Introduction ‘Better Care, Better Values’ highlighted the importance of outpatient new to follow up ratios (NFRs) (1). Trusts are encouraged to reduce NFRs or may perform unpaid activity. This has implications for patient care, yet can conflict with Speciality guidelines for follow up. There are no published data on the diagnostic case-mix attending secondary care Gastroenterology appointments nor are any diagnostic data available from Hospital Episode Statistics (HES) for outpatient-based specialties.
Methods We performed a retrospective audit of all Gastroenterology follow-up patients attending Wirral University Teaching Hospital (catchment population 360,000) during a 3-month period. All clinic letters were identified from the hospital IT system and the following information obtained.
Number of new and follow up attendances per Consultant-led clinic
Primary diagnosis for each follow-up encounter
Appointment outcome- further follow up or discharge
Discharge rate per diagnosis
Number seen in dedicated Specialist Nurse clinics
Results - 675 new and 1622 follow up appointments were seen by Medical Staff (Consultant, Registrar or SHO) giving an overall NFR of 1:2.4
516 patients were seen in Nurse-led clinics
NFR and diagnostic case-mix varied by Consultant team
Table 1 shows the diagnostic case-mix and outcomes
Conclusion Almost 40% of secondary care follow up patients are seen with IBD or chronic liver disease. Fewer of these patients are discharged than patients with other diagnoses. In order to improve NFRs we now have primary care discharge pathways for stable patients with coeliac disease and limited colitis. Additional pathways are planned but diagnostic case-mix appears to be a major determinant of NFRs and should be taken into consideration when NFR targets are set.
Disclosure of Interest None Declared.
NHS Institute for Innovation and Improvement. Converting the potential into reality: 10 steps a provider can take to realise the benefits of Better Care, Better Value indicators.
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