England’s top doctor is calling on the NHS to enlist the power of tech and innovation to reduce the thousands of unnecessary outpatient appointments carried out every day.

In his foreword to the Royal College of Physicians report published today, NHS England Medical Director, Professor Stephen Powis, says it’s time to ‘grasp the nettle’ to help reduce some of the 118 million outpatient appointments every year – many of which are unnecessary.

He said, over the last 70 years the NHS has evolved and innovated to meet the changing needs of the patients but it is ‘crucial’ that NHS now looks at how it interacts with patients to ensure it continues to provide the best possible care.

Today he calls on trusts and CCGs to embrace skype, apps and online tools so thousands of patients will be spared hospital visits, time off work and school while also saving the NHS millions.

Professor Powis said: “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.

“As part of the long term plan for the NHS, it’s right we look at ways to cut unnecessary appointments, save thousands of journeys, reduce traffic and pollution and make the NHS more efficient.”

The report highlights that outpatient appointments should be patient centred meaning there should be a clear health benefit when asking people to travel to appointments, taking time off work and school. Ending unnecessary appointments will free up clinical specialists to spend more time with complex patients where they can make the biggest difference.

Professor Powis added: “For many people, care can be delivered more timely and conveniently closer to home, by specialists at the GP surgery or by using technology in new and exciting ways. This report shows a snapshot of exciting new models already working successfully through apps, skype, text messaging and remote monitoring systems that are changing the shape of care; we need to bottle and spread those examples building a new consensus for the future based on the views of clinicians and patients.”

Case studies

Tower Hamlets: have started a pioneering virtual e-clinic where GPs send questions on kidney patients direct to specialist consultants for a quick reply, eliminating the need for an outpatient appointment. If patients do need to see the consultant they can be seen more easily. Barts Health undertakes about 220,000 dialysis sessions a year and the numbers requiring this have been growing steadily in recent years. Only one in five kidney referrals now go to hospital and this could generate savings of up to £1million across North-East London alone to be recirculated in the local NHS.

Berkshire: patients suffering high levels of pain now receive a specialist appointment in around a month after services were overhauled. More than nine out of 10 are seen within six weeks, compared to between seven and nine months previously. Patients suffering pain symptoms had been going to pain, trauma and orthopaedics, neurology and rheumatology outpatients for tests and consultant appointments they did not need. Now patients at risk of chronic pain are identified early and seen by the Integrated Pain and Spinal Service (IPASS), meaning fewer hospital admissions or multiple attendances.  Berkshire West Clinical Commissioning Group aims to reduce multiple attendances linked with pain by at least half each year and hope for a 5% reduction in related day case procedures.

North West: A neurology hotline for GPs in the north west has spared patients unnecessary worry and travel time, while £100,000 a year has been reinvested back into the NHS. The advice line, run by the Walton Centre in Liverpool, means GPs in the Cheshire and Merseyside area can call neuro consultants for fast advice any weekday reducing extra patient appointments. It means less time off work for patients, less travelling and consequently less pollution for the environment.  Of the 181 calls received in 2017/18  37% were resolved by the GP saving £51,698 which over a year saves around £100k.

North West London: Children’s doctors and GPs in London have reduced the number of unnecessary hospital appointments needed for children by up to 80 per cent through a new model of ‘child health hubs’ which see families closer to home or answer their problems through the GP. GPs meet specialists once every four to six weeks at a GP surgery where they discuss patient cases widening the GPs specialist knowledge and getting patients an answer to problems faster. A specialist clinic is also held during the visit so patients can be seen by a GP and the paediatric consultant at the same time if needed. They also have a number of other professionals involved in the hub such as Health Visitors, dietitians, mental health workers and others to give a holistic assessment of the child’s health.