Source · Select Committees · Public Accounts Committee
Recommendation 13
13
Accepted
Outpatient transformation efforts failed to increase remote consultations and PIFU uptake
Conclusion
In 2022 our predecessor Committee was told by NHSE that the area where it has most potential to free up clinical time and see more patients is in outpatients services because “80% of the waiting list is tied 18 NIHR Policy Research Unit on the Economics of Health and Social Care Systems and the NIHR Policy Research Unit on Economic Methods of Evaluation in health and care interventions (NWT0040) 19 NHS England, NHS publishes waiting list breakdowns to tackle health inequalities, england.nhs.uk, 17 July 2025 [accessed 30 September 2025]; NHS England, Waiting List Minimum Data Set (WLMDS) Information, 2025 [accessed 30 September 2025] 20 Q 15 21 Q 47 22 C&AG’s Report, paras 11, 2.21 and 2.23-2.24 9 up by outpatients”.23 NHSE told us at our September 2025 evidence session that outpatients remains the key to solving elective waiting lists, and that it was committed to reducing waiting times by transforming outpatient care. Making use of remote consultations and patient-initiated follow-up (PIFU) aimed to address concerns in the clinical community that patients who need a follow-up might not get one if there was too much focus on reducing the number of follow-up appointments.24 However, the NAO reported that the proportion of outpatient appointments delivered remotely actually declined during the programme from 21.5% in June 2022 to 18.8% in November 2023 against a target of 25%. NHSE originally aimed to increase of PIFU take-up by 5% by March 2023 but the target has now been extended to 2029.25
Government Response Summary
The government states that DHSC and NHS England undertook a review of programme governance and integrated outpatient transformation work to improve performance and deliver the Elective Reform Plan. It also sets out aims for transforming outpatient care with single points of access, reduced follow-ups and use of technology.
Government Response
Accepted
HM Government
Accepted
2.1 The government agrees with the Committee’s recommendation. Recommendation implemented 2.2 DHSC and NHS England undertook a review of programme governance to ensure the right structures are in place to deliver the ERP, which was published in January 2025. This included integrating outpatient transformation work within the elective care programme into refreshed programme governance, as well as improved reporting on performance, programme delivery and outcome tracking to the Programme Board and relevant sub-groups. 2.3 In order to deliver the commitment to improve the percentage of patients waiting no longer than 18-weeks from referral to treatment to 92% nationally by March 2029, it is essential to transform outpatient care. Outpatient care accounts for the majority of pathways on the elective waiting list, with 80% of elective pathways ending (for example through treatment or being discharged) in an outpatient setting (that is without an admission). That is why the Medium Term Planning framework (2026-27 to 2028-29) has set out ambitious proposals for the further use of Advice and Guidance (A&G) asking systems to ensure all referrals go through a single point of access, this delivers a more robust approach to triage, so patients are cared for closer to home and there are fewer outpatient appointments in secondary care. The framework requires a significant reduction in the number of clinically unnecessary follow-ups, which will be supported by Getting it Right First Time (GIRFT) and potential changes to payment for follow-up activity. This is part of a new model of planned care which will deliver the ambitions of the 10 Year Health Plan. Further details will be published in due course.