Our advice and guidance around COVID-19 is being regularly reviewed. Visit https://www.bsg.org.uk/covid-19-advice/ to see the latest published guidance.
Renewal, Redesign and establishing the “New Norm”
The COVID-19 pandemic presents a unique opportunity in the history of the NHS to redesign outpatient services utilising digital technology and remote consultations. This guidance is a consensus of expert opinion which has been developed by the BSG Clinical Services and Standards Committee (CSSC), BSG Executive and co-opted members.
It sets out how to reconfigure outpatient gastroenterology and hepatology services using a toolkit of pre-existing and innovative technologies.
It should be emphasised that this guidance is the first step in rebooting outpatient services – a process that will continue to evolve over