Fewer patients attend acute sites

Below are the change ideas that can be tested to reduce the number of patients attending acute sites. The change ideas listed here will be updated as more learning is generated as part of the Access Learning System. Select change ideas to test based on what you have learned whilst understanding your current system.  


Types of services offered

Identify and stop pathways with low impact on positive patient outcomes or may contribute to patient harm

The Scottish Access Collaborative’s ‘Effective and Quality Interventions Pathways’ (EQuIP) toolkit can help services identify alternative pathways when existing interventions or treatments have been proven to be unnecessary (or unhelpful). The toolkit provides examples and templates for implementation which have been tested by other Boards and, explains how these can be tailored to suit teams needs.


Creating digital opportunities to engage with patients 

To overcome restrictions on face-to-face appointments, a team developed a new prehabilitation programme to support cancer patients remotely. The team have successfully provided nutritional advice, exercise, and psychological support to patients.


Mobile testing 

To help reduce the need for a patient to visit the hospital for a blood test, a new mobile phlebotomy service has been created by Guy’s and St Thomas’ NHS Foundation Trust. This new service provides blood tests in the comfort of a patient’s home. 


Demand for consultations

Implement Active Clinical Referral Triage  (ACRT) to clinically vet referrals

Created by the Scottish Access Collaborative (SAC), the ACRT toolkit helps staff enhance their vetting to triage patients more efficiently through reviewing all relevant patient records (such as imaging and lab results). This differs from traditional vetting where referrals from primary care are added to waiting lists for a face-to-face appointment. Instead, services identify more appropriate referral outcomes (and reduce waiting times) such as:

  • enhanced patient information leaflets
  • advice to GPs
  • attend anywhere appointments, and
  • onward referral to more appropriate clinics.

Read more in this case study which highlights how the University Hospital Hairmyres Gastroenterology team were able to use ACRT to reduce clinic demand by ~50% and still service the same volume of new patient referrals as before.  


Validate waiting list to remove patients no longer needing an appointment

By reviewing current waiting lists it is possible to re-evaluate the need for patients to attend face-to-face consultations. Teams may wish to consider the following:

  • What other appointment options are there (video/telephone)?
  • Do they need to be seen now?
  • Could they self-manage with further educational resources?

A team in NHS Ayrshire and Arran used pre-clinic telephone consultations to assess the patient, prioritise and identify urgent suspected cancer cases. 


Patient educational resources

Have you considered what information can be given to patients during their consultations to support self-management at home? For example, the Health and Care Video Library created by Health and Care Innovations (HCI) includes over 600 videos.  

An app has been created by Calderdale and Huddersfield NHS Foundation Trust, to enable patients to take control of their pre and post operative exercise, as part of the new digital orthopaedic surgery pathway.


Remote appointments

Use telephone and NHS Near Me

Telephone and NHS Near Me calls can be used for appointments as well as pre-clinic telephone consultations and enhanced vetting. A team at NHS Tayside used enhanced vetting and a new telephone clinic to reduce their waiting lists


Online platform or apps for receiving results and self-management of long term conditions.

Services can reduce the risk of exposure by providing alternative means for patients to log details about their treatment or receive results. At Chelsea and Westminster Hospital NHS Foundation Trust patients have access to an app on which only NHS staff have access to the information the patient submits. It allows service users and staff to communicate remotely. 


Off-site alternatives

Remote or off-site delivery of clinics

A team in NHS Greater Glasgow and Clyde, repurposed an existing mobile clinic space to see patients in the community.

To prevent risk of infection, a team at NHS Forth Valley created a new drive-thru clinic appointment system outdoors. 


Referral guidance to reduce demand

A team in NHS Greater Glasgow and Clyde reviewed referral guidance and created new information guides for staff within care homes. This allowed them to avoid a spike in referrals during COVID-19. 

Additionally, services may wish to review details provided above about ACRT. In the case study we show how the team provided advice and guidance to GPs to reduce demand.


Your change ideas

If you have developed your own change ideas that could be included in this change package then get in touch through the feedback form or by emailing us at his.accessqi@nhs.scot