Part 3 Assessing costs to the system
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Section Takeaways • The guidance documents from NHS England’s Outpatient Recovery and Transformation Programme have a real opportunity to make an impact on the barriers identified in Part 2. • However, guidance is not being implemented consistently across the country due to lack of capacity; variation in approach; incompatible IT systems; and a lack of equipment and funding. • To support guidance adoption, a financial and resource case needs to be made to demonstrate the longer-term savings that could be achieved. • An initial analysis of limited available data shows that just reducing the number of pre-referral appointments could save £1,779,660 in psoriasis and £3,948,019 in atopic eczema. • In practice, the total savings at the delay to referral stage and throughout the rest of the pathway could be much higher, particularly when considering the wider socio-economic impacts. Many of the barriers in accessing care, services and treatment for patients with inflammatory skin conditions set out in Part 2 are long standing and were exacerbated by the pandemic. However, since then a series of welcome national initiatives (outlined in the introduction) have been published with the aim of improving patient experience in line with the optimum pathway set out in Part 1. Whilst the delivery of the Long-Term Workforce Plan will take time to implement, the GIRFT report recommendations and the guidance documents from NHS England’s Outpatient Recovery and Transformation Programme are implementable in the shorter-term and have a real opportunity to make an impact on these barriers. One assessment of the potential impact of the urgent virtual skin cancer pathway concluded that if this pathway alone was fully adopted across the system it could save as many as 48,000 hours of specialist time that could be locally reallocated to caring for other dermatology patients. 6 It calculated that this time could be the equivalent to almost 15% of the unfilled WTE dermatology consultant posts as identified in the GIRFT report. 13 However, there is concern that this and similar elective recovery aspirations – as noted by the Public Accounts Committee above in Box 1 – are not being implemented consistently across the country due to lack of capacity and adequate training; variation in approach across the country; incompatible IT systems; lack of equipment and funding; low clinical buy-in and low patient understanding and interaction. 16 To help the service achieve the changes needed to overcome the barriers noted in Part 2, a financial and resource case must be made to demonstrate the longer-term savings that could be realised.
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FROM NATIONAL GUIDANCE TO LOCAL ACTION
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