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The Digital Outpatient Appointment Follow Up demonstrator project commenced in 2018 and aimed to evidence the impact that the use of digital questionnaires can have on reducing unnecessary follow up outpatient appointments. This project was a collaboration between Nottingham University Hospital NHS Trust (NUH), DrDoctor as the supplier and HIEM providing support for the project.
NUH initially introduced bespoke digital questionnaires, designed by clinicians, for two clinical specialities (oncology and breast services) to establish the need for outpatient follow up appointments. This approach enabled them to reduce unnecessary appointments, create efficiencies and improve the patient experience, reducing the time taken for a patient review from 15 minutes to 2 with the digital pathway. The initiative has grown significantly since then and is now used in around 70 pathways across a wide number of specialties.
Following this successful implementation, HIEM provided funding to two fast follower sites during 2021 to further test this approach using other digital platforms and applying this way of working to further clinical specialities.
The fast followers selected were University Hospitals of Derby and Burton NHS Foundation Trust with Patient Knows Best (PKB) and Northamptonshire General Hospitals and Kettering General Hospitals with Islacare. Both sites delivered successful roll outs of their solutions and all three continue to operate as ‘business as usual’.
An evaluation conducted on the NUH/DrDoctor collaboration which was delivered in 2022 showed the success of the project and estimates that up to 17% of face to face follow up appointments could be replaced with digital.
The NHS Long Term Plan sets out the ambition to reduce face-to-face outpatient appointments by a third, using digital technology to provide convenient ways for patients to access advice and care. The Plan suggests that 30 million trips to the hospital would be saved and over £1 billion a year in new NHS expenditure would be averted if this reduction was made.
In the East Midlands, local commissioners set a target of 25% reduction in outpatient activity, with the majority of this concentrated on follow up activity.
By determining if appointments are necessary (from the perspective of both the patient and the clinician) and removing unnecessary follow up appointments, clinicians are able to see more patients therefore reducing waiting lists.
A reduction in outpatient appointments can also greatly benefit the patient. For example, the average cost of attending an outpatient appointment for a patient is £50 or more (based on the HMRC’s research paper ‘costing customer time’). There are also other factors such as the reduction in stress and anxiety related to hospital appointments and reducing the risk of infection to immunocompromised patients.
NUH initially introduced bespoke digital questionnaires, designed by clinicians, for two clinical specialities (oncology and breast services) to establish the necessity of outpatient appointments.
Patients who are suitable and happy to collaborate with their clinician through a digital pathway are able to complete the questionnaire at home, allowing the clinical team to establish whether they need to see the patient. Questionnaires are provided through the DrDoctor platform which allows an automated approach, enabling clinicians to review completed questionnaires from patients.
Impacts have been positive across each pathway within the two specialities and NUH used these results to develop a business case (supported by HIEM) to secure Trust board support to roll-out the approach further, leading to almost 70 pathways now being live with the solution.
The fast follower sites of University Hospitals of Derby and Burton, Northampton General Hospitals NHS trust and Kettering General Hospitals NHS trust have seen success with their roll outs with two different suppliers, Patient’s Know Best and Islacare. UHDB have gone live in 6 specialties and NGH/KGH in 20 as of 2023, with plans to continue to engage and onboard.
The approach has been successful with staff and patients and formed a key part of each Trust restoring services following the pandemic.
Results of the project differ between different clinical specialities and Trust sites. However, NUH has seen impressive results, including:
In 2019, the project was shortlisted in the Digital Patient Services Initiative category of the Health Service Journal (HSJ) annual awards. More recently, in September 2020, the project was runner up at the annual Patient Experience Network (PENNA awards).
As an outcome of this demonstrator and to share ideas and learnings with other trusts interested in digital outpatient appointment management, we facilitated a sharing event that showcased case studies of digital outpatient systems/processes across the region.
Access the event content
Read the case study
Read the project evaluation conducted by Unity Insights
HIEM have produced a dedicated FutureNHS collaboration platform, sharing tried and tested digital questionnaires across a range of specialities, as well as an implementation toolkit to support others wishing to design, develop and implement their own digital questionnaires.
For more information about the digital outpatient project, or to have a conversation on how we can support, email: This email address is being protected from spambots. You need JavaScript enabled to view it.