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Comment: Why it’s time to put tech at the heart of outpatients overhaul

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David Ezra, managing director at health tech firm Vantage Health, on how technology can  tackle the outpatient services backlog.

It’s time to blue light outpatient services. The pressure within the system has reached the critical stage with waiting lists for elective care surging past the six million mark and Health Secretary Sajid Javid admitting they are likely to continue to rise for a further two years.

However, the build-up can’t be totally attributed to Covid as the immense strain the system was already under prior to the pandemic was already starting to show.

In the five years before the virus struck, the waiting list grew from 2.9 million in January 2015 to 4.4 million people waiting for diagnostic treatments, scans, surgery, or treatments by the end of December 2019.

The need for a radical overhaul was acknowledged in the NHS Long Term Plan in its vision to digitalise the system. However, whilst there was acceptance of the pressing need amongst clinicians and hospital trusts to find new ways of working, the appetite for a swifter pace of change was missing. The pandemic proved a catalyst to change and kickstarted the movement towards greater acceptance by clinicians of technology to improve referral pathways and speed up delivery of care.

A legacy of this otherwise bleak time therefore could be a positive and permanent change to the future ways of working and delivering care in the healthcare sector.

A better way to manage patient demand

Patients are feeling increasingly frustrated by the long wait times. An Ipsos Mori poll reported 85% of those surveyed said they were waiting longer to be seen, with six out of ten finding this unacceptable. 

But it’s not just patients who are feeling frustrated by the long waiting lists, clinicians are equally frustrated by the ‘antiquated’ processes. A survey by the Royal College of Physicians found that 25% of doctors felt that between 10-20% of new patients did not need to attend an outpatient clinic at all.

However, it is always darkest before the dawn and Covid has shown that it is possible to redesign service delivery.

David Ezra, Vantage Health

Greater use of technology within the medical sector could improve patient outcomes by providing the opportunity to improve the quality of interactions between doctors and patients and between doctors and clinicians.

In June 2020, Vantage Health helped trusts in North West London implemented a new policy for GP referrals to outpatient services where unless the need for referral was entirely beyond doubt, an electronic A&G query had to be raised first.

When an advice and guidance request was made and information sent back, the system captured all the information as a PDF which could be added to the clinical record, allowing the GP to refer to it at a later stage if needed. Information was extracted from the GP clinical system and there was space for the GP to add questions and seek additional guidance. This helped foster closer collaboration between primary and secondary care and a better working relationship between clinicians.

Making Advice and Guidance (A&G) services more easily accessible for GPs can help reduce outpatient attendance, give patients quicker access to consultants and ensure diagnostic tests can be carried out prior to a consultation.

The Covid-19 recovery plan recommends providing alternative consultation routes to reduce outpatient attendance.

Supporting doctors to speed up delivery of care

England is now falling behind most other European countries with an estimated 2.8 doctors for every thousand people compared to an average 3.4 doctors per 1000 in the EU.

The shortfall of more than 50,000 GPs and hospital doctors is forcing medics to work longer hours to cope with patient demand, increasing the chance of burnout and workforce attrition. Senior GPs have warned that general practices are reaching breaking point due to the intense workload pressure facing doctors.

A survey by the British Medical Association found thousands of doctors were considering leaving the profession and the GMC has highlighted that protecting the health and wellbeing of doctors is vital to avoid potential medical errors as well as safeguarding retention levels. Ensuring working conditions in both primary and secondary care are supporting doctors is fundamental to the success of healthcare services.

To better support the battle-weary medical community to tackling the growing waiting lists it’s vital not to revert to outdated past practice, but to give them the right tools to manage them in an efficient, streamlined, and compassionate way for the benefit of both doctors and their patients.

In the short term this means focussing on supporting GPs with rapid access to specialist opinion, which will better support those working in primary care and help to tackle the number of people on the waiting list. In the longer term, more advanced solutions to improve the referral process and better manage demand should be sought.

The Covid-19 NHS Recovery Plan calls on providers to use the digital solutions that proved successful during the pandemic to improve outpatient service delivery. Advances in technology can offer solutions that slash waiting lists, treats people away from hospitals and free up doctors’ time.

Modernising the referral pathway

The pandemic has laid bare the complexities and build-up of delays within a referral system that has not kept up with the growing demand of an aging population.

Improving the process and better managing demand is critical for ensuring that only patients who require specialist referrals receive them, given the time and cost of such care for patients, clinicians, and the NHS.

Supporting clinical decision making is key and making referral guidance more accessible to GPs could make the process more efficient. 50% of all referrals come from GPs so it’s imperative they are supported to make the right clinical decisions.

Several solutions have been introduced to manage demand for outpatient services. Referral Management Centres and clinical triage have both been trialled but have proven not to be cost or clinically effective.

Referral guidance is usually of high quality and based on local consensus views, but when shared in the form of manuals and templates, it is virtually unusable by a GP with limited time.

However, more advanced digital technologies have enabled GPs to have all the information they need at their fingertips by automatically cross referencing the individual patient’s data against specific referral criteria.

The technology works as it is not just an ‘add on’ but a clear pathway for clinicians to follow and has made it easier for GPs and hospitals to manage referrals into secondary care.

Road to recovery

Whilst the pandemic has without doubt placed an unprecedented strain and demand on our healthcare service, it’s also presented an opportunity for rapid transformational change. As there is now more widespread acceptance by clinicians of using technology to improve referral pathways and speed up delivery of care.

Although the huge numbers on the waiting lists continue to make the headlines, it’s a bigger issue than that.

It’s about the realities of caring for an ageing population and carers who can’t always make the journey to and from hospital, it’s about the link between patient satisfaction and service delivery and the number of DNAs (did not attend) and it’s about the waste both direct and indirect of continuing to root outpatient care in hospitals. And if course it’s also about the burden on the medical community and the personal cost to the patients behind the headlines with their anxious waits to be diagnosed.

These remain tough times for our medical colleagues and the NHS remains very much under siege and although technology alone cannot provide a sole cure to the problem of long waiting lists, it does offer a treatment plan to help triage the situation using advanced digital solutions.

David Ezra is managing director of health tech firm Vantage Healthpart of NEC Software Solutions.

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