SNP cuts face-to-face hospital appointments

Hands-on consultations for minor issues may soon be a thing of the past. Photograph: Greg Macvean

Doctors are to encourage patients to look after themselves at home and face-to-face appointments will be replaced with “virtual” consultations.

Drastic changes to NHS outpatient services are being planned across Scotland to speed up waiting times and take the burden off cash-strapped wards.

Around 10 per cent of routine referrals are being cut to save £17 million annually on “wasted appointments”, and ease pressure on Scotland’s hospitals.

Every year 1.5 million new patients are seen in outpatient departments across the NHS in Scotland to undergo tests, scans and consultations. Outpatients attend a hospital for treatment but do not stay there overnight.

A raft of new measures are now being introduced that will significantly change patients’ experience of health care. The scheme was revealed by senior NHS managers at a recent meeting of board chief executives.

The move will see many patients with minor or long-term conditions told to “self care” at home instead of coming into hospital for monitoring.

There will also be “virtual clinics” where consultants review patients’ results via teleconference or patients speak to doctors on the phone.

NHS managers admit the scheme is “radical” and health campaigners last night warned patients could suffer if they do not see doctors face-to-face, where medics can better assess patient’s health.

But pressure is growing on outpatient departments to treat millions of patients each year against tightening budgets and staff cutbacks. Scotland’s outpatient departments see 4.6 million appointments each year including 1.5 million new patients.

The scheme was presented to a meeting of Scottish NHS board chief executives last year by Elaine Mead, of the NHS Transforming Outpatient Services team.

Mead, who is also the chief executive of NHS Highland, said: “The Scottish Government and NHS Scotland are taking further steps to really transform outpatient services across Scotland.

“This is to ensure patients get the most appropriate treatment or advice as close to home as possible and within the fastest possible timescale.

“There is scope for considerable improvements by harnessing new technologies, making best use of all clinical skills and better direct communications with patients.

“Bringing all these things together will mean that people will only need to attend outpatients if they really need to, and if they do they will be seen quicker. It will cut down on wasted appointments and better meet the needs of patients.”

Boards have already begun rolling out the plans. Examples will include patients with simple fractures being discharged straight from Accident and Emergency departments with information leaflets and splints they can remove themselves instead of having a cast put on which requires several appointments with a clinic.

Patients with long-term health conditions will be given information about how to look after themselves via smartphone apps instead of face-to- face appointments. Consultants have also begun discharging patients by phone instead of calling them in to check them over and discharge them in person.

The move will also see some referrals for scans made directly by GPs, instead of consultants. And patients with back or knee problems will be told to make appointments with physiotherapists themselves instead of being assessed by a doctor first.

Patients will be seen by more specialist nurses in areas such as ophthalmology, orthopaedics and spinal injuries instead of being seen by consultants.

However critics, including politicians and patient groups, are sceptical about the changes and fear care will suffer.

Margaret Watt, chair of the Scotland Patients Association, said: “There is no substitute for face-to-face appointments between a patient and a doctor, no matter how inconvenient it may be, to help doctors diagnose whether something is wrong.”

Scottish Conservative health spokesman Jackson Carlaw said: “It has to be motivated by the right reasons, and not because the SNP is failing to hit its targets.

“Any action like this must be backed by the recruitment of more nurses to ensure those who do need attention can receive it promptly.”

A Scottish Government spokesman defended the move saying the Government was “investing in innovation” in NHS Scotland to “help us bring the future of health care closer”.

He said:“We want to ensure patients are treated as close to home as possible, and that is why we have been working with health boards to transform outpatient services across Scotland, to ensure they get the most appropriate treatment within the fastest possible timescale.

“Through a number of projects, clinicians, managers, patients and the public are working together to redesign outpatient services so that people get the right care and information, from the right person, at the right time and in the right place for them.

“We are already on this road, with some patients using technology – such as digital TV’s, computers, smartphones and telephones – to get support and advice on how to monitor and manage their own conditions.”

NEW CARE AT ARM’S LENGTH

CASE STUDY 1: Patient attending A&E with a minor fracture to the wrist or ankle.

OLD: Patient would have been referred from A&E to the hospital’s fracture clinic. A plaster cast is applied which then requires a further outpatient appointment for removal. This was the case for 100% of patients.

NEW: Patient would be given a splint at A&E which they can remove themselves alongside self-care and advice leaflets.

Their case notes are reviewed by a consultant at a “virtual clinic”. Patient does not need to attend but is telephoned by a senior nurse and either discharged over the phone or referred to a specialist if needed. Further appointments are only necessary for around one third of patients.

CASE STUDY 2: Patient with non-urgent cardiac problems such as irregular heartbeat.

OLD: Patient attends outpatient appointments at hospital for ECG.

NEW: Patient goes to local GP surgery equipped with ECG machine which feeds information straight to hospital consultant.

CASE STUDY 3: Patient with coeliac disease, a lifelong intolerance to gluten that requires a special diet.

OLD: Patient would attend several outpatient clinics for advice with consultant and dieticians.

NEW: Patient can download specially-designed app with advice from doctors, patient stories and cooking tips.