Abstract
BackgroundThe cost-effectiveness of the traditional outpatient model for specialist care provision is increasingly being questioned in view of the changing patient needs, workforce challenges and technological advances.SettingThis report summarises two RCGP London events showcasing new ways of delivering care for long-term conditions.QuestionsWhat are the alternative approaches to the traditional outpatient model and do they have common themes? What are the challenges and opportunities of these new models of care?MethodsPresentation of examples of new ways of long-term condition care delivery and round-table facilitative discussion and reflection on the challenges and solutions around service re-design and implementation, the commissioning and funding of new models of care, the facilitation of system-wide learning and the collection of data for evaluation.ResultsDifferent ways of delivering care for people with Chronic Kidney Disease (CKD) and Chronic Obstructive Pulmonary Disease (COPD) were presented. Most of the interventions included virtual clinics (during which patient care was reviewed by a specialist remotely without the need for a face-to-face consultation), improved communication between primary and secondary care clinicians, an element of referral triage/prioritisation, the use of trigger tools to identify people at risk of deterioration, patient education and a multi-disciplinary approach.Discussion-conclusionsDifferent models to the traditional outpatient long-term condition care are feasible and can result in improvements in the quality of care and staff satisfaction. However, such initiatives require careful planning, close collaboration between health care professionals and allocation of appropriate resources and training within primary care. There is also a need for systematic evaluation of such pilots to assess their cost-effectiveness and their acceptability to clinicians and patients. This requires systematic collection of population level data, agreement on the key outcomes for evaluation and a commitment of all stakeholders to sharing learning and resources to enable continuous improvement.
Highlights
The cost-effectiveness of the traditional outpatient model for specialist care provision is increasingly being questioned in view of the changing patient needs, workforce challenges and technological advances
Different models of accessing specialist advice and care include the partial substitution of hospital clinicians with primary care clinicians, the relocation of hospital specialists to the community or virtual setting and joint working between specialists and primary care practitioners via shared care arrangements and consultation liaison [4]
City Health Conference workshop The workshop that followed the renal symposium aimed to disseminate the learning on renal outpatient transformation, present alternative approaches for the management of a different long-term condition (COPD), explore the similarities and differences of these different ways of delivering care and identify common themes
Summary
The traditional model for accessing non-urgent specialist advice and care within the NHS is via face-to-face consultations within outpatient hospital clinics. Outpatient transformation has been prioritised by commissioners and providers in many areas across the UK and alternative ways of delivering outpatient services are increasingly being explored and piloted [5,6,7,8,9,10] The development of such new approaches is important in the area of long-term condition (LTC) management where demand is rising due to an aging population and multi-morbidity [11]. City Health Conference workshop The workshop that followed the renal symposium aimed to disseminate the learning on renal outpatient transformation, present alternative approaches for the management of a different long-term condition (COPD), explore the similarities and differences of these different ways of delivering care and identify common themes
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