Reimagining elective care: a new diagnostics-first outpatient model

Feedback Medical hosted a webinar with the Health Service Journal (HSJ) on Thursday 24 April, which discussed modernising outpatient care through a digitally enabled, asynchronous model, aiming to improve efficiency, reduce costs, and streamline patient pathways.

Watch the full webinar here

Key speakers and perspectives

1. Dr Tom Oakley (Feedback Medical CEO) – Advocated for a new outpatient model: ‘diagnostics-first’ and asynchronous specialist reviews.
2. Dr Ian Francis (Clinical SRO, Sussex Integrated Care System) – Shared practical implementation of the model via its community diagnostic centres (CDCs) in Sussex.
3. Dr Minesh Patel (GP Partner, Moatfield Surgery) – Provided the primary care perspective, including on advice and guidance (A&G).

Chaired by HSJ Bureau Chief James Illman, the topic focused on the digital breathlessness pathway delivered by Feedback Medical with Queen Victoria Hospital NHS Foundation Trust (QVH), part of the Sussex ICS, providing a single point of access for patient referrals and, in turn, reducing outpatient appointments and patient wait times.

A diagnostics-first outpatient model

Dr Oakley began with an outline of how the traditional outpatient model will not enable healthcare organisations to hit their efficiency targets so how can this be delivered differently? By introducing a diagnostics-first pathway approach and facilitating a live view of the GP record to secondary care clinicians, you can remove the need for initial outpatient appointments, deliver the pathway more efficiently and thereby improve the patient experience.

• Traditional model: Referral → consultation → diagnostics → follow-up.
• Proposed model: Pre-referral diagnostics + access to GP records → Remote specialist review.
• Benefits (actual and indicative):
  • Up to 90% reduction in outpatient appointments.
  • 63% reduction in patient wait times compared to national referral to treatment (RTT) target.
  • 3x more consultations in same time.
  • Significant cost savings (~£787,000 per pathway per ICB).
  • Creates a single platform for A&G, diagnostics, and waitlist rationalization.

Following the recent planning guidance and updates around advice and guidance, ICBs need to decide how much activity they want to deliver as a pre-referral A&G process and how much as post-referral A&G. What’s needed is a platform that can handle both workstreams flexibly – which Bleepa® can.

The key message is that the NHS has to deliver 118% above baseline, which is linked to providers’ indicative activity plans. His recommendation is that integrated care boards (ICBs) should consider a single point of access model, either:

1. As a mechanism for delivering baseline activity and 118% uplift more reliably and at a lower cost basis – because you can use the staff that you have more efficiently; or
2. As additional activity in your indicative activity plans to increase the total envelope of funding for the upcoming year and therefore deliver, not only more activity and more funding, but also at a lower price point, increasing your margins as an organisation and commissioning body.

A genuine neighbourhood health service

Dr Francis presented an overview of how Sussex is taking the success of the breathlessness pathway delivered via the QVH CDC, with Moatfield Surgery and Feedback Medical’s Bleepa®, and building that out across a wider integrated care service.

• Characteristics of the healthcare landscape in Sussex:
  • 7 CDCs, second largest number of sites within a single system across NHS in England.
  • Geographical challenges spreading east to west without good infrastructure,
  • Health inequalities and poor cancer outcomes, increasingly elderly population with multiple comorbidities, large backlog in acute care.
  • Capital funding of £58 million, with ongoing revenue support for the programme of £48 million.
• Pathway case study: Breathlessness—patients get all diagnostics in one day, reviewed asynchronously by specialists.
• Outcomes:
  • Only ~9% needed secondary care.
  • Up to 65% wait time reduction.
• Reviewing how to expand into wider integrated care system as single point of access for patient referral across multiple pathways

Patients, once reviewed by their GP, can be referred into the breathlessness pathway through an order that is then clinically triaged. The patient attends the CDC for one day to undertake a variety of tests. The tests are then reviewed at an appropriate time by the clinicians and the decision taken for the forward management plan, either to support ongoing delivery of services within primary care or arranging to see them within secondary care.

The next stage within Sussex is to onboard and increase GP participation within the pathways, then use a system hub (QVH) for single point of access within the ICS across all CDCs, to drive activity closer to home for patients and join up the clinical discussions. The third phase is to establish a genuine neighbourhood health service using the capacity that the CDC offers alongside the technology that allows clinicians to make safe decisions for patients into the future.

A single point of access for patient referrals enables:

• Tackling the backlog waiting list – addressed the 65-week position but need to address the 52-week position
• Reducing the volume of patients pushed from primary to secondary care by pulling directly into system hub and using CDCs to deliver multiplicity of pathways
• 10 potential pathways (including lower GI, dermatology, heart failure, urology, non-site specific cancer, breathlessness, postmenopausal, prostate)
• Capacity to do single diagnostic tests within system hub
• Secondary care clinicians for virtual review and decision-making

Dynamic conversations across primary and secondary care

Dr Minesh Patel, from Moatfield Surgery in Sussex, provided an overview of existing A&G as a highly valuable, very efficient way of transferring knowledge and skills from a specialist to expedite the care of a patient. But in terms of the context across primary, secondary and integrated care, it’s important to create a much more dynamic conversation.

• A&G is seen as valuable to GPs but under-supported.
• £20 incentive for pre-referral A&G is controversial as to its value for money and if it’s enough to fund the additional work.
• Key issues:
  • Added GP workload.
  • Need for system-wide integration and training – for appropriate use of A&G for right people/right problem
  • Need for richer, asynchronous communication rather than transactional exchanges.

He highlighted how the work with QVH and Feedback Medical has been really valuable at dealing with undifferentiated illness with no certainty which way someone’s diagnostic pathway should be orientated.

Conclusion

System-wide benefits

• Facilitates collaboration across providers.
• Enables pooled resources and shared waitlists across geographies.
• AI integration potential: decision support, diagnostics, workflow optimisation.

Challenges and cultural shifts

• Behavioural change and staff engagement are essential.
• Importance of co-designed pathways with mutual understanding between primary and secondary care.
• Example: Sussex created a clinical oversight group for pathway approvals.

The webinar highlighted that outpatient transformation via digital tools like Bleepa, a diagnostics-first approach, and coordinated care pathways can significantly improve NHS efficiency. However, success depends on strategic change management, clinician buy-in, and system-level integration.

Watch the full webinar here

For more information about delivering a new outpatient model, please contact us here