Since the clinically led Elective Care Transformation Programme started in spring 2017, we have worked with health and care systems to develop integrated, person-centred solutions that ensure patients see the right person, in the right place, first and every time.

Specialty based transformation

We supported frontline teams to run rapid testing of innovative approaches to transform outpatient services in 14 high-volume elective specialties.

Over the course of five waves, each lasting 100 days, local systems worked with us to develop evidence-based guidelines and tools to ensure patients see the right person, in the right place, first and every time.

The teams identified practical and effective ways to:

• Improve patients’ ability to self-care – for instance, when patients with osteoarthritis in Stockport attended knee workshops, the proportion who said they felt confident about managing their own condition soared from 10 per cent to 73 per cent.
• Improve referrals – for instance when gastroenterology consultants offered advice to GPs considering a referral, 54 per cent of patients were managed without a hospital appointment.
• Improve triage – for instance, consultant led community clinics in Lincolnshire for quick checks of spots, moles and other skin blemishes found only one in ten people needed to be investigated further for cancer.
• Offer alternative services – for instance patients with back and joint pain who have a local First Contact Practitioner service can contact a physiotherapist with enhanced skills direct, rather than waiting to see a GP or getting a referral to hospital.
• Offer different kinds of appointments – for instance, a one stop clinic in Somerset which offered MRI scans and other tests on the same day for patients with a specific type of hearing loss helped cut waiting times for clinic appointments from 89 to 41 days.
• Offer different kinds of follow-up – for instance a nurse-led follow-up clinic offered phone appointments for people who had had prostate surgery in Dudley. 100 per cent preferred them to being seen face-to-face.

This learning is summed up in handbooks with practical “how-to” tips including how to get the right people involved from the beginning, negotiate internal processes at pace, and choose the right metrics for different projects.

They cover three main areas:

• rethinking referrals
• shared decision making
• transforming outpatients.

Wave 1 sites investigated gastroenterology, and musculoskeletal (MSK) and orthopaedic services.

Wave 2 sites explored diabetes, dermatology and ophthalmology interventions.

Wave 3 focused on ear, nose and throat (ENT), urology and cardiology.

Wave 4 examined gynaecology, respiratory and general surgery.

Wave 5 looked at general medicine, neurology and radiology.

High Impact Interventions

To provide clinical commissioning groups (CCGs) and sustainability and transformation partnerships (STPs) with easy to use tools to transform their services, the Elective Care Transformation Programme identifies good, evidence-based practice and collates it into simple specifications.

We have developed specifications for musculoskeletal (MSK) triage, ophthalmology failsafe prioritisation, and clinical peer review, and supported pilots of First Contact Practitioners (physiotherapists with enhanced skills that patients can refer themselves to for back or joint pain and other MSK conditions).  Now we are working on a specification for endoscopy.

We also developed a clinically led Consultant to Consultant Referrals Good Practice Guide. This provides an overview of some of the issues that impact on consultant-to-consultant referrals and highlight ways in which providers and commissioners can:

• support patients to be treated closer to home within the community where possible
• support GPs to manage their patients’ treatment
• reduce the numbers of referrals in the system.
• make more effective use of resources and manage demand.