As of December 2024, Referral to Treatment (RTT) figures show that there are approximately 6.2 million patients waiting for treatment (7.4 million cases). NHS England reports that over 80% of all elective pathways conclude without patients needing hospital admission. Therefore, eliminating outpatient backlogs is a critical enabler for NHS Trusts to achieve the targeted 72% of patients waiting no longer than 18 weeks for a first appointment by March 2026.

On a positive note, while the focus has historically been on theatres, the dial appears to be shifting. Over the last 12 months, we have seen a significant shift in energy to Outpatients improvement, demonstrating the NHS’s recognition of the pathway-wide benefits that can be achieved by optimising Outpatient processes, using patient-initiated follow-up (PIFU), and increasing remote monitoring through patient engagement portals (PEPs).

It is encouraging to see further focus on a move to handle elective care appointments via the NHS App. The target of 70% of all appointments being scheduled via the App is a significant step in modernising outpatient planning and patient communication routes.

With ongoing work through the GIRFT ‘Further Faster’ programme, options to help Trusts think differently about patient management in Outpatients are developing.

However, many of the aims and guidelines outlined in the national priorities are not new, such as enhanced Advice and Guidance implementation, 12 weekly validations for new appointments, increased usage of PIFU, and so on. While it is evident that these are the correct measures, the effectiveness of the guidance is dependent on their implementation.

How can Outpatient departments meet these targets?

The Outpatient service is vast. With so many improvement initiatives requiring distinct, speciality specific focus, making a tangible impact can feel like a mammoth and overwhelming task. However, some quick wins and important fundamentals can make a significant difference:

1. Know your capacity and demand

A robust understanding of expected demand streams and what resources you have to manage this can focus the mind on priority areas and bring everyone on the same page about the size of the gap that needs to be closed. Developing this baseline position and modelling the impact of various improvement opportunities helps teams visualise the art of the possible and think differently about the changes they could make.

2. Use what you have

Maximise the utilisation of your clinic slots. Direct your booking teams to vacant capacity ensuring the proper structures and digital tools are in place to fully re-book slots. Dig deeper into DNA rates to identify groups of patients, driving them and involve patients in solutions.

3. Maximise estate

Many clinic rooms sit unused, simply due to a lack of oversight. Implement governance processes to identify and reallocate these spaces to departments most in need.

4. Pilot new initiatives

With strong foundational practice in place, clinical and operational teams can feel confident in adopting more innovative changes to manage patients differently. Support champions to push ambition through the clinical body and demonstrate the art of the possible with well-planned pilots that can swiftly spread and scale into business-as-usual procedures.

5. Ensure the right resource is used

Empower specialist nurses, physician associates and allied health professionals to take on more responsibilities and free up consultant time for the most complex patients. You could also consider using chatbots and virtual assistants to answer common patient queries.

Although the Government has set out ambitious plans for the NHS and elective care in general, there is still a long way to go to achieve its targets. Working collaboratively, progress is being made, and it’s positive to see that in December alone, the NHS carried out 1.33 million treatments, up 6.5% on 1.25 million the year before.

We see on many of our programmes how hard NHS and Outpatient teams are working to care for patients and, like us, they understand that, at the end of the day, each one of the 7.4m cases is a person, not just a statistic