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Development of modern outpatient services

The current design of hospital outpatient services cannot cope with increasing demands


Return appointments account for 67% of all acute outpatient activity.

Certain specialities are under particular pressure, including gastroenterology, orthopaedics, ophthalmology and dermatology. This is not a problem exclusive to Scotland. The challenges of the rise in long-term conditions, ageing and patients with multiple conditions are being experienced all round the world.

It is widely recognised that the current design of hospital outpatient services cannot cope with increasing demands, both from initial referrals and follow-up appointments. The underlying service model needs to be transformed.

Our role is to help the Scottish Government and other partners to better understand the scale of the challenge and what it might entail. To make the task manageable, our work will focus on individuals who have multiple long-term conditions which currently require regular interaction with outpatient services.

Annually in Scotland there are approximately 4.5 million outpatient appointments in a secondary care or hospital setting

Some high-volume specialities have experienced significant growth in new attendances, Gastroenterology has grown by 104%, Respiratory medicine has grown by 78%, dermatology by 22% and General surgery by 26%.

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400,000 outpatient appointments have the potential to be redesigned.

We are supporting the Scottish Government and NHS Scotland on identifying what the service might look like in future, with a focus on the use of digital tools and services to improve healthcare provision, while also better managing growing demand. 

Work to date

The Scottish Government has led work on modern outpatient services, with various initiatives over the last decade aimed at supporting NHS boards and local healthcare providers. Much of this has focused on steps to improve or even optimise the current service as it is delivered today.

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