NHS England enacts winter pressures protocol as services feel strain

NHS England has kicked into gear a series of recommendations to help hospitals handle increased pressure on services, activating the NHS Winter Pressures Protocol.

This includes extending the deferral of all non-urgent inpatient elective care to 31 January, deferring day-case procedures and routine outpatient appointments and advising clinical commissioning groups to temporarily suspend sanctions for mixed sex accommodation breaches.

The measures, put forward by the National Emergency Pressures Panel (NEPP), come in response to strains being felt by NHS services across the country over the festive period.

The Fifteen Steps Challenge – Quality from a patient’s perspective: A toolkit for clinics and outpatient settings

This document from NHS England, focuses on clinics and outpatient settings, is part of a suite of toolkits for The Fifteen Steps Challenge, which helps to explore patient experience and are a way of involving patients, carers and families in quality assurance processes.

Annual outpatients activity report

NHS Digital has published a report on hospital outpatient activity, 2016/17.

The figures include the number of outpatient appointments and attendances, as well as appointments where the patient did not attend over the past financial year, broken down by age and gender.

Elective care: model access policy

The purpose of this policy from NHS England is to ensure all patients requiring access to outpatient appointments, diagnostics and elective inpatient or day-case treatment are managed in line with national waiting time standards and the NHS Constitution.

Ambulatory emergency care: reimbursement under the national tariff

This HFMA briefing aims to create a better understanding of the current approaches taken to the recording and reimbursement of ambulatory care. HFMA surveyed its members to establish some basic benchmarking information to see how the guidance is currently applied.

New outpatient tariffs and the impact on ophthalmology – managing change for commissioning services

The RCOphth has issued a further response to the December 2016 statement on how the new outpatient tariffs place unnecessary pressure on departments to discharge patients at a time when there is no suitable community care option available.

Patients coming to harm due to delays in treatment and follow-up appointments

The Royal College of Ophthalmologists has published a surveillance report of patients coming to harm due to delays in treatment and follow-up appointments.  The research, conducted through the British Ophthalmological Surveillance Unit (BOSU), found patients suffering permanent and severe visual loss due to health service initiated delays.

Barrett's oesophagus patients attending hospital: Baseline clinical, patient history and quality of life data from BOSS and AspECT

European Journal of Surgical Oncology, November 2016, Volume 42, Issue 11, Page S223-S224

From 2005 to 2011 two large UK studies recruited 6327 evaluable patients with Barrett's Oesophagus attending hospital clinics. Baseline clinical, patient history and quality of life data was collected prior to randomisation and this rich dataset is the basis for this abstract.

UHCW Research: Jankowski, Janusz

Hospital Outpatient Activity data published

"Hospital Outpatient Activity 2015-16" describes the quantity and type of outpatient activity carried out. It also includes detailed tables at national level as well as broken down by hospital providers.

The report from NHS Digital does not examine statistics relating to admitted patient activity, or attendances at A&E departments, although these are available separately.

Changes to the NHS Patient Survey Programme following consultation

Following feedback earlier this year, the CQC will be introducing changes to the NHS Patient Survey Programme from April 2017, including:

• Further investigate incorporating questions on people’s outpatient experiences into the inpatient survey.
• Extending the A&E survey to include all relevant urgent care services such as urgent care centres and not just A&E departments.
• Carrying out the children and young people's survey every two years.
• Piloting a brand new survey for community health services to help address the current gap in information about people's experiences of care in the community.
• Increasing the frequency of the A&E and maternity surveys so that they run at least every two years, instead of every three years.
• Exploring how the CQC can give providers early access to their survey results in advance of the publication of the national findings to allow them to develop their action plans sooner.
• Trialling how to improve response rates from NHS trusts across all of our surveys.

Outpatient endometrial ablation

Answer to the question, 'What is the evidence regarding the safety, and patient satisfaction of outpatient endometrial ablation (EA) techniques?' added to the RCOG Query Bank.

A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

Annals of the Royal College of Surgeons of England98.7 (September 2016): 468-474. 

Introduction In 2013 our hospital introduced an in-hours, consultant-led, outpatient acute surgical clinic (ASC) for emergency general surgical patients. In 2014 this clinic was equipped with a dedicated ultrasonography service. This prospective cohort study evaluated this service before and after the introduction of ultrasonography facilities. 

UHCW Research: Pidgeon, T E; Shariff, U; Devine, F; Menon, V 

Transfer of some hospital outpatient services to general practice is effective, but costs are unclear

This NIHR funded review strengthens evidence that transferring some hospital outpatient services to general practice is beneficial and liked by patients. It highlights a number of promising service configurations that could make NHS outpatient care more efficient. These include giving GPs direct access to some diagnostic tests and investigations giving specialist advice to GPs by phone or email. Where expertise is available, the report found that GPs performing minor surgery and providing long term follow up for chronic diseases were also effective.

This was an update to a 2006 review, which had similar findings. However, economic evaluations of the strategies were rarely reported, and community care may not necessarily be cheaper. If care is transferred to the community, the views of patients and the effect on overall costs are also important considerations.

From the NIHR Dissemination Centre

Project to improve management of painful bowel condition wins 2016 Shared Learning Award

In Somerset, NICE’s recommendations on IBS were not being carried out in several areas. This was leading to unnecessary referrals to hospital outpatient clinics, inconveniencing patients and wasting money.

Consequently, Somerset Gastroenterology Flexible Healthcare Team decided to improve the diagnosis and management by better aligning practice with NICE guidance.   After 3 years, the team found that there was a 5% reduction in appointments among 16 to 45 year olds likely to have IBS.

Just launched: a nationwide drive to digitise outpatient services

NHS Improvement has launched a nationwide drive to digitise outpatient services to improve patient experience and care quality – which could also help save the NHS up to £2.9 billion.

Its Digital Outpatients programme aims to help NHS providers accelerate work from first principles, support the sharing of best practice, unblock barriers to uptake and deliver solutions that have been built with patients and clinicians from the start.