Outpatient clinics are ripe for reform

So says David Oliver in the current British Medical Journal     

Oliver advocates Outpatients being bought into the 21st century – if you are a patient, what would you change?

Below are extracts from Oliver’s article, (he’s a consultant in geriatrics and acute general medicine), written for doctors, etc.”

He points out, “The journey to hospital sites can take hours out of patients’ and families’ days, implying that their time is less valuable than a clinician’s”.

There are signs that some of the promised £20 billion extra for the NHS might earmarked for improving Outpatients’ services.  All of a sudden, NHS England has Outpatients Clinics under discussion.  So patients should get in quickly to tell hospitals what is wrong, before NHSE commissions trendy architects to advise.

NHS Improvement’s Chief executive, Ian Dalton, has commented that “modernising outpatient services should be a priority. There are even plans to alter tariff payment structures for outpatients to incentivise different behaviour and models and to make the excessive use of clinics less attractive for hospital trusts”.

I was collared by a group of French doctors at a medical conference in Paris one day, and asked “what is this clinique system”.  Try explaining it’s benefits (as a patriotic Englishwoman) when, as a patient,  you do your utmost to make sure you always get to see the same doctor.

“Outpatient clinics absorb around 7% of the NHS budget, with over 60 million attendances a year ….. are a prime example of an area that has been relatively neglected amid calls from politicians and the media to reform services”.

What would my ideal Outpatients look like

The Saturday crowd at my local hairdressers didn’t want Receptionists looking at their screen and barking “NAME”  – don’t we merit a smile?  And why not tell us if the consultant is running late – we might have time to fit in a test, have a coffee or something else.

NHS England published one of their reports ‘The 15 steps challenge’ saying a mother had commented that it took just 15 steps to identify if a hospital dept. was going to help her daughter – or not.  It takes me even less.  I am always hoping I will be greeted with a smile – but it doesn’t happen often.

Check-in machines

Patients can avoid these, thinking they spread MRSA.  Put a hand sanitiser next to them, and handles to hold on to if you are unstable.


 Ugh!  We all hate “sludge colours” , especially dark brown.

Simon Stevens, CEO NHS England, believes the current NHS outpatient model is “obsolescent.  The Saturday crowd believe unwelcoming Receptionists cast a gloom over the room, and say “slap on some bright paint to cheer up Dementia patients”.


Self-referral happens in Europe, so why not here? Appointments officers demand a folow-up re-referral from my GP, who gets cross “because I’ve already referred you”.

Dignity, Safety, etc.

Yeah! Yeah!   What’s dignified – or secure – about asking our Date of Birth in front of a crowded room when we check in? To make things easy for any hacker present, the Receptionist then shouts out “Do you still live at …….?”

The Saturday crowd asked  “address us properly”.  First names are for friends. Even the schoolgirl sweeping the floor said she didn’t like informality, it made her feel childish.


Purlease!  Chairs in stiff rows went out with The Ark.  There is nothing more depressing than being dumped in a line and forced to stare at a blaring TV.  Let’s copy an idea I saw in America –  chairs clustered around tables, each one with a giant jigsaw spread on it.  Patients were talking and laughing with each other, but there were chairs positioned by the walls where you could sit quietly if you wanted.

Get rid of uncomfortable ‘cheesegrater’ metal chairs, with no support for your head or neck. And make sure chairs are high enough so we don’t struggle to rise when our name is called.


Have hospital CEOs ever tried to find their way around their own premises?  e.g. get the CEO of the John Radcliffe in Oxford to find his way to the Mammography unit (actually, he’s a man, he won’t need to).  The JR’s signs in this dept. are written in white lettering on a grey background!  Try working those out with limited vision!

Insulting ‘did not attend’ notices

If hospitals are going to put up notices saying “XX number of patients did not attend appointments”, give us the right to point out that this was because YOU forgot to send out the appointment letter, YOU didn’t pass on the message to tell you we would have to cancel,  YOU lost our notes, or YOU had delayed us in another part of the hospital, etc.

SIgns inside Outpatients

King’s College, London, has easy to read electronic boards that show your name when Consultant is ready for you;  Bleeps when a new name comes up and tells you to “go to room xxx”.

Austrian hospitals have coloured strips on the floor leading  off to consulting rooms.  Chelsea and Westminster has coloured bobbles on the ceiling, but these aren’t any use if you have scoliosis, etc.

And while we are about it – European hospital light switches are activated by a panel you hit with your elbow – cleaner than fingers.  I was shocked to see a doctor showing TV cameras around the Operating Theatre at the Royal Marsden – proudly using a finger switch on the new lighting system!


The Saturday crowd HATE wishy-washy tea and coffee; charge for a decent cuppa.  Vending machines should offer healthy alternatives to calorie-laden milk chocolate and crisps.

Drunks in Waiting Rooms

The Crowd was adamant they wanted drunks to be charged.  OK, A & E isn’t what I was asking about, but this straw poll came up with “drunks have paid out a lot to get drunk – so get their credit card off them and charge a couple of hundred”,

And finally

I disagree with Oliver when he says “The suggestions above may not necessarily be cheaper.”

If something works efficiently, of course it’s going to be cheaper than the current system.  If only because happy patients complain less. You only have to look on any NHS hospital trust website to see the multitude of complaints that refer to bad experiences in Outpatients.  Count the cost of time etc., of staff who write replies, administration costs, time …….

We want your Comments

What are YOUR feelings about facilities in Outpatients?  Does your local hospital have an idea others can copy?  Post a comment below.

Do YOU have an idea to make the experience more pleasant?  Give us a comment.

Are you a weary Nurse or medic fed up with the way your hospital operates its Outpatients?  Again, comments please below.


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