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Transforming outpatient care

The Director of Innovation Delivery at NHSX looks at how patients are benefitting through the healthcare technological revolution:

The NHS has made huge advances in recent years to improve patient care using new technology.

From electronic records and referrals to devices that patients can wear to help to track their health, technology is helping transform the way hospitals and community services care for patients.

The NHS Long Term Plan was published earlier this year and identified the use of new technology as crucial to the future of the NHS. The Plan described joined-up services with an emphasis on prevention and a personalised service for patients. It also pledged that ‘digitally-enabled’ primary and outpatient care will become mainstream across the NHS over the next five years.

The Shelford Group is a collaboration of ten of the largest teaching and research NHS hospital trusts in England. The transformation leaders in these trusts have worked together to review their own progress in digital innovations in outpatient services and share where it might be possible to extend and scale initiatives across the NHS.

The delivery of NHS outpatient services is substantial in scale and complexity. From simple single outpatient appointments to pathways that cut across different clinical settings and multiple diagnostic services over many years – there is the potential to redesign and improve. There are many opportunities from supporting patients to manage their conditions, to streamlining the booking process, to delivering digital pathways in their entirety.    Examples of all of these have been successfully implemented.

Several NHS organisations have implemented technology to support patients to self-manage their conditions, including King’s Health Partners who are using wearables to promote exercise as part of the diabetes pathway. Cambridge University Hospitals NHS Foundation Trust are using a system known as MyChart to create a communication channel with clinical staff and enable patients to see their records, change appointments and message the clinical team rather than attend an appointment. University Hospitals Birmingham NHS Foundation Trust has also implemented a portal that can receive messages and undertake voice and video consultations. Patients are already saying that these methods of communication enable them to manage their conditions better at home.

There are many examples of remote care that are making pathways faster and more convenient for patients. These include remote monitoring of gestational diabetes at Oxford University Hospitals NHS Foundation Trust to track glucose levels; implementing a fetal telemedicine ultrasound service across Cumbria led by the Newcastle upon Tyne Hospitals NHS Foundation Trust; delivering a virtual fracture clinic at King’s College Hospital NHS Foundation Trust and virtual ENT services at Manchester University NHS Foundation Trust. Imperial College Healthcare NHS Trust has extended their use of video consultations to a range of specialties and Sheffield Teaching Hospitals NHS Foundation Trust has created a virtual pre-operative assessment service that replaces face to face appointments for patients that do not require them.

Trusts have also improved the booking process with University College London Hospitals NHS Foundation Trust using algorithms to predict patients who may not attend and Guy’s and St Thomas’ NHS Foundation Trust having implemented an electronic booking service for patients with faster easier communication for patients.

These good practice examples, and many more, are included in a new toolkit for new models of outpatient care. The toolkit includes case studies showcasing patient pathways which, in different ways, are being transformed with the use of technology.

All these initiatives place patients at the centre of the design and delivery of care and support staff to improve services. We are early in the evolution of many of these new technologies and can expect them to grow in number and sophistication.

There is a clear ambition from the NHS both nationally and locally to offer a streamlined digital service for patients and an expectation that we will need to invest to deliver this.

Lisa Hollins

Lisa Hollins is the Director of Innovation Delivery at NHSX.

Until September, she was Executive Director of Improvement, Informatics and ICT, at King’s College Hospital NHS Foundation Trust and Chair of the Shelford Group Transformation Directors.

Lisa is an experienced health leader and has worked in the NHS for over 25 years. Until September 2019, she was Chair of the Shelford Group Transformation Directors and has held senior positions in NHS trusts with University College London Hospitals, Barts Health and King’s College Hospital as her most recent organisations.

She has held regional and national roles in quality improvement and previously published a number of articles on quality improvement and efficiency.

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