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

Outpatient demand has grown for a sustained period of time, almost doubling over the past decade from 54 to 94 million, at a cost of £8bn a year (NHS Long Term Plan, 2019:27). Evidence indicates that traditional service models requiring physical patient attendance in an outpatient setting are often not in the best interests of patients; better alternative are available (Royal College of Physicians, 2018) such as straight to test, telephone consultations & referral advice services. These alternatives have the potential to address a matrix of challenges including workforce shortages, falling patient satisfaction levels, speed of time critical pathways & the NHS carbon footprint. To avoid adding to the complexity of what is a largely fragmented innovation landscape, this project will map existing programmes such as GIRFT, RightCare, AHSN case studies, to provide an evidence based one-stop platform. We aim to enable a reduction in outpatient demand to levels set out in the LTP.

What does your project aim to achieve?

The project aims to enable reduced outpatient demand by providing a platform for shared learning, spread of innovation & best practice across the NHS. Three objectives structure the design and direction of the project to this effect:

1. Distillation: a challenge faced by would-be adopters across the NHS is a shortage of time (and sometimes organisational capability) to digest and evaluate the vast spectrum of alternative candidate innovations that exist across the NHS (and beyond).
2. Presentation: having effectively distilled a range of high impact outpatient innovations and models of best practice, the project will curate these to present them in a format and on an online platform that enables rapid review and decision making across the NHS community.
3. Facilitation: we will work with national leads in national bodies & regional teams to explore how this platform can be best aligned with national programmes, including the emerging support offer from NHSE/I to systems and providers.

How will the project be delivered?

The work has been informed by discussions undertaken by directors responsible for transformation across the Shelford Group collaboration as well as through the Chief Medical Officers (CMOs) sub-group. The Transformation Directors sub-group have drafted a toolkit document for digital outpatient transformation which provided a seed for this more ambitious approach; the CMOs held a session on outpatient transformation in March which shared learning with a GP lead from London and a hospital clinician, drawing insight from their experiences which have successfully delivered more outpatient care outside of hospital by strengthening the primary-secondary care interface.

Delivery of the project will be overseen by the Group Managing Director and Chairs of the Transformation Directors sub-group.  A Project Manager will work with this community of providers, drawing on a spectrum of expertise through an established national collaboration, dedicated to delivering benefits across the wider NHS.

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

Our approach to shared learning will consider:

• Codify: the need for new outpatient models to be sufficiently codified in order for their inputs, outputs and outcomes to be clearly communicated.
• Relevance: there needs to be rapid iteration with a wider community across secondary & primary care, as well as patient groups, to ensure that models address priorities that providers, systems & patients face.
• Application: models need to include a granular account concerning real world application. For example, details including business cases, roles & responsibilities, as well as learning from implementation in different systems.
• Support: provide a clear sense of who can be contacted to provide insights and advice on application to leads planning implementation locally.
• Alignment: by aligning with national & regional leads, the project should achieve amplification and longevity of approach with a positive nudge effect; this may mean the project output being subsumed within a national programme.