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Found 47 results
  1. Content Article
    ‘Patient-initiated follow-up’ (or PIFU, for short) is not a new idea and has been referred to in different ways over time, such as open-access appointments, self-managed follow-up, and see-on-symptom appointments. However, this approach has been given renewed attention given rising waiting times and the backlog of care that built up throughout the Covid-19 pandemic.  Moving outpatient attendances to patient-initiated follow-up (PIFU) pathways is considered a key part of plans to reduce outpatient follow-ups. But what exactly is PIFU? In this Nuffield Trust explainer, Sarah Reed and Nadia Crellin describe more about what it is, the problems it could solve, and what is known so far about how well it works.
  2. Content Article
    Error management is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analysing them. However, almost nothing is known about the incidents doctors in outpatient care consider to be critical and how they deal with them. This interview study aimed to to explore outpatient doctors’ views on error management, discover what they regard as critical incidents and find out how error management is put into practice in ambulatory care.
  3. News Article
    A trust is reviewing more than 100,000 patients on its outpatient lists, after concerns emerged that some had ‘been lost whilst on hold’ for follow-up appointments. A report from Buckinghamshire Healthcare Trust, leaked to HSJ, found 116,575 patient records without a scheduled follow-up after an outpatient consultation, with more than half of those left inappropriately without action, some dating back a decade. The review was triggered after staff spotted cases in which patients had been “lost whilst on hold”, the report said. The trust this week told HSJ that, since the initial discovery in the summer of last year, it had been validating the lists and reduced the number of outstanding records to 47,778. It aims to complete the reviews in the next two months. It told HSJ it had undertaken a harm review and found no “systemic harm”. Concerns have been raised over several years about the extent of overdue and unreviewed patients on follow-up lists, and the potential for them to deteriorate and come to harm. There are no national figures monitoring the patients, many of whom have long-term health needs. Read full story (paywalled) Source: HSJ, 15 December 2023
  4. Content Article
    The Patients Association has been working with NHS England and the Royal College of Physicians on the development of an outpatient strategy for the past year. In this series of three blogs, they discuss what they have heard from patients about the state of outpatient care and what patients would like to see change. What patients want from an outpatient strategy Kindness, reasonable adjustments and consistency needed across outpatients Personalising care and offering patients choice
  5. News Article
    There will be no national mandate for GPs to use advice and guidance in a certain number of cases, NHS England has told Pulse. National medical directors for primary and secondary care said that formalised pathways should be developed ‘locally’, and decisions should be based on an area’s population. In September, it was reported that NHS England’s upcoming outpatients strategy would further increase the use of advice and guidance (A&G) before GP referrals are accepted, with the RCGP then "voicing concerns" about this proposal. However, when asked about the reports that this would be mandated, Dr Stella Vig, national medical director for secondary care and clinical director for elective care, said she ‘doesn’t know’ where that came from, and ‘doesn’t recognise’ those comments. NHS England also released guidance clarifying the medico-legal risks and clinical responsibility for clinicians using A&G or referral assessment services (RAS), which is now available on the NHS Futures website. The guidance said that these forms of specialist advice are "expanding rapidly" as a result of improvements to digital services. On legal issues, it said liability ‘will be determined on a case by case basis’ but that GPs could be liable if "all relevant clinical information is not provided" when sending an A&G request. But specialists at hospitals would be accountable if they send back advice to the GP which is ‘not clinically appropriate’ or if they ‘refuse to accept a patient’. On turnaround times, NHS England has said that ‘local variables will ultimately dictate the agreed response times’ for hospital teams dealing with A&G – but the guidance recommends that the response time "should not exceed 10 working days for routine requests". Read full story Source: Pulse, 30 November 2023
  6. Content Article
    Working in partnership to improve patients' experiences of outpatients was chaired by Sarah Tilsed, Head of Patient Partnership at the Patients Association. Joining her were: Dr Fiona McKevitt, Clinical Director for Outpatient Recovery and Transformation, NHS England Dr Theresa Barnes, Clinical Lead for Outpatients, Royal College of Physicians Irene Poku, Representative Patient and Public Involvement and Engagement with experience of using outpatient services. In a wide ranging discussion, the panel talk about collaboration, equity of access and group consultations.  This webinar was part of Patient Partnership Week 2023. 
