Surgical backlogs, theatre capacity, and inpatient flow have long dominated the conversation around NHS elective recovery. However, with over 7.57 million patients on the waiting list (as of December 2024) and more than 80% of elective pathways concluding without hospital admission, it’s clear that the real opportunity lies elsewhere: Outpatients.

The outpatient backlog isn’t just a symptom of wider system pressure; it’s a pivotal lever for tackling it. If the NHS is to achieve its long-term recovery ambition of 92% of patients starting treatment within 18 weeks by 2029, then outpatient transformation must move from the periphery to the centre of strategy.

A Shift Worth Noticing

The good news? We’re starting to see that shift take root.

Trusts across England are investing in new outpatient models, from expanding Patient-Initiated Follow-Up (PIFU) and embedding remote monitoring tools to ramping up digital engagement via the NHS App, which is now targeted to handle 70% of all appointment bookings.

Programmes like GIRFT’s Further Faster provide a platform for clinically led redesign, supporting specialities to challenge traditional patient follow-up, triage, and discharge models.

But while the ambition is clear, success lies in delivery—and delivering change in Outpatients is no small task.

So, How Do We Actually Transform Outpatients?

Outpatient is not one service; it’s many. The complexity is real, but so is the opportunity. Below are five practical tips that NHS leaders and operational teams can use to drive tangible change:

1: Know Your Demand. Know Your Capacity.

It sounds simple, but many outpatient services still lack a reliable view of real-time capacity or expected demand across specialities. Investing time in building this baseline allows for smarter prioritisation, clearer accountability, and better modelling of the impact of change initiatives.

2: Use What You Already Have

Clinic utilisation remains one of the most significant areas of waste. Direct booking teams to underused slots and use digital tools to ensure clinics are fully rebooked after cancellations. Dive into DNA data: Who’s not attending, and why? The answer often leads to immediate, low-cost interventions.

3: Maximise Your Estate

Underused clinic rooms remain a hidden bottleneck. The issue isn’t always space; it’s oversight. Introduce light-touch governance to regularly review room usage and reallocate space to specialities most in need. Quick win, significant impact.

4: Pilot and Scale

You don’t need to start with a system-wide redesign. To lead the change, begin with small, measurable pilots, like virtual group consultations in dermatology or asynchronous follow-ups in MSK and back clinical champions. With clear metrics and strong governance, successful models can scale quickly into business-as-usual.

5: Widen the Workforce Lens

Not every patient needs a consultant. Enable specialist nurses, AHPs, and physician associates to lead appropriate clinics. Introduce virtual assistants or chatbots to manage routine enquiries. Freeing consultant time for the most complex cases increases productivity and often improves patient experience.

More Than Numbers

In December 2024 alone, the NHS carried out 1.33 million treatments, up 6.5% from the year before. That progress is driven by the relentless effort of clinical and operational teams who know that behind every case is a real person, not just a statistic.

Outpatient transformation isn’t just a checkbox in a national plan; it’s an opportunity to reshape how patients experience care, how clinicians manage demand, and how the NHS will sustain itself in the future.

By focusing on Outpatients, we’re not just catching up—we’re moving forward.