Agenda item

The Committee considered a report of University Hospitals of Leicester NHS Trust (UHL) which informed the Committee regarding actions the Trust was taking in response to a recently published report by the Royal College of Physicians on Outpatients and provided members with an overview of work that was being undertaken to improve Outpatient services across the Trust. A copy of the report, marked ‘Agenda Item 10’, is filed with these minutes.

The Committee welcomed Mark Wightman, Director of Communications & External Relations, UHL, and Ket Chudasama, Director of Performance & Corporate Affairs, West Leicestershire CCG, to the meeting for this item.

Arising from discussions the following points were noted:

(i)        The report from the Royal College of Physicians was welcomed by UHL. In the past the focus of the Trust had been on acute services, and it was acknowledged that action needed to be taken with regards to Outpatient services. The main driver for reform was reducing waiting times rather than saving money. UHL delivered over 900,000 Outpatient appointments per annum and as part of the NHS Long Term Plan it was intended to reduce this to 300,000. To achieve this reduction there would be a focus on ensuring that patients were seen by the most appropriate specialist at their first appointment thereby avoiding the need to attend future appointments if they were unnecessary. It was also intended to dispense with appointments that had no clinical value. Routine follow up appointments were part of the culture of the Trust and this needed to be changed in future with patients deciding for themselves whether they needed another appointment. A member raised concerns that patients would not have sufficient knowledge to make that decision and suggested that information guides should be handed to patients to help them decide whether they needed another appointment with a clinician.

(ii)       It was intended that in future greater use would be made of the specialist skills that GPs and other practitioners such as optometrists had to enable them to conduct procedures that would normally be conducted at an Outpatient appointment. Additional training would be provided to GPs to make sure they had the skills and could carry out the procedures safely. Members raised concerns that this plan of action would only move the backlog from Outpatients to GP Practices at a time when GP Practices were struggling to meet the growing demand. In response it was acknowledged that, without investment in prevention services, demand would continue to outstrip supply. However, GP Practices were enthusiastic about this opportunity and saw it as a mechanism to make GP Practices more attractive places to work. In addition as some of the other practitioners such as optometrists were based outside of the Trust, there would be additional capacity for this work.

(iii)      In response to a suggestion from a member that Outpatient clinics could be locally rather than centrally based, with the clinician travelling to a location convenient for the patient, it was explained that the clinics would have to operate at scale and there may not be sufficient numbers of patients in each locality to make it feasible. Instead it was hoped that the new Planned Care Centre proposed for the Glenfield Hospital would enable patients to undergo more than one intervention during the same appointment such as blood tests, scans etc. to make the system more efficient and economical.

(iv)      Members raised concerns regarding the amount of patients that failed to attend appointments and questioned how UHL were going to tackle this issue. Members suggested that part of the problem was that appointments were often cancelled and rearranged and several appointment letters were sent out to patients causing confusion. In response it was explained that going forward greater use would be made of technology such as with two way text reminders and mobile phone apps. UHL were aware that some elderly patients did not use this technology and therefore it was hoped that they would receive greater support from the voluntary sector and GP Practices.

(v)       It was acknowledged by UHL that finding the way to the clinics could be a problem for some patients at older hospitals, and paper maps often became out of date quite quickly. It was hoped that the ‘way finding’ mobile phone apps which were in development would help patients locate their clinics.

RESOLVED:

(a)       That the contents of the report be noted;

(b)       That officers be requested to produce for a future meeting of the Committee a further report regarding outpatient appointments to include performance data broken down into individual specialties.