  7. News Article
    Retired doctors will have an option to “keep caring” and re-join the NHS to carry out outpatient appointments in a new initiative to help reduce waiting lists. From autumn, newly-retired doctors will be able to sign up to a new digital platform where they will be able to offer their availability to trusts across England to perform outpatient appointments, either virtually or in person. NHS hospitals will choose the consultant whose skillset and availability best matches the appointments they need covered, which are scheduled and arranged with patients in the normal way. More than four-fifths of people on the waiting list require an outpatient appointment such as a follow-up for cardiology or rheumatology – rather than a surgical procedure. Consultants carrying out remote appointments could be based anywhere in England, which can help those hospitals in areas with higher demand. Those requiring a face-to-face appointment or follow-up will be seen in the usual way. Speaking at NHS Confed Expo, Amanda Pritchard, NHS Chief Executive, said: “Ahead of the NHS 75th birthday in July, this new platform is an innovative example of how we are constantly adapting the way we work to benefit patients by helping to reduce waiting times as well as supporting staff. “Using this digital tool will help us to match patients with retired doctors who we know are keen to stay working in a flexible way so they can keep caring for patients, as well as allowing us to expand capacity to see even more patients – and faster. “NHS staff have already made excellent progress against our Elective Recovery Plan – and this platform will not only help us continue to reduce the longest waits but it will also help us slash agency spend, using the existing capacity of experienced doctors who still have so much to offer the NHS”. Read full story Source: NHS England, 14 June 2023
  8. Content Article
    The following account has been shared with Patient Safety Learning anonymously. We’d like to thank the patient for to sharing their experience to help raise awareness of the patient safety issues surrounding outpatient hysteroscopy care.
  9. News Article
    Trusts have been told today by NHS England that they must book appointments by the end of this month for all patients who have been waiting longer than 78 weeks. A letter from NHS England sent to trust leaders set out the new orders and represents system leaders’ attempt to ramp up progress on this cohort of patients, which the NHS and government elective recovery plan commits to eliminating by March. The appointments must be issued this month, and be dated before the end of March, for these pathways, of which about 48,000 are recorded nationally. The letter also warns trusts that, while NHSE will accept some inpatient cancellations are unavoidable, cancelling outpatient appointments — even during strike action — is viewed as less acceptable. Read full story (paywalled) Source: HSJ, 12 January 2023
  10. Content Article
    This blog for Refinery 29 by journalist Sarah Graham examines the gender health gap, a term used to describe the inequalities in treatment and health outcomes that men and women experience. She talks about the stories relating to sexism and institutional bias she has come across during her time as a health journalist, that result in poor care experiences and outcomes for women. While acknowledging that women should not have to make extra effort to be heard by the health system, Sarah offers tips for women to help them voice their concerns and improve their chances of being listened to by medical professionals.
  11. Content Article
    This opinion piece by GP educator and writer John Launer looks at the current delays and cancellations to routine appointments facing patients with long term conditions. He describes his personal experience of waiting three years with no face-to-face of phone appointment to review his condition, when this should happen every six months. John outlines the fact that routine outpatient care in some hospitals is unravelling, but with no monitoring of the situation and without publicity. He highlights the risks for patients who are not receiving the regular contact with healthcare professionals that they need, including medical complications, emergency admissions and even preventable deaths. There is particularly risk to patients who do not feel able to contact their consultant or specialist. When speaking to the hospital department about how the risks were being mitigated, John was concerned to discover that there were no screening procedures in place for clinicians to determine which patients were at highest risk; no prioritisation as going on and there was no system in place to monitor the consequences of this.
  12. Content Article
    This German study in the Journal of Patient Safety aimed to analyse the strength of safety measures described in incident reports in outpatient care. 184 medical practices were invited to submit anonymous incident reports to the project team three times in 17 months. The authors coded the incident reports and safety measures, classifying them as as “strong” (likely to be effective and sustainable), “intermediate” (possibly effective and sustainable) or “weak” (less likely to be effective and sustainable). The study found that the proportion of weak measures was high, which indicates that practices need more support in identifying strong patient safety measures.
