What should the future of outpatient care look like?

Articles

Vantage Health was delighted to partner with HSJ on a webinar that explored the topic of what should the future of outpatient care look like.

During the discussion, the panel were asked how will transformation be delivered? What will need to change and what should stay constant? And how can we ensure that GPs are supported to make the right referrals at the right time?

A summary of each of the panelists responses is below. To watch a recording of the webinar, please click here.


Toby Hillman, Consultant in respiratory and general medicine, University College Hospitals Foundation Trust

  • As an author of the initial Royal College of Physicians 2018 report, Toby provided context to the report, explaining how those who compiled it were looking for areas of inefficiencies within the NHS
  • A key area of frustration was outpatients, where little had changed since the 19th century
  • They decided to examine the system from start to finish and to determine what it should look like
  • Current social, economic and environmental costs were too high: 5% of all journey on English roads were due to the NHS and 20% of pensioners felt worse after they had outpatient visits due to the journey
  • Once recommendations had been made, Covid-19 transformed everything, accelerating use of video conferencing, telephone consultations
  • Now health secretary recommends there should be no face to face until a virtual consultation has taken place

“5% of all journey on English roads were due to the NHS”

Toby Hillman

Rishi Das-Gupta, Chief innovation and technology officer, Royal Brompton & Harefield NHS Foundation Trust

  • As a chief technology officer, Rishi has been asking how the trust should change its models of care
  • There is no single technology solution. Instead, there is a mixture of clinical, operational and technology and his role is to bring these together
  • Challenge is, how do we manage a cohort of patients without them having to come to hospital?
  • Key question is, what are the 4-5 types of interactions they have? And what supports those interactions?
  • It is also important to ask, why are we having an appointment? And what are the tools that support this?
  • In addition to telephone and video which are now the norm, there is remote monitoring and diagnostic tools to determine if a patient is ill and whether they need to be seen face to face
  • The last of the tools they look at are how to involve local services. If patients are not coming to them, what can they do locally? How we communicate better with local services, GPs and community care and secondary care hospitals?

“How do we communicate better with local services, GPs and community care and secondary care hospitals?”

Rishi Das-Gupta

Alan Selwyn, GP IT Lead, Brent CCG

  • As a GP, Alan addressed one of the major issues facing many GPs which is dealing with referrals
  • He believes the system is complex, unmoving and one of the riskiest process GPs are involved in; whether to refer or not or referring to the wrong place
  • He receives a lot of complaints from patients and it causes a lot of administrative hassle and uncertainty
  • GPs accused of over referrals and unnecessary referrals yet they do not know what an appropriate referral looks like
  • Pathways designed from secondary care perspective which leads to a number of mandatory referral pathways which bounce back if they are not fully learnt by GP
  • Only way to properly manage the referrals is with technology such as Vantage Health’s Rego  which they used and tailored to their data and processes
  • Following Covid-19, Vantage Health’s Rego rapidly adapted for Advice & Guidance with the system used to send questions to consultants and receive response within minutes on how to deal with patients

“The current system is complex, unmoving and one of the the riskiest process GPs are involved in; whether to refer or not or referring to the wrong place”

Alan Selwyn

David Ezra, Head of transformation, Vantage Health

  • As a provider to the NHS, David described the work Vantage Health had done with Brent CCG
  • A fundamental part of the work was in operationalising pathways that had been developed over 2-4 years and making them work
  • Experience had been sitting down with clinicians from primary and secondary care, examining maps developed, and seeing how we can embed them within their daily work flow so they can work
  • Useful to see vision of Brent CCG for outpatient transformation: do they wish patients to have investigations before being referred in? Or do they wish for patients to have community services as their first port of call? And supporting them in this using technology

“A fundamental part of the work was in operationalising pathways that had been developed over 2-4 years”

David Ezra