Updates from the Outpatients taskforce.

Re-starting clinics

Over 140 applications have been reviewed and returned.

Most of them can start at 75% of their agreed numbers of face to face patients for the first few weeks. This will allow us to monitor and establish safe flows of patients through the clinics.

We have learnt from the application review and can draw more conclusions about the service we can provide:

  • Some specialties have thought through their clinic processes and pathways and are delivering their services by remote media for 80-90% of their activity.
  • Consultants are sharing one face to face consult room, if they only have the need for few face to face consultations. They leave to do their phone calls elsewhere.
  • It takes about 1.3 times the space and workforce to deliver the same activity.
  • Involved services, like Xray, phlebotomy and pharmacy, have limited capacities and will affect patient flow. This increases footfall and crowding in the building.
  • Some services do not have a clinic space as some are used by Covid-related Trust activities.

To ensure equitable and risk-based access to clinic facilities, we have agreed a framework to allow divisions and directorates to plan for their services:

Space will be limited

  • Specialties are expected to plan for at least 40% of their activity to be by remote media
  • Each service will be allocated about 70% of their pre-Covid rooms to run their clinics
  • Clinic rooms must not be used for phone consults. For clinicians who cannot work from their offices, we are identifying rooms which cannot be used for face to face and we are trying to set up a call centre. We will provide you with more information about access to these facilities.
  • We are hoping to allocate remaining capacity to services without a home or a need for more space using risk based criteria.

Imaging

Services, which traditionally use walk-in imaging, must state this in their application and this has to be agreed with imaging. We will help with developing pathways for patient visits. External/mobile imaging facilities will become more available in the coming weeks and the use of those can be arranged in such pathways. Please communicate with imaging and Ally Perkins of the Outpatients team if you need a higher volume of imaging to support your remote clinics. They will be able to help to set up pathways to support you.

Phlebotomy

CUH Outpatients and GP surgeries can only deliver about 40% of their usual activity. Our GPs have noticed a significant increase of requests for blood investigations over the Covid-19 period. This is now amounting to an unmanageable amount.

Please be aware that GPs should not be asked to perform blood tests to support CUH clinic appointments.

We are trying to address this with several measures:

  • HCAs in clinics are being trained to take blood in clinic
  • A drive-through phlebotomy service is very likely to be available within the next few weeks. We will inform you when set up and about the ordering process.
  • We are talking to the GP federations to establish longer-term solutions.

Advice and Guidance and Clinical Assessment Service (CAS)

All referrals by GPs to CUH are being dealt with by the Advice and Guidance service.

The benefits are that we can communicate with GPs and support them in the management of their patients and that we can control our own resources. This has also lead to a major increase in triaging demand on our clinicians and the admin services behind the processes involved due to the technical limitations of the system.

GPs have given positive feedback about the speed and quality of most CUH advice and guidance but have highlighted some specialties, whose replies are less helpful. Please consider that a good reply may make a big difference to the patient and your colleague GP.

Also, once permission is given to refer, patients are now placed by the GP in ERS (referral platform) on a ‘parking’ clinic slot in mid 2021. Once the referral is received, the clinical team triages the patient. The booking teams then place the patient into an earlier slot depending on the clinical risk allocated by the clinician.

In the coming weeks this will be replaced by a Clinical Assessment Service (CAS). This is a better technical platform and had already been used by Gynaecology prior to Covid-19.

It allows clinicians to give guidance to GPs but also to triage and convert the referral into an appointment.

Services will be approached to establish how they want to use the benefits of this more efficient system.

Triaging and prioritisation

Services are asked to use the Epic functions for prioritisation at the time of triaging of new referrals, follow-up appointment ordering, PreOPA triaging of their clinics and for review of their waiting lists.

Epic tipsheet – Priority Stratification for Clinicians.