We’re transforming our outpatient services – here’s why and how

A visit to hospital can be daunting, even when coming in as an outpatient. Outpatient services at Imperial College Healthcare NHS Trust see around one million people a year, at a wide range of clinics. We launched our outpatient improvement programme in spring 2015 as one of our key organisational initiatives. Clinical director of central outpatient services Dr Frances Sanderson explains how this programme is beginning to deliver real benefits for patients.

Going in to our 2014 Care Quality Commission (CQC) inspection, we knew that our outpatient services were significantly challenged and they were a focus for improvement. The inspection findings – we were rated as inadequate for outpatients – acted as a catalyst and helped us to develop a more strategic response that encompassed immediate changes as well as longer term solutions to the more deep rooted issues.

Our ambition is to move towards a new model of care to support people with their health and wellbeing, and deliver the care they need, when and where it’s most effective.

The programme

The outpatient improvement programme has a 3-5 year timescale – as such, we took some time to fully scope it, drawing on staff, patient and stakeholder views, input and involvement. There are five broad themes of activities:

  • Improving customer care: We are developing a patient service centre that acts as a central point of contact for all outpatient clinics and will make booking an appointment much simpler for patients and GPs
  • Redesigning and refurbishing our clinics: Our waiting areas are a key focus  we are creating larger waiting areas with more seating and light
  • Improving patient and GP communications: ensuring clear, up-to-date and consistent information in appointment letters for patients and clinic outcome letters for GPs
  • "Going digital": giving patients the choice of email communications including booking online, the introduction of digital referral triage processes for staff; and making patient records available digitally in clinic
  • Improving feedback routes and access to data: ensuring that the staff who run our clinics have the tools to continuously improve the services we offer.

Progress so far

Eighteen months in, there is still more to do, but we believe we are beginning to deliver significant improvements, sustainably.

By improving the content and delivery of our appointment letters, introducing an expanded text and voicemail reminder service and rolling out the centralised patient services approach, we are starting to reduce the number of missed appointments – down from 17 per cent in September 2014 to 11 per cent this October. We want to bring that number down further, primarily through our new patient service centre, supported with £4 million from Imperial College Healthcare Charity, due to open in the new year.

With a further £3 million from our Charity, we have embarked on a redesign and refurbishment programme for a range of outpatient clinics on all of our sites except St Mary’s – where we are progressing plans for a new purpose-built outpatient facility. The first development – a new ear, nose and throat (ENT)/ophthalmology clinic has just opened at Charing Cross Hospital, with much more spacious and welcoming waiting and treatment areas.

We have rolled out electronic patient records and we are now uploading increasing numbers of documents, such as referral letters, as well as clinical information, such as medicines prescribed. This means that when you see a doctor in an outpatient clinic, they will have your relevant records to hand and can update them directly as part of your consultation.

What happens next?

We have a busy schedule of developments in train for the coming year, building on all of the work to date. This includes the launch of the patient service centre, completing the clinic refurbishment programme and further implementation of new technology to help improve our processes. And, through Trust-wide planning, we are looking at ways of better balancing capacity and demand, including through the development of new models of care, such as community-based clinics integrated with GP services.

We’re also planning an outpatient improvement ‘collaborative’ for the new year – working with a core group of ten multi-disciplinary teams, with patient and GP involvement too, to focus on making improvements at a clinic and service level. We especially want to find ways of reducing the number of clinic cancellations and improving patient experience.

Please keep a look out in our hospitals and clinics for our expanding poster series explaining the key improvements and what they mean for you. And we are always on the lookout for patients who want to help us with our improvement – by acting as a ‘lay’ representative on project teams or just coming along to a one-off service re-design session. Please email involvement@imperial.nhs.uk if you are interested.