1. Stockport Together Outpatients Business Case Clinical Engagement Event
26th June 2018
Karen Snelson – Senior Responsible Owner (SRO)
Andrea Stewart – Senior Programme Manager
With you. For you. About you

2. Agenda Welcome and Introduction to Outpatient Business Case
Why we are redesigning Outpatients
How we are redesigning Outpatients
Proposed pathway redesign
Overview of our priorities
Priority 1 – Active support for patients to take more control, including shared decision making, self-care and provision of advice
Priority 2 – Support for clinicians in clinical decision making
Priority 3 – Appropriate clinical triage of referrals
Priority 4 – Alternative mechanisms to traditional follow-up appointments and support to enable discharge from out-patient clinics
Priority 5 – Identifying out-patient activity that can be stopped
Any questions

3. Why we are redesigning Outpatient services
We want to:
Develop more streamlined and joined up pathways for patients to ensure that patients are seen in the right place by the most appropriate health professional to meet their needs
Reduce inefficiencies to relieve pressure across the system
Delivering a whole system change across organisational boundaries to provide appropriate, preventative and proactive support at each stage of the patient journey
Change organisational infrastructures to support a more joined up system
Reduce financial pressures – aiming to achieve a 38.5% reduction in OP activity over next 3 years
Scale of the challenges and risks are recognised but…
transform the ways that outpatients are delivered in ways that will be better for patients

4. How we are redesigning Outpatients services
We will:
Work with key players across the patient journey
Obtain feedback from patients – initial consultation informed the development of the business case
Identifying how to change the way key players work, interact and behave eg.
Patients
Clinicians across the health system – primary and secondary care
Admin/non-clinical processes
Test out proposed changes to see if they work, learning what does and doesn’t work

5. Proposed Outpatient Pathway redesign

6. Priorities that we have committed to deliver
PRIORITY 2:
Support for GPs in clinical decision making
PRIORITY 1:
Active support for patients to enable them to take more control of their condition
PRIORITY 3:
Appropriate clinical triage of referrals and diagnostics
PRIORITY 4:
Alternative mechanisms for traditional appointments and support to enable discharge from outpatient clinic
PRIORITY 5:
Identifying outpatient activity that can be stopped

7. PARTIAL BOOKING WITH OPT-IN
Priority 1 - Active support for patients to enable them to take more control of their condition including decision making and self-care and provision of advice
PARTIAL BOOKING WITH OPT-IN
Gives more control to patients to:
Confirm that they want the appointment
Let us know their availability when best for them to attend
Incorporates protocols and exclusions to ensure patient safety
Benefits:
Known to reduce DNAs where used elsewhere
Reduces rework of rearranging appointments

8. Priority 2 – Support for GPs in clinical decision making
ADVICE & GUIDANCE FOR GPs
Allows GPs to contact consultants for specialist advice before resorting to a referral to the hospital
Enables the GP to provide better manage patient care
Avoids the need for the patient to attend a potentially unnecessary hospital appointment
Recognised as best practice so a national Advice & Guidance standard has been introduced
Trust aims to provide advice by phone and electronically for written requests using the national e-Referral System
Lots of informal advice is already provided but we want to provide a more systematic approach
Phone advice is already provided in 7 specialities
E-referral system is being tested in Diabetes and Lipids and the findings will inform further roll-out
Benefits:
Avoids patients being unnecessarily referred to secondary care or referred to the wrong clinic
Strengthens primary care knowledge and understanding
Enables referrals to focus on those that require specialist input

9. Priority 3: Appropriate clinical triage of referrals and diagnostics
MANDATED VETTING OF GP REFERRALS INCLUDING ADVANCE DIAGNOSTICS AND POST-REFERRAL ADVICE AND GUIDANCE
Aims to ensure that referrals are reviewed by a specialist before an appointment is arranged so that:
Any advance tests needed can be arranged before the patient attends their appointment
The referral is allocated to the right clinic
If the there is no benefit to the patient attending a hospital appointment the GP can be provided with appropriate advice as to how best to manage patient care
We are exploring how best to implement in specialties
Analysing data re. time required to vet
Potential mechanisms in terms of time and systems that could be used - being tested in Diabetes and Lipids and the findings will inform further roll-out
Benefits will include:
Avoids wasted or unnecessary appointments for the patient
Avoids multiple appointments if the patient attends their appointment only to be told they need various tests and investigations
Improves the patient experience when they come for their appointment

10. Priority 4 – Alternative mechanisms for traditional appointments and support to enable discharge from outpatient clinic
INTRODUCTION OF CALL/RECALL INFRASTRUCTURE INCLUDING NEIGHBOURHOOD PHLEBOTOMY
Exploring potential for a monitoring system for patients with long-term conditions in the community so that they don’t need to attend multiple appointments unnecessarily
Benefits
Reduces face-to-face appointments and will improve patient waiting lists
Avoids patient attending hospital for follow-up monitoring blood tests
Enables more timely intervention where necessary
TELEPHONE FOLLOW-UP CLINICS
Extending provision of telephone follow-up appointments to more specialties
Reduces the need for the patient to attend a face-to-face appointments unnecessarily and improve patient waiting lists
Potential to reduce facility and support costs associated with OP appointments
FIT & STRAIGHT TO TEST FOR URGENT LOWER GASTRO-INTESTINAL (LGI) PROBLEMS
Offer FIT test option to GPs for suspected LGI cancers
Develop straight to test colonoscopy pathway for LGI referrals that meet certain criteria
Reduces patient wait times and potential for 2WW breaches
Reduces requirement for some patients to undergo a potentially unnecessary colonoscopy

11. Priority 4 – Dr Gill Burrows / Dr Karen McEwan / Karen Moran
Alternative mechanisms for traditional appointments and support to enable discharge from outpatient clinic
2018/19 PRIORITY PROJECTS:
FIT & STRAIGHT TO TEST FOR 2WW LGI
Improve pathway to offer FIT test option to GPs for 2WW LGI
Develop straight to test colonoscopy pathway for LGI referrals that meet certain criteria
Benefits
Reduces patient wait times and potential for 2WW breaches
Reduces requirement for some patients to undergo a potentially unnecessary colonoscopy
Reduces pathway cost
Linkages and Dependencies
Contractual agreement with CCG re. tariff etc

12. Priority 5 – Identifying outpatient activity that can be stopped
INCREASED CONTROL OF REFERRALS FOR PROCEDURES OF LIMITED CLINICAL VALUE VIA THE INTRODUCTION OF BLUETEQ SYSTEM
Blueteq is a Greater Manchester (GM) IT system to provide a more robust mechanism for managing GP referrals of limited clinical benefit
Areas of focus where Stockport is an outlier in GM include Bunionectomy, Tonsillectomy, Insertion of Grommets
Where appropriate referral criteria are met, system issues a code and CCG will only pay providers for procedures with a valid code
Benefits
Reduces unnecessary patient referrals for procedures that will have little benefit to them
Provides more robust audit trail and rigour
Could enable funds saved to be redirected to higher priority areas

13. Thank you and any questions…