  13. Content Article
    The pandemic has had an enormous impact on health and care services in the UK. In this article, Nuffield Trust fellows Jessica Morris and Sarah Reed take a closer look at access and waiting times before and after the start of the Covid-19 pandemic. They highlight that before the pandemic, pressure on the system was already reducing access to NHS services and making waiting times longer. Covid-19 has made the situation significantly worse due to the need for heightened infection control practices, rising levels of staff sickness and burnout, the cancellation of routine care and redirection of staff. Enabling services to recover will be challenging given these ongoing pressures and real-term budget cuts for the NHS this year. The article examines the impact of the pandemic on waiting times relating to: General practice Elective (planned) care Diagnostic testing Cancer care A&E Ambulance
  14. Content Article
    Serious case reviews from the past twenty years have repeatedly highlighted the absence of professional curiosity as a core failing in the actions of health and social care professionals. However, 'professional curiosity' as a term is still not commonly used amongst healthcare professionals and there is no shared understanding of its meaning. This paper published by Diabetes on the Net, critically reviews current research surrounding professional curiosity and discusses the main themes. explores how inter-agency working can promote professional curiosity by supporting healthcare professionals to overcome the complex barriers that may arise during safeguarding cases. It discusses the role of Children and Young People’s diabetes clinics as an ideal platform for utilising the benefits of professional curiosity.
  15. News Article
    More than ten million patients are on “hidden” waiting lists for NHS care. There are 6.7 million patients on the official NHS waiting list, which includes people who have been referred by GPs for hospital treatment such as cataract or hip and knee surgery. However, data released by health service trusts under freedom of information laws suggests there are 10.3 million further patients who need follow-up care, illustrating the scale of the task facing the NHS. Louise Ansari, national director at the patient group Healthwatch England, said: “Waiting a long time for treatment can put a huge strain on patients and their loved ones. But this can be so much worse when there is ‘radio silence’ from the NHS, leaving people uncertain if their referral has been accepted, unclear about how long they may have to wait and often feeling forgotten.” Read full story (paywalled) Source: The Times (30 August 2022)
  16. Content Article
    This study in BMJ Open examines the impacts of the four episodes of industrial action by English junior doctors in early 2016. The authors looked at the impact of the strikes on A&E visits, outpatient appointments and cancellations, admitted patients and all in-hospital mortality. The study concluded that industrial action by junior doctors during early 2016 had a significant impact on the healthcare provided by English hospitals. It also found that t here were regional variations in how these strikes affected providers, and that there was not a measurable increase in mortality on strike days.
  17. Content Article
    In this opinion piece in The BMJ, consultant radiologist Giles Maskell examines changes to the ways in which medical imaging is used in the health service. He states that imaging used to be ordered, when necessary, at the end of a diagnostic process, whereas now many doctors are asking for scans before they will see a patient for the first time. The article highlights some of the implications of this shift in practice, including on screening service capacity and on the interpretation of test results.
  18. News Article
    An LMC has created template letters to help practices reject secondary care workload dumping, including rejected referrals and requests to complete work on behalf of hospital trusts. Cambridge LMC said it developed the tools amid a growing ‘tsunami’ of secondary care workload transfer into general practices. One template letter tackles the rejection of a referral ‘on the basis that a proforma was not enclosed or completed in full’. It points out that the GMC requires GPs to refer when they ‘believe it is necessary to do so’ and that their ‘contractual obligations make no mention of a requirement to complete a proforma’. Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told Pulse that ‘we need the temperature to rise on the understanding around pressures across general practice’. Read full story For more information on the issues raised, read a blog by Patient Safety Learning about the patient safety risks of rejected outpatient referrals. Source: Pulse (19 August 2022)
  19. News Article
    Patients at trusts with long waiting lists should no longer think ‘they have to go to their local hospital’ for outpatient appointments, but should instead be offered virtual consultations elsewhere in the country where there is greater capacity, Sir Jim Mackey has told HSJ. The NHS England elective chief said recent efforts to abolish two-year waiters by July had meant a “very big” surgical focus. However, the next phase of the elective recovery plan would see a major shift of emphasis onto reducing the wait for outpatient appointments. Sir Jim said: “Providers have been split into tiers again with tier one having national oversight and tier two, regional oversight. Behind that we will be pairing up organisations so that organisations with capacity can help those with the biggest challenges from a virtual outpatient perspective. He added: “There still is a lot to work through [on virtual outpatients], we’re going to be testing the concept… We need to work through how all the wiring and plumbing needs to work. For example, what happens if the patient needs a diagnostic locally, having seen a clinician virtually in another part of the country? “It would be great also to try and stimulate more of a consumer drive on this – encouraging patients to ask about virtual outpatients when the waits locally may be too long, so they don’t just think they have to go to their local hospital. I think this could really help shift the model if we can get it right.” Read full story (paywalled) Source: HSJ, 9 August 2022
  20. Content Article
    With the number of outpatient hospital appointments in England recently as high as 125 million per year and a huge elective care backlog following the Covid-19 pandemic, patient-initiated follow-up on outpatient appointments has been touted as a potential solution in appropriate cases. But can it free up much-needed capacity while maintaining quality of patient experience and outcomes? As the NHS begins to expand its use of the approach, the NIHR RSET research team has conducted a first review of the available evidence.
  21. Content Article
    The Department of Health today published the 2021/22 Inpatient, Day Case and Outpatient Hospital Statistics for Northern Ireland. Analysed by HSC Trust, hospital and specialty, these Hospital Statistics publications outline: the number of inpatient and day case admissions. the number of attendances at consultant led outpatient services in Northern Ireland during 2021/22.
  22. News Article
    A large acute trust is carrying out a major expansion of patient-initiated follow-up (PIFU) appointments, which is said to be “the most ambitious” project of its kind in the NHS. Norfolk and Norwich University Hospitals Foundation Trust has categorised around half of its outpatient follow-up list as “possible or probable opportunities” for patient-initiated pathways. NNUH wants to make PIFU the “default model” for patients who are not on active pathways, and where it is safe to do this. Its project is being closely watched by national leaders and has already drawn praise from NHS England’s director of elective recovery, Rob Stones, during a webinar last month. It is understood to be more ambitious than NHSE’s official PIFU pilot projects. NHSE’s elective chief, Sir Jim Mackey, has said he wants to expand PIFU pathways on an “industrial” scale. Read full story (paywalled) Source: HSJ, 29 July 2022
  23. Content Article
    Specialty referrals—when a clinician refers a patient to a specialist for evaluation or treatment—are on the rise in the US. Despite the introduction of electronic health records (EHRs), the referral process is often hindered by lack of clarity over roles, communication breakdowns, workloads and variations in requirements among specialists. These difficulties can lead to missed or delayed diagnoses, delays in treatment and other lapses in patient safety. This guide from the Institute for Healthcare Improvement offers recommendations that aim to help standardise how primary care practitioners activate referrals to specialists and then keep track of the information over time. It describes a nine-step, closed-loop process in which all relevant patient information is communicated to the correct person through the appropriate channels, in a timely manner.
  24. News Article
    A big rise in GP referrals being deferred because no appointment slots are available, in the wake of the covid pandemic, has sparked concerns that patients are going undiagnosed and missing out on the correct treatment. Outpatient referrals are typically classed as having an “appointment slot issue” when no booking slot is available within a timeframe specified by the provider, under the NHS e-referral system. The latest NHS Digital figures, analysed by HSJ, show the number of ASIs was 52% higher in March 2022 than February 2020 — up from 245,582 to 374,209. The statistics suggests appointment slot issue accounted for 77% of all bookings in March 2022, 26% of all referrals and 19% of bookings and referrals combined. In February 2020, this was 32%, 17% and 11% respectively. The Royal College of GPs told HSJ there was a risk of patients “simply disappearing” off lists if the issue was not properly managed, while charity Patient Safety Learning said the issue was a “growing problem” which NHS England must “urgently investigate”. Patient Safety Learning chief executive Helen Hughes said: “NHS England needs to urgently investigate, quantify the scale of the problem and take action if we are to prevent these capacity problems resulting in avoidable harm for patients. “Patients who cannot access outpatient services may deteriorate further while they wait for care, and it is not clear that in these cases there is the appropriate support available for them. There is also the potential for patients to be misdiagnosed and receive inappropriate treatment without specialist involvement, and the potential of a postcode lottery of care emerging for some conditions.” Read full story (paywalled) Source: HSJ, 6 May 2022 Read Patient Safety Learning's blog: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs
  25. Content Article
    Hospitals are rejecting GP referrals for investigations and outpatient treatment at an increasing rate. In this blog, Patient Safety Learning looks at the patient safety issues caused by rejected referrals and lack of capacity in outpatient specialities. We call for the government and NHS leaders to investigate the problem and take action to mitigate risks to patient safety.
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