The end of the outpatient problem?

Abstract

The outpatient problem in Britain has had a long and troubled history, but at last a solution seems to be in sight. This is happening by default rather than by design, not by tackling head on problems of delayed access to consultation for patients suffering from pain, anxiety, or illness, nor by substantially reducing unnecessary reattendances by patients, but by redefining the problem out of existence. The main problem has always remained constant: too many patients being seen in a system of care in which responsibility for outpatients is disputed by different sectors of the medical profession. Towards the end of the 19th century general practitioners believed that too many people were gaining access to voluntary hospitals too easily. In 1887 one and a half million visits were recorded for the total London population of four million. General practitioners became reluctant to refer patients to hospital in case they were poached by consultants and they formed an association to try to stop abuse of the system. The inauguration of the NHS and the formalisation of the referral system unified the profession to a certain extent, but outpatients have remained in a contested terrain. The problem of repeat attendances by outpatients was revived in the 1960s and 1970s with the publication of a survey funded by the Nuffield Provincial Hospitals Trust. Articles in the medical press deplored the thousands of season ticket holders. Through no fault of their own these patients were …