Cardiology, mental health and respiratory to form part of major A&G expansion

Advice and guidance (A&G) will be expanded to more specialties, with a focus in the next few years on ophthalmology, cardiology, respiratory medicine and mental health.

This forms part of plans to ‘end outpatient care as we know it’, the Government said in today’s NHS 10-year plan.

The plan will see outpatient services significantly redesigned to avoid patients having long waits for ‘low-complexity’ appointments, amid a shift from hospital to community care. Patient-initiated follow up – where patients obtain an appointment when they need it, for example if symptoms change, rather than by default – will become the standard ‘for all clinically appropriate pathways’ by next year, the plan states.

Over time patients will be able to use the NHS App to request follow up or update their clinicians on their condition to get ‘faster, more accurate decisions’ through a virtual service. A&G will also become more embedded in more specialities over the next decade after showing success in reducing the need for hospital appointments.

In 2024/25, GPs requesting advice from a consultant through NHS e-referral helped to divert 1.3 million referrals from hospitals, with the approach ‘particularly effective’ in ‘high-volume’ specialties.

‘Technology will enable us to embed it in many more specialties through the next 10 years,’ the plan said.

The Government had already hinted at plans for most outpatient care to happen outside of hospitals by 2035 through neighbourhood health centres which will bring ‘historically hospital-based services into the community’ including diagnostics, post-operative care and rehab.

The elective waiting list is currently 7.4 million, up from 2.3 million in 2010 with just 60% of people seen within 18-weeks. Yet there are many changes that can be made that will ‘benefit patients, free up clinical capacity and boost productivity’, the plan said.

Teledermatology hubs which triage suspected skin cancer in community-based photo clinics which discharge benign cases without need to see a specialist will become standard practice by 2028/29 subject to approval from NICE.

Similar approaches, making greater use of technology, will be actively expanded to other areas where clinically appropriate with ophthalmology, cardiology, respiratory medicine and mental health prioritised for redesign.

On the A&G expansion, the plan said: ‘We will take an active role in expanding similar approaches to other specialties (where clinically appropriate). In the next few years, we will prioritise ophthalmology, cardiology, respiratory medicine and mental health.’

For mental health, it could mean virtual therapists providing round the clock support for mild or moderate need, or for those with more severe illness, remote monitoring to ‘support a proactive response in crisis’, the Government said.

Increasingly diagnostics tests can be done in the community and surgeries carried out as day cases so patients can avoid stays in hospital, it added.

According to the plan, these measures will ‘end hospital outpatients as we know it by 2035’.

It said: ‘By 2035, most outpatient care will happen outside of hospitals.

‘Digital tools will help people manage their care from the convenience of their home, with support from clinicians when needed.

‘Personalised support, informed by advances in individual data, will help people get ready for planned treatment, and receive effective rehabilitation in the community afterwards,’ the plan outlined.

Redesigning outpatient services

There are many ways we can reduce the number of low-complexity elective hospital appointments – to benefit patients, free up clinical capacity and boost productivity.

We will make patient-initiated follow-up a standard approach for all clinically appropriate pathways by 2026.

Over the course of the plan, we will use the NHS App to further expand this approach. First, by allowing patients to sign up for patient- initiated follow-up directly through the App. Second by enabling patients to update their clinicians directly on their condition, to help them make faster, more accurate decisions on next steps.

To help support more patients to receive specialist care at home, we will ensure the NHS can provide GP and consultant-led elective services virtually through the NHS app – available to everyone, regardless of where they live – where safe to do so and always subject to patient choice

For those who need an operation or more complex test, there is also much we can do
to deliver their care in the community

We will take an active role in expanding similar approaches to other specialties (where clinically appropriate). In the next few years, we will prioritise ophthalmology, cardiology, respiratory medicine and mental health. In the case of mental health, that could mean virtual therapists providing 24/7 support for mild or moderate need. For people with more severe illness, remote monitoring will help support a proactive response in crisis.

Source: Government’s NHS 10-year plan