The Modern Outpatient 90 Day Challenge NHS Greater Glasgow & Clyde January 2018

GGC Outpatients 20 Adult OPDs 380,000 New OPs 780,000 Return OPs

The scale of the challenge

Funded projects General Surgery: See and Treat clinics Urology: Nurse-led Bladder Dysfunction clinic Urology: Andrology clinic Respiratory: AHP-led PE/DVT service Neurology: Nurse-led Headache clinics Neurosurgery: Spinal Surgery clinics

-5 % -3 % General Surgery 5 year trend 1 year trend New Outpatients, 2012-2017 5 year trend -5 % 1 year trend -3 %

General Surgery See and treat clinics Patients from South Glasgow with excessive waits for hernias and lumps/bumps, inc POA and return appts to be seen in evening clinics at Glasgow Royal Infirmary Diagnostic and inpatient costs to be funded locally 13 weekly Monday evening clinics 2 Consultants x 12 patients each 312 patients Staffing per session: 2 Consultants, 2 Band 5 Nurse, 1 Band 2 Nurse  Cost £20,800

General Surgery See and treat clinics 30 patients already attended clinics in week 1 42 patients booked into weeks 2/3 330 further slots left to be booked until the end of March. 32 patients removed through the process of making contact to offer slots and patients advising the appointment is no longer required

Urology New Outpatients, 2012-2017 5 year trend 2 % 1 year trend 0 %

Urology Nurse-led bladder dysfunction clinic Weekly nurse led bladder dysfunction clinic for new Urology patients This patient group is currently being seen exclusively at consultant clinics, therefore this will release new appointment slots on consultant clinics for more specialist work/USOC referrals 1 clinic per week over 12 weeks 75-80 patients Band 6/7 Nurse, with consultant supervision for first four clinics Cost £4,900

Urology Nurse-led bladder dysfunction clinic Vetting processes agreed and amended Clinical protocols developed First four clinics are on Trak and 64 patients have been vetted into them

Urology Additional andrology clinics This has been identified as a specific area of pressure with patients waiting over 12 weeks to appointment due to having only one consultant offering this sub-specialism (and lack of services in surrounding NHS Boards) 1 clinic per week 15 slots per clinic 180 patients Consultant session Nursing support and sundries Cost £11,000

Urology Additional andrology clinics 15 additional clinics booked on Trak Patients for first four clinics have been confirmed Slight increase in WL from 62 (Dec) to 70 (Jan) Average waiting time has reduced from 103 days (Dec) to 64 days

11 % -4 % Respiratory Medicine 5 year trend 1 year trend New Outpatients, 2012-2017 5 year trend 11 % 1 year trend -4 %

Respiratory Medicine DVT/PE Nurse Practitioner clinic Develop the DVT/PE service to reduce wait for new patients Medical Nurse Practitioner clinic to be established to run in parallel with consultant clinic to reduce wait for patients and free up consultant slots for more complex work 15 clinics 8 patients per clinic 120 patients Band 7 MNP Cost £4,900

Respiratory Medicine DVT/PE Nurse Practitioner clinic Additional clinics set up on Trak Medical staff in place for parallel clinics Service postponed to start in Feb due to illness of appointed postholder

23 % 2 % Neurology 5 year trend 1 year trend New Outpatients, 2012-2017 5 year trend 23 % 1 year trend 2 %

Neurology Nurse-led Headache clinics Due to a recent retiral and absence headache, patients are waiting longer than clinically indicated for headache treatments (injectable therapies) This will allow patients to be vetted, seen and treated by an experienced CNS 3 clinics per week 6 patients per clinic 216 patients Band 7 CNS Cost £6,000

Neurology Nurse-led Headache clinics 4 injection clinics per week have been established Backlog of new patients waiting for first appointment and assessment has been fully appointed 24 patients seen in weeks 1-2

40 % -6 % Neurosurgery 5 year trend 1 year trend New Outpatients, 2012-2017 5 year trend 40 % 1 year trend -6 %

Neurosurgery ESP/Consultant Spinal Surgery clinics Due to increasing demand and a recent absence, OP waits for spinal surgery have increased  Patients will be seen in weekend clinic either by Spinal ESP (1) or consultant (3), as per vetting 4 clinics per week 6 patients per clinic 288 patients Band 8A ESP 3 consultants Cost £25,000

Neurosurgery ESP/Consultant Spinal Surgery clinics 30 patients already attended clinics in weeks 1/2 36 patients booked into weeks 3/4 Further clinics being arranged for Feb and March No patients removed through the process of making contact to offer slots, as the service had already undertaken a telephone clean-up of all patients with long waits