A UK report recently issued from the Royal College of Physicians (RCP) entitled "Outpatients: the future – adding value through sustainability"  describes the need for a re-appraisal of how outpatient care functions and discusses how this might be brought into line with current patient expectations and lifestyle.
The RCP report highlighted the cost to both patients and the NHS that the traditional outpatient care system incurs. It describes that one in five attending pensioners reportedly feel worse flowing their outpatient appointment due simply to the stresses incurred by the journey itself and explained that if A&E were excluded, remaining hospital activity would consist primarily (85%) of outpatient appointments and yet DNA's (where a patient Did Not Attend) occur roughly a quarter of the time.
Assessments of value (cost vs outcome) and sustainability (enduring consequences) are needed, says the report, and moving forwards the volume of face to face consultations might be substituted, where appropriate, with more modern alternatives while patents might be encouraged to take control of their care, becoming partners in all relevant decisions, with trusts being flexible enough to facilitate this. At the heart of these changes is suggested adoption of modern technology and other innovations including telephone consultations, skype, apps and online tools, text messaging and remote monitoring systems.
5 key recommendations were determined in this report focusing on improvement being measured in terms of population and system effects (as well as individual outcomes), remuneration of trusts for clinical value, national guidance creation in relation to outpatients, collaboration with organisations/charities in order to develop resource signposting and finally guidance being established regarding partnerships with the voluntary and community sectors.  
Professor Stephen Powis National medical director of NHS England is quoted here as calling for "honest conversations within our local health communities – with patients, with colleagues in primary care and community services, and with professionals across different specialties and providers – to ensure that reforms are in the interests of all concerned and sustainable in the long term. This report provides an excellent basis on which to base those conversations, and on which to build the consensus for change."
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