Comment: Don't panic, prioritise

DrDoctor helps more than 30 NHS trusts be more efficient through the use of backlog-busting technology. In this article, BBH speaks to company chief executive, Tom Whicher, to find out how the NHS is tackling a backlog of nearly 20 million patients and sets out four simple ways it can bring that number down

DrDoctor's technology is helping the NHS to address the backlog of patients which has built up as a result of the COVID-19 pandemic

The backlog in NHS care is top of the political agenda.

Additional funding has been promised to help clear a situation that NHS Providers has said could take up to five years to deal with.

And DrDoctor’s own figures suggest that the appointments backlog could be close to 20 million.

The impact of people seeking care who weren’t able to be treated because of the pandemic, and those who refrained from seeking treatment, will be immense.

In some areas, the NHS is responding with sensible pragmatism, by putting patients at the heart of the backlog recovery.

Clinicians are risk stratifying patients according to their clinical need, and providing them with a choice on how, and when, they can be seen

It is prioritising, rather than panicking, as it addresses the backlog, with technology that makes the most of patient involvement in the delivery of care.

And there are four simple ways that NHS organisations can use to reduce the impact of the appointments backlog.

1. Ask people if they still need to be seen

Healthcare providers are asking patients via text or email if they still need to be seen.

Many people know themselves that they no longer need an appointment, if their circumstances, or symptoms, have changed.

We have seen how one health organisation cut its gynaecology waiting list by 12% in just a few days by asking this simple question. it used a blended approach of digital and traditional means to cut this down by 27% in just a few weeks.

And, for trauma and orthopaedics; gastroenterology; and ear, nose and throat patients, the same approach has wiped 6% off the waiting list.

As trusts become more adept at the approach, with more-targeted messages, we expect this impact to grow.

In terms of effort per impact, this is hard to beat.

2. See the people that need to be seen

Clinicians are risk stratifying patients according to their clinical need, and providing them with a choice on how, and when, they can be seen.

Patients who are highly activated in their care, for example those with a long-term condition, may be best suited for Patient Initiated Follow Up (PIFU) appointments.

The impact of people seeking care who weren’t able to be treated because of the pandemic, and those who refrained from seeking treatment, will be immense

In this way, under the direction of the hospital, patients monitor their symptoms and initiate an appointment online when they feel it is required.

Chelsea and Westminster NHS Foundation Trust has introduced PIFU appointments with cardiology patients as part of its test bed programme.

This has seen fewer patients turn up at A&E for care.

More-complex patients may need more-active monitoring by clinicians and hospitals are setting up remote monitoring and contacting patients when their symptoms flag the need for further investigation.

Tom Whicher

Ongoing monitoring and ‘seeing on need’ at Nottingham University Hospitals NHS Trust (NUH) has reduced the risk of patient deterioration and provided a much-improved patient experience.

3. Ask people to go online

NHS trusts are asking patients to manage their healthcare interactions online, for example with video consultations and using a more-digitised appointments process.

NUH has already surpassed the national target to reduce face-to-face appointments by 30%.

With 42% now virtual, the trust is looking to make 50% of its appointments virtual in the next few weeks.

This releases capacity for staff managing ‘traditional’ access routes, who can focus their efforts on those patients who most need to be seen.

Even before COVID-19, we saw repeatedly the benefits of engaging patients digitally in their care

And it means no patient gets left behind on this digital journey.

Patients are also opting to receive digital letters, which is also freeing up staff capacity.

In four trusts that have taken our digital letters solution, around 70-80% of patients have opted to go digital.

Email and text appointment reminders are also helping to reduce Did Not Attends (DNAs), so that clinical capacity can be better utilised.

At the Royal Orthopaedic Hospital in Birmingham, this has reduced the DNA rate by 35%.

And patients can also complete their pre-assessment forms online, further freeing up staff time.

4. Check people are receiving the same high standard of care

The digitisation of the delivery of healthcare should not come at the expense of quality or safety.

We have seen the use of patient reported outcome measures soar by 585% as clinicians look to measure the impact of remote care.

This looks set to stay; as it should, as we all want to get this right.

Ultimately, this may even enable the move to an outcomes-based healthcare system.

Now we can more clearly show staff, patients, and policy makers that there is light at the end of the tunnel, and that digital patient engagement is critical to backlog recovery

The NHS backlog is a huge task, but it need not be complicated or cause panic.

There are many examples of how the NHS is solving the problem in partnership with patients.

Even before COVID-19, we saw repeatedly the benefits of engaging patients digitally in their care.

Now we can more clearly show staff, patients, and policy makers that there is light at the end of the tunnel, and that digital patient engagement is critical to backlog recovery.

Long term, this may be the catalyst we need to solve some of the underlying structural challenges with how we currently deliver care, and move to a much more needs-based, patient-centric care system.

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