Clinician involvement vital to rethinking outpatient services

A two-way conversation between GPs and consultants has the potential to treat more patients in the community and support clinicians in their decision making.

Press release

Published: 30/08/2018

Successful and radical rethinking of outpatient services can only be achieved when clinicians are at the heart of the process. That’s according to a new briefing out today by the Nuffield Trust.

Rethinking outpatient services’ draws on a Nuffield Trust workshop, held in collaboration with NHS Improvement, which heard from health leaders across the country who have made significant changes to their outpatient services. It comes as Simon Stevens recently called the health service’s current outpatient model ‘an obsolescent mode of specialty long-term support’.

It reveals that underpinning some of the most impressive outpatient redesigns has been the transformation of relationships between consultants and GPs - who have traditionally been frustrated with the one-way referral process - and their wider clinical teams.

Authors heard that there are significant opportunities to improve the design of many elements of outpatient care, such as making follow-up appointments more flexible and to add most value to patients.

Developing a two-way conversation between GPs and consultants, attendees said, has the potential to treat more patients in the community and support clinicians in their decision making. It may also enable them to ask for advice, promote trust between clinicians and patients and, in turn, reduce referrals.

Examples of different ways of working trialled by attendees included the following:

  • A child health GP hub that facilitates collaboration between primary and secondary care, including multi-disciplinary team meetings to discuss concerning cases and easy routes for GPs to ask consultants for advice, including during a patient’s GP appointment.
  • “Virtual clinics” that enable novel use of skill mix for low-risk patients. For example, a low-risk glaucoma clinic where ophthalmic science practitioners take readings and the results are then reviewed by more senior staff.
  • Innovative approaches to follow up, including using an email questionnaire to determine (with patient agreement) whether an appointment is needed, leaving the consultants to focus on the more complex cases.

Other suggestions included creating virtual follow-up clinics, using an email questionnaire to determine whether an appointment is actually needed and using data to find solutions to ‘did not attend’ rates. 

The briefing warns, however, that there is no one-size-fits-all approach to redesigning outpatient services. Attendees emphasised the importance of looking at the patient journey from start to finish and ensuring each member of staff is adding the most value possible.

Commenting on the briefing, author Sophie Castle-Clarke says:

“With over 110 million appointments scheduled a year in England, and nearly 24 million of those not attended, the time to rethink outpatient services is long overdue.

“The good news is that with this significant challenge comes great opportunity to do things differently. Clinicians we spoke to are already seeing the benefits of shaking up traditional models of outpatient services, with fewer missed appointments and better quality consultations.

“A clear thread running through successful changes to outpatient services was allowing clinicians to orchestrate these changes and build strong and productive working relationships. Clinicians and hospital managers should not underestimate the time it takes to achieve this.”

  1. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.

For more information or to speak to Sophie Castle-Clarke, please contact: Leonora Merry or Meilir Jones on 020 7462 0555/0537 or email