Three big ways to accelerate elective recovery without adding to capacity

When it comes to cutting NHS waiting lists, doing more of the same won’t work. In recent years, increasing staff numbers has been attempted to try and solve the problem, but waiting list numbers still rise.

So how do we get out of the productivity dilemma? Rather than focusing exclusively on the 7.4 million patients already on waiting lists, we also need to set services up to keep pace with tomorrow’s demand. There three ways I have seen NHS trusts do this successfully.
 

1. Move all outpatients onto digital, triage-first PIFU

Across NHS trusts today, outpatient appointments are typically scheduled independent of clinical need. Approximately two-thirds of appointment slots are used for follow ups, but these often don’t coincide with when a patient actually needs care. A patient may need care sooner but struggles to get hold of their specialist team and goes to their GP or A&E.

More often, patients have an appointment but don’t feel it’s necessary at the time. This is one of the main reasons that patients ‘DNA’, coupled with the difficulty of cancelling or rearranging an appointment.  Many patients also attend appointments for needs that could be resolved without one, such as reporting a flare in symptoms or getting an updated prescription. 

Fundamentally, these improvements to outpatient care can be a powerful lever in tackling elective demand

Fully embracing patient-initiated follow up (PIFU) can help trusts to tackle these challenges. PIFU is a model for delivering outpatient services that sees patients initiate contact with their healthcare provider if or when they need to. But simply bolting PIFU onto existing workflows may hinder rather than help staff. A more effective approach to implementing PIFU well would be to:

1. move away from the routine booking of in-person follow-up appointments
2. provide a PIFU route for all outpatients, one which is digital by default but with a phone option
3. triage patients who initiate contact via PIFU to determine the most appropriate way to resolve their needs.

Including automated backstops in this system would trigger follow up if a patient does not make contact for a prolonged period. Fundamentally, these improvements to outpatient care can be a powerful lever in tackling elective demand.

2. Make productivity gains by moving appointments to messaging

Healthcare delivery across the NHS often automatically takes the form of an appointment. So long as this is true, we can’t save time and resources and make the productivity gains needed to stem the tide of elective demand. Instead, we should shift the paradigm away from appointments exclusively, to include messaging as an alternative.

Take a patient with a skin condition, for example. Where previously they would’ve had to book to see their GP – often for multiple appointments – they can now send photos to their GP via SMS to help manage the condition. Using messaging in this way has transformed general practice and freed up a huge amount of clinical capacity.

But such examples aren’t exclusive to primary care. The thoracic team at University Hospitals at Leicester (UHL) has recently been using Accurx to send patients’ normal CT scan results by SMS. This not only reduces unnecessary appointments, but massively improves experiences for patients waiting to hear if signs of cancer have reappeared.

In both cases, clinicians can resolve patient requests quicker, protect appointment slots, and provide a more responsive service. By delivering more healthcare outside of appointments, we can make the vital productivity gains needed to support elective recovery.

3. Screen and prioritise patients at scale

For years, we’ve talked about the need to improve proactive care in the NHS. But by and large, services still find themselves reactive, fire-fighting the pressures of the day. Given potential demand will always outstrip capacity, the focus must therefore be on allocating resources to those with the greatest need.

A key area where services can see a significant improvement is the mass-screening of patients via SMS questionnaires. One example is how GPs use Accurx to send patients on their asthma list a structured set of screening questions, which the practice can use to segment their list of patients with asthma and assign each cohort to a different intervention. The patients with well-controlled asthma often don’t need anything more than a quick acknowledgement. 

…this has helped the trust identify and remove over 19,000 patients from its waiting list

Similarly, at UHL, multiple services are using batch SMS messages to ask patients on waiting lists whether they still need their overdue first or follow-up appointment. To date, this has helped the trust identify and remove over 19,000 patients from its waiting list – an incredible result – all at minimal expense in time and resources. It’s also picked up some patients who needed to be seen a lot sooner.

Ultimately, we won’t get ahead of elective demand by doing more of the same. Instead, we need to offer care to patients only when they need it, move activity away from appointments, and proactively prioritise patient needs at scale.

Jacob Haddad is chief executive of Accurx. You can follow Jacob on Twitter @jacobnhaddad