultant for an outpatient appointment. 48% of such calls had resulted in a referral not being needed.

The Programme involved a whole system joint approach across primary and secondary care which would lead to a more patient focused service. Engagement was being undertaken to involve service users and clinicians in the design of services. The Programme was also looking to reduce non-attendance rates at appointments and to improving booking utilisation in order to improve the efficiency of the outpatient service. Although the programme did aim to reduce the number of outpatient appointments, it also aimed to improve the speed of patient diagnosis and to standardise care across locations.

Committee Members asked a number of questions which were responded to as follows:

Consult and Connect – The platform would be readily available and would support patients being diagnosed in primary care without requiring a consultant referral. The system would not increase GP workload. A national platform was available which would mean that a consultant in another area would answer the call when no one was available locally. The average call length was two minutes, which was significantly quicker than writing a referral letter. Patients who still needed a referral would go down the ordinary referral pathway. It was anticipated that the target 30% reduction in hospital outpatient appointments could be exceeded.

Timescales, patient outcomes, neurology referrals and education – A Member asked about the timescales for delivering the programme, patient outcomes and the identified 70% of neurology patients awaiting referral who could be directed to another more clinically appropriate service. The Member also asked about education in primary care and how the changes could be embedded through this. The Committee was advised that neurological conditions were difficult to diagnose. GPs generally referred a patient based on the symptoms they presented with to a consultant rather than diagnosing neurological conditions themselves. To support rapid diagnosis GPs should be able to access rapid support from a consultant who was a specialist in that condition. Often patients who required physiotherapy and had no underlying neurological condition, were referred unnecessarily. This increased waiting times for other patients and delayed the start of physiotherapy.

Proposed changes would lead to less divergence between primary and secondary care. This would support GPs who had not previously had readily accessible telephone advice. There had been good engagement with GPs through primary care, which had protected learning time sessions each month. This had been used to explain the outpatient work. GPs were also being given the opportunity to buddy up with consultants to develop their specialist interests. The Programme aimed to reduce outpatient appointments by 30% over five years.

Engagement Service - An independent patient engagement service had been commissioned to undertake patient surveys and help ensure their feedback was taken into account. All pathways were tested before launch. Medway Community Healthcare had undertaken an audit of 100 patients. This had revealed that consultants were not always having the time to review and understand reasons for patient referrals and that pathways were not consistent. Consideration was being given as to how referrals could be reviewed earlier to ensure the patient saw the most appropriate person.

Rheumatology Task and Finish Group – The establishment of a task and finish group for neurology was dependent on the outcome of similar work in Dartford. Establishment was anticipated in quarter 3 or 4 of the current year.

Clinician Capacity and NHS 111 – Consult and Connect would help utilise both GP and consultant capacity more efficiently and prevent unnecessary referrals for issues that could be dealt with in primary care. Patients waiting for outpatient appointments often repeatedly visited their GP while waiting. Therefore a reduction in outpatient appointments would help reduce this. The work would take two years in total, with part of the next phase being to consider how new technologies could be utilised to reduce referrals and help patients manage their conditions. The NHS 111 programme had been nationally mandated. It was hoped that the Outpatient Programme would not face problems as it was a local programme using local knowledge, local data and local clinicians working together.

Patient Engagement and voluntary sector engagement – Communications and Engagement agency Pea had been commissioned to undertake engagement work. NHS Medway CCG had used Pea previously and they were considered to have good local knowledge. A full communications and engagement plan had been produced. Healthwatch had also been invited to all communications and engagement sessions. In response to the Member’s concerns about levels of engagement with the voluntary sector, the Committee was advised that engagement had taken place with a number of organisations. A targeted approach had been used during the first phase of the programme with additional groups now being targeted. There was a clear timeline for each specialty area. It was clarified that Consult and Connect was a pilot but that the outpatients programme as a whole was not. 

Inequity across services – It was confirmed that the aim was to ensure consistent pathways across Medway and Swale during phase 1 of the project. Pathways would be uploaded to the system used by GPs to ensure consistency. It was acknowledged that there may be a need to undertake some location specific commissioning to address inequity. It would be ensured that all pathways met best practice guidance.

Consistency of approach by consultants and service managers – There had been variations across hospital departments in terms of follow up appointments e.g. not inviting patients back in for a follow up or conversely, inviting them for follow ups that were not needed. There was also variance in the processes used to direct patients back to primary care and community services for ongoing condition management. Medway Foundation Trust had undertaken work to centrally manage appointments in order to reduce variation and to notify patients of appointments sooner. Consultants would be managed against a set of performance indicators. 28 internal clinical leaders were responsible for setting standards for colleagues.

Decision

The Committee considered and commented on the report and requested that the following be circulated to the Committee

i)     A timeline of the Outpatient Improvement Programme.

ii)    The Programme Communications and Engagement Plan.