Ep 29. How the health sector can improve patient pathways, Rachael Millward, Sue Moore, and Rob Music

National Health Executive Podcast

With the brunt of winter fast upon us, and the flurry of increased demand that has followed, the NHS is drawing upon all its nous and creativity to see how it can generate efficiencies and optimise patient pathways.

With that in mind, National Health Executive sat down with three leading industry voices to discuss how we can arrest the backlog and keep patients flowing in and out of the door this winter.

Communication

One of the more notable things that was addressed during our discussion was the necessity of not just communication but effective communication – that doesn’t just apply to patients either, it also includes colleagues and sector partners too.

Sue Moore, the Director for Outpatient Recovery and Transformation at NHS England suggested that by collaborating with the NHS’s various regional bodies, Primary Care, the Royal Colleges, and sector providers, the healthcare industry has an opportunity to identify what ‘best practice’ is – or, at the very least, what best practice is not.

This is one of the “key areas” being focused on by biopharmaceutical research and development experts AbbVie, according to its Head of Medical Affairs for Immunology, Rachael Millward.

She said: “One of the key areas that we are trying to establish is how do we, as an organisation, partner better with the NHS?”

Because it is only through that communication and collaboration with providers and stakeholders that the health sector can establish what best practice – the best practice that will help serve the seven million people who are currently waiting for treatment.

One of the best examples that was mentioned was Super September, where providers are given the chance to trial small initiatives and ideas that might help expedite treatment pathways.

What Sue and her colleagues at NHS England found was that, during the two-week period in which the Super September scheme ran, over 66,000 more patients were seen and “significant” inroads were made into the lists housing the very longest waiters.

Sue explained: “Some people did some work on Did Not Attends, some people did work on the validation of lists and asking patients if they still wanted or needed that appointment, there was work on looking at how clinics are constructed and the templates [they used] – a whole range of things.”

But the question is, how do we take initiatives like Super September and scale them up? How do we ensure the best and most effective methods are adopted nationally? Because as is said a lot in this industry, and indeed many times during our discussion, there isn’t one thing that is going to solve everything; there is no panacea for patient backlog and treatment pathways – one size does not fit all.

The answer: That word again – communication.

One of the first things Sue noted on the podcast was what the Outpatient and Recovery Programme is focusing on. Two of those things were ensuring that patients see the value of even going to an appointment in the first place and the other centred around exploring and developing the idea of creating clinical environments where patients, who are medically suitable, can initiate their own follow-up appointments. Or in other words a patient-initiated follow-up (PIFU).

The key to achieving success in both those areas goes hand-in-hand – by empowering patients and seeing them more “as a partner”, as Rob Music the CEO of The Migraine Trust alluded to, the health sector can help patients see the value of appointments and give them more ownership over their care.

By doing this, and providing patients with the requisite education around the relevant diseases, clinicians can help the public optimise their own treatment pathways and reduce delays and waiting times.

Technology

Guidance around how best to implement PIFUs was released by NHS England back in May 2022; the document detailed everything from how many specialities to start up with and what specialities are even suitable, all the way to the benefits and potential pitfalls of this method of care.

This is also something AbbVie have been able to help other providers with. Rachael explained that when they collaborated with some rheumatology services and explored the potential of PIFUs, a lot of services said they still needed help developing and then establishing their PIFUs.

She said: “It became very clear to us that we needed to help services connect together, so that they could understand what the pitfalls are, what the hurdles are, and what are the things you need to consider in order to set up a PIFU service that would be successful, whilst also mitigating some of the challenges.”

It was then flagged how a lot of “myth busting” needs to be done around PIFUs and how some staff’s notion that they would be overwhelmed by an avalanche of triggered appointments isn’t actually true – or doesn’t necessarily need to be true.

As long as you have the right technological infrastructure in place, implementing successful, effective, and efficient PIFUs is “not that difficult to do,” according to Sue.

Sue explained: “There needs to be a really effective tracking mechanism to enable patients to trigger an appointment, if they meet the criteria. But similarly for the clinical team to know that a patient has triggered an appointment.”

Sue added: “For me, this is about confident patients, clinical leadership, and being really respectful that not one model fits all.”

In support of that mantra, Sue’s Outpatient Recovery and Transformation Programme worked in conjunction with the Getting It Right First Time team to produce outpatient guidance for the top 10 by-volume specialties that identifies, by subspecialty, which people would be suitable for PIFUs and which people would not.

Sue commented: “It collates all the best practice guidance of really where you start, and what we've said on an individual basis is we're very happy to support and make the connections for people to do that.”

Final thoughts

Rachael Millward

· There isn’t one thing that is going to solve everything – it will be a range of different factors and measures that combine to achieve the desired outcome.

· But we also need to be clear on what those desired outcomes are and understanding that patients present in very complex ways.

· PIFU and education around things like remote monitoring will be a key part of that solution.

Sue Moore

· Providers need look at the entire pathway when exploring innovations and they need to employ an enthusiastic approach and drive themselves forward to implement the necessary change.

· Communicate, collaborate, and congratulate.

· Use technology for the right reasons and when it is necessary, rather than for the sake of it.

Rob Music

· More people need to be trained as specialist GPs and nurses, drawing upon some of the best practice in the community.

· Better leadership from ICSs in terms of their service design and how patients interact and ...

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