Scottish Government

Introduction

The Centre for Change and Innovation ( CCI) is supporting the NHS to spread good practice and to increase its capacity for sustainable improvement. It works alongside the National Waiting Times Unit to improve patient access, a key challenge for the NHS over the next few years. This document provides a brief overview of the CCI Outpatient Programme from 2003 to 2006. It is not intended to be a comprehensive analysis of all local projects but rather an overview of the type of service improvements supported by the programme, its impact and associated learning points.

The Outpatient Programme was designed to support NHS Boards to meet and sustain the Partnership for Care (2003) target that no patient should wait more than 26 weeks for an outpatient appointment by December 2005. Over the lifetime of the programme NHSScotland implemented streams of work to support comprehensive service improvement (redesign) projects across a range of specialties, affecting millions of patients.

Key Outcomes

Demand: The Programme has influenced demand on acute outpatient services through the production of 80 Patient Pathways for local adaptation and adoption, the introduction of referral management services and development of community-based outpatient services.

Activity: By introducing Patient Focussed Booking ( PFB) to an annual equivalent of 1 million appointments the Programme has reduced Did Not Attend ( DNA) and cancellation rates positively impacting upon variation in clinic activity.

Capacity: The Programme has helped to identify and release bottlenecks in service capacity through training 171 alternative staff to see patients in new ways, creating in excess of 48,000 patient appointments a year. Capital funding also supported the release of capacity.

Queue: For the first time an outpatient waiting list exists in every NHS Board and is being actively managed by those in medical records. PFB is helping to ensure that routine patients are being seen in date order and principles of queuing theory (routine patients being seen fairly "in turn") are being applied.

Culture: The beginning of a culture shift towards further measurement and better informed planning of services is being seen across NHSScotland.

Further details of the outcomes of individual projects and further resources are available at:www.cci.scot.nhs.uk

Specialty-based projects

Key: Redesign Projects Capital Projects

NHS Orkney ran a joint redesign project between Dermatology, ENT and Orthopaedics, supported by a capital project. They also began implementation of the Patient Pathways and, with NHS Grampian, set up a neurological tele-medicine link.

NHS Shetland have implemented a number of the Patient Pathways and Patient Focussed Booking for both new and return appointments.

NHS Western Isles ran redesign projects in ENT and community based Orthopaedics, supported by a capital project. They have also implemented a number of Patient Pathways and Patient Focussed Booking for new appointments.

Cross-specialty projects

Key: Redesign Projects Capital Projects