As the number of people on the NHS waiting lists continues to make headline news, it’s time to rethink how we deliver outpatient services and take steps to modernise a patient care system fit for the 21^st century. 

The traditional methods of delivering secondary care were already under pressure before the pandemic struck, with a growing acknowledgement that there was a pressing need to find new and more efficient ways of working. This need for a radical overhaul was highlighted in the NHS Long Term Plan which placed digitalisation of the system at the heart of its vision.

COVID-19 may have kickstarted the movement towards a greater acceptance by clinicians of using technology to improve the referral pathways and speed up the delivery of care, but now it’s time to move the dial even further.

Identifying those who need care quicker 

For those patients living with potentially life-shortening illnesses like cancer, any time spent waiting for diagnostic tests and appointments can feel overwhelming and stressful.

The latest NHS performance figures show that cancer waiting times of over 62 days have doubled since before the pandemic, with the trend set to continue. This uptick has been attributed as partly due to a greater number of urgent GP referrals during 2021/2022.

However, it is possible to shorten the wait and identify those who are at greater risk can be seen quicker.

Greater use of technology within the medical sector could improve patient outcomes by providing the opportunity to improve the quality of interactions between GPs and patients and between GPs and clinicians.

Fast-tracking the more urgent cases 

 Let’s take the example of Ipswich Hospital Dermatology Service. As COVID-19 restrictions started to lift and outpatient demand increased, the service began to experience significant pressure on the 2WW pathway. This was due to the sheer volume of cases.

However, of the 10,000 urgent referrals reviewed by consultants in person, only 40% were subsequently kept on the 2WW pathway. The remaining 60% were reduced in severity to routine referrals.

It was evident that there was a pressing need to find a way to identify and separate the two groups ahead of hospital attendance, so that the more urgent cases could be fast-tracked and the less urgent seen in a slower time.

What the Trust needed was a robust solution that would enable earlier triage, keep the final referral decision with the GP and stay compliant with the Cancer Waiting Times Guidance.

To help them solve the problem, they used a new triage process that is fully integrated with the GP referral system, eRS. The technology simplifies the referral process and allows GPs to upload high-quality images of skin lesions for review by consultant dermatologists. Once reviewed, any suggestion to downgrade a case to a routine referral instantly alerts the relevant GP, who can then decide to accept or reject the advice with cases triaged for a 2WW appointment being automatically booked on the system.

The impact for Ipswich Hospital Dermatology Service was immediately clear with 93% of cases between an initial four-month period triaged in one day and 50% of the total number downgraded to either a routine referral or not requiring hospital treatment.

Rebalancing the healthcare system

These remain tough times for those working in the NHS, where once they battled against a virulent virus, now they struggle to combat the record-breaking waiting lists. The vast number on the lists underlines the huge pressures the NHS is under and the potentially long road that lies ahead before the situation eases. It is not an easy journey to travel and the personal cost to clinicians, staff and patients should not be overlooked.

Technology, of course, is an enabler and not a panacea but digitising clinical pathways does offer the right treatment plan to help reduce the burden on the NHS and reduce the wait for patients.

About the author 

David Ezra is managing director at NEC Rego, formally known as Vantage Health, a healthcare technology company that provides technology-driven solutions to the NHS as part of its mission to help transform the way healthcare is delivered. David is passionate about the role of technology to support healthcare and is driven by creating solutions that help reduce the demand for secondary care services.