1. Outpatient Pathway Transformation in NW London
Presenter: Nicola Burbidge, Chair Hounslow CCG

2. The purpose of Programme is to transform Outpatient services to
provide the right specialist advice, in the right place at the right time,
overall improving quality,
decreasing costs and
increasing patient and staff experience (e.g. not wasting patient and clinician’s time)

3. Our work is underpinned by the following statements
Reducing patients’ need to travel to hospital
Revisit (and ? Redesign) the entire clinical pathway (patient/primary care/secondary/tertiary care)
Implement the clinical pathways across eight CCGs and four Trusts
Apply new system-level financial models (not tariff) to incentivise transformation
Investment will be required at outset to support co-design of pathways and implementation with expected £14m return on first five specialties

4. The Programme has succeeded in obtaining sector-wide buy-in
Trust Chief executives, 2 CCG Chief Officers and the STP Chair
NW London Provider Board
Trust Medical Directors and CCG Chairs
NW London STP Clinical Board
CCG Chairs, Chief Officers, CFOs, NW London Directors
NW London Collaboration Board
Trust and CCG representatives
NW London CFOs

5. The data shows a number of opportunities across the high cost/high volume specialties
Specialty
Cost of activity £ms
Number of attendances (First + FUP)
High follow up ratio, variance from national benchmark
Value of follow ups being followed up in third year after first attendance
Value of first attendances with previous attendance (same specialty and trust) in previous 90 days
% of non-GP referred First attendances
Potential lost income due to DNAs
(as per tariff)
Gynaecology
£18.6m
114,477
£0.0m
£1.8m
£0.5m
35%
£2.2m
Trauma & Orthopaedics
£16.0m
124,195
£1.7m
57%
£2.7m
Cardiology
£14.7m
76,987
£3.0m
46%
£2.4m
Gastroenterology*
£11.4m
67,675
£1.5m
£0.1m
23%
£2.5m
Urology
£11.1m
57,054
£0.2m
34%
£1.9m
Ophthalmology
£10.7m
95,543
£7.6m
£2.0m
Dermatology
£9.3m
83,611
15%
Clinical Haematology
£9.1m
47,200
£3.2m
£1.3m
Paediatrics
£8.1m
35,785
£0.8m
£0.3m
49%
ENT
£8.0m
65,926
£1.1m
19%
£1.6m
Most costly specialties
£117.0m
768,453
£3.5m
£24.6m
38%
£19.7m
* Slides 4 and 5 show Additional analysis undertaken in terms of referral/conversion growth (gastro) from external sources
Key: Top five specialties in each category highlighted in green
Source: Business Intelligence, Strategy and Transformation team, NW London CCGs

6. Clinicians have come together to lead transformation on behalf of the sector in five specialties
Specialty
Trust Clinical Lead
GP Lead
Cardiology
Jamil Mayet (Imperial)/ Dr Richard Grocott-Mason (Brompton) + 3 others
Neville Purssell (Central London CCG) + 7 other GPs
Trauma and orthopaedics
Jacquie Waterman (Hillingdon)
/Lower Limb consultant [TBC] + 3 others
Ian Berstein (Ealing CCG) + 7 other GPs (all CCGs)
Gynaecology
Liz Owen (ChelWest) + 3 others
GP lead + 7 other GPs (all CCGs)
Gastroenterology
Ana Wilson (London North West)
+ 3 others
Dermatology
Claire Fuller (ChelWest) + 3 others
Note full names of nominees (Consultants/GPs) expected by 12 October.

7. Large number of stakeholders across the sector are engaged with this Programme

8. This work will build upon established work on referral guideline development in Primary Care

9. This work will build upon established work on referral guideline development in Primary Care

10. Groups will explore further drivers to transformation

11. Clinical and managerial leads have committed to deliver at pace
Thank you