1. Portfolio/Number/Name:H/T 4 Outpatient Programme/Specialty Redesign Projects |
2. Programme/Activity: The redesign of orthopaedics, ENT and dermatology, will pilot services that help bring the demand, capacity and activity of services closer into balance. In many projects service redesign includes training alternative staff such as nurses, physiotherapists, podiatrists and GPs to diagnose and treat patients traditionally seen by a consultant. |
3. Efficiency | 3.1 Current target; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 0 | 0 | 0 |
Time | 0.897 | 0.897 | 0.897 |
3.2 Efficiencies delivered; £m | | 2005-06 | 2006-07 | 2007-08 |
Cash | 0 | - | - |
Time | 1.249 | - | - |
4. Accountable Officer for delivery | Kevin Woods |
5. Project Manager | Stephen Gallagher |
6. EGDD Portfolio Manager | Rowena Simpson |
7. Description of efficiency and actions to be taken | 7.1 What is the efficiency improvement? How will the efficiencies be made? By training other staff to appropriately take on some clinical tasks previously conducted by consultants this frees consultants to provide the specialist services that they are trained for. In some circumstances care being provided by an alternative practitioner such as a nurse will mean that that service is provided at less expense. For example a consultant appointment costs approximately £65 where an appointment cost at a clinic run by another health professional is approximately £31. The Centre for Change and Innovation ( CCI) projects are piloting 27 Allied Health Professional( AHP) and nurse led clinics. If each of these new services do only 2 clinics a week for 42 weeks this would save £771,120 on the cost of the equivalent numbers of patients being seen by a consultant. 10 GP with Special Interest clinics are also being piloted. At one clinic a week this will save £126,000 over the course of a year based on the cost of a GP appointment of £35 per appointment (based on 10 appointments per week in a 42 week year). Where review or follow up patients are seen by alternative staff this will allow consultants to see more new patients in the same amount of clinics. |
7.2 What are the main actions that are needed to secure the delivery of this efficiency improvement? NHS Boards need to be fundamentally signed up to supporting and developing their staff to explore new roles and different ways of working. |
8. Associated costs | 8.1 Are there any development or redundancy costs associated with the delivery of this efficiency? This project was embarked upon to secure better patient access and was not embarked upon on efficiency grounds alone. Consequently any development costs will not be netted off the time releasing saving. |
9. Measurement | 9.1 What are the inputs that will be measured? The inputs measured are the number of patients referred to a given specialty. Because the NHS does not work "just in time" these patients are selected from waiting lists. Data collected throughout these projects will include numbers of patients seen by alternative practitioners and referral rates. We will incorporate financial saving into the final review. |
9.2 What are the outputs that will be measured? The outputs are the number of patients seen by an alternative health professional other than a consultant as would previously been the case. |
9.3 What is the baseline for inputs and outputs? The Outpatients' Programme established specific projects to test and implement new roles in its redesign of long wait specialties and community outpatient services projects. The baseline in 2004/5 is zero contacts and projects came on stream incrementally throughout 2005/2006. |
10. Quality cross-check | 10.1 What quality indicators are being used to ensure that quality of service is maintained or improved? Local NHS Boards will be leading on the evaluation and the audit of local services. The quality of the services involved is expected to increase as the patient will see the most appropriate clinician to their needs. Waiting times will also be reduced in many areas. |
11. Monitoring | 11.1 What are the arrangements for monitoring the delivery of efficiencies? These projects were not set up to demonstrate cost savings however we will cover this in the final evaluation. Data to be collated is collected monthly to Programme closure in 2006 and where possible is collected from data already collated by the Health Board. The majority of data is quantitative. Due to the poor nature of some of the outpatients data currently collected and the fact that data on patients seen by anyone other than a consultant not yet collected there are some risks to collection and accuracy. |
12. Reporting | 12.1 What are the arrangements for reporting the delivery of efficiencies? Local Project Managers report data to Outpatient Programme data analyst. |
13. Dependencies | 13.1 Explain if your efficiencies are dependent on legislation or other structural changes being achieved. There are no legislative dependencies. |
14. Use of efficiencies | 14.1 How are the efficiencies released from improvement activity being used to improve front-line services? Funding allocations from SEHD to NHS Boards for outpatient services did not assume an increase in the number of patient contacts. Due to the nature of the project there is no time released, but time is more productively applied. |