A new pathway redesign guide from Feedback Medical argues that the NHS is unlikely to meet the target of 92% of patients receiving treatment within 18 weeks unless it fundamentally redesigns pathways around faster clinical decision-making.
While much of the national focus has been placed on increasing treatment capacity, the Pathway Redesign Playbook: Leveraging Diagnostics to Drive Elective Transformation highlights that the majority of patients on elective pathways are still awaiting diagnosis, clinical decision-making or non-surgical management. It suggests that redesigning these earlier pathway stages could have a greater impact on patient flow, waiting times and productivity than further optimisation of treatment services alone.
Drawing on real-world evidence from Queen Victoria Hospital NHS Foundation Trust (QVH), the guide warns that current funding and contracting arrangements continue to reward activity within existing models of care, limiting adoption of diagnostics-first, digitally enabled pathways that could accelerate diagnosis, reduce unnecessary appointments and improve patient flow.
Four principles for pathway transformation
The guide argues that successful pathway redesign should be built around four core principles:
- Design for faster decisions – Focus on achieving the earliest safe clinical decision.
- Deliver diagnostics earlier – Bring testing and information gathering forward within the pathway.
- Remove unnecessary touchpoints – Every patient and clinician interaction should add measurable value.
- Digitally enable the entire pathway – Only digital pathways can enable coordinated referrals, diagnostics, collaboration, communication and decision-making at the scale required to transform productivity.
The guide calls on national policymakers, commissioners and NHS leaders to ensure that future funding and contracting arrangements support the care models the NHS needs to deliver. Achieving widespread adoption of diagnostics-first, digital pathways will require financial incentives to reward value and outcomes rather than traditional outpatient activity.
“The outpatient model used across much of the NHS was designed around constraints that no longer exist. We now have digital technology, advanced diagnostics and new ways of working that enable information to move faster than patients.
“The organisations achieving the greatest improvements are those designing pathways around decisions rather than appointments or other ‘gateposts’.
“The challenge now is ensuring funding and contracting models evolve to reward these more efficient approaches, rather than continuing to reinforce the outpatient model they are designed to replace.”
Chief Executive Officer at Feedback MedicalReal-world evidence from Queen Victoria Hospital NHS Foundation Trust
The guide contains several case studies from QVH that demonstrate the benefits of redesigning pathways around earlier diagnostics, digital workflows and multidisciplinary collaboration.
One example is the Trust’s digitally enabled insomnia pathway, where patient questionnaires, sleep diaries and remote triage are completed before specialist review. Early pilot data showed:
- 36% of patients discharged with a management plan
- 28% listed for home diagnostic testing
- 36% directed into specialist sleep services due to alternative diagnoses
Patients were able to access specialist advice in as little as three weeks, compared with traditional waits of up to 20 to 25 weeks for an outpatient appointment.
The playbook also highlights QVH’s award-winning digital breathlessness pathway, designed around rapid access to diagnostics and earlier clinical review. The pathway achieved:
- Average active length of five weeks.
- More than 90% discharged back to GP without appointment.
A blueprint for the future outpatient model
The guide concludes that the future of elective care is not about creating more appointments but about reaching safe clinical decisions faster.
By combining diagnostics-first pathways, asynchronous multi-disciplinary collaboration and connected digital workflows, NHS organisations can shorten pathways, improve patient experience and make better use of limited clinical capacity.
It also highlights the growing role of digital single points of access, enabling patients to move through diagnostics, triage and specialist review before entering traditional provider-specific waiting lists.
You can read the Pathway Redesign Playbook and summary version here.