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What is the challenge your project is going to address and how does it connect to your chosen theme?

Traditionally acute providers of outpatient services in NCL have worked in silo, delivering different models of care, with limited sharing information or working towards the same outcomes or goals. As a result resources are used inefficiently, patient activity is duplicated and pathways are inconsistent. Some work has been done to address this through the STP planned care workstream but more is required to accelerate progress to meet the trajectory of reducing 30% of outpatient appointments over the next 5 years.Patients are waiting longer to be seen and with expected population growth in the area this problem will deteriorate further.  Improvements to outpatient services are required to make more efficient use of resources & meet the increasing demand for capacity. This cannot simply be delivering more of the same; providers must transform how care is delivered to reduce demand, optimise resources & transfer care to more appropriate settings .

What does your project aim to achieve?

This project aims to support collaborative transformation between providers and commissioners across Enfield & Haringey to deliver new models of outpatient care.  The funding will be used for project management resource to work with commissioners and providers. The resource will work with the clinical, operational and transformation teams to facilitate the development and implementation of changes to outpatient services. The resource will ensure providers & commissioners co-develop solutions and work collaboratively to deliver the best outcomes for patients.  The resource will research best practice and innovative solutions and ensure that when the new models of care focus on:- Cancellations and failed attendances; planning and pathway inefficiencies; lack of information and collaboration; lack of digitalised services and processes.    By implementing new outpatient models of care, we aim to reduce follow-up outpatient attendances by 5-10% within 12 months.

How will the project be delivered?

The project resource will utilise QI methodology & tools throughout the project. Broadly, the delivery steps will be:

1. Agree with partners how to work collaboratively going forward, building relationships & setting expectations on transforming and aligning models of care
2. Prioritise  specialties using benchmarking data, performance data & local knowledge of services
3. Facilitate diagnosis & structuring of the issues driving poor performance e.g. with driver diagrams
4. Set aims with outcome, process and balancing measures
5. Develop solutions engaging all stakeholders
6. Implement using PDSA cycles
7. Risks will be managed through outpatient transformation boards.

Engaging Q members will be integral to the design process in order to identify and adapt best practice models and share learning across the network.

What and how is your project going to share learning throughout?

NCL has a diverse patient population which presents a challenge its healthcare providers; there are some of most and least deprived wards in England and life expectancy ranges from 56-71 years. Successfully transforming the outpatients model of care that can meet the needs of a diverse group of patients is challenging but would provide ample learning opportunities for other healthcare systems. We will use improvement methodologies to design, implement and text ideas.   We will use our expertise & knowledge of the IHI Model for Improvement as well as Experienced Based Co-Design with patients & staff. Peers with similarly diverse patient populations or with just similar elements could adapt something from this project. Sharing the learning from the project would be done throughout, through existing forums such as Q online groups, Model Hospital Trust Ambassador Kahoots & the GenQ alumni.  We aim to publish results at the conclusion, either in journals or blogs/LinkedIn articles.

How you can contribute

  • Expert advice from anyone that has already successfully reduced hospital outpatient attendances & improved outcomes & experience for patients
  • Networks - please connect us with other projects around the country
  • Critical friends - let us know what may work well or any perils & pitfalls to be avoided
  • Champion our idea & successes via the Q networks & your own personal networks
  • Collaborate with us across North Central London
  • Connect us with national strategies and external resources

Plan timeline

30 Mar 2019 PDSA cycles for each test of change
30 Sep 2019 Confirm priority areas (i.e. specialities) to work
30 Sep 2019 Confirm stakeholders for each speciality area
16 Nov 2019 Complete baseline analysis for each speciality
30 Nov 2019 Driver diagram analysis completed for each speciality
15 Feb 2020 Complete stakeholder co-design sessions with each speciality
1 Mar 2020 Commence testing new models of care
1 Apr 2020 Adapt and change models as per PDSA


  1. Hi Claire, this is a great idea, and as CKD clinical lead for Renal at RFH we would be very happy to help support it if Nephrology was chosen as one of your specialties. We already have developed some alternative pathways to traditional hospital outpatients in other CCGs, with an IT platform that enables GPs to communicate with secondary care, and community based nurses seeing patients closer to home. We plan to roll out to Haringey in the next few months, and Enfield have shown some interest, so there is potential there.

  2. Hi Sarah

    Can you send me details of the Webinar?  If I can't join, one of my team may be able to.



  3. Hi Claire - I hope you can join the webinar tomorrow.  We'll be looking at taking a systems engineering approach to redesigning outpatients, which might be appropriate for the scale of transformation you're considering here.  If you can't join, happy to follow-up separately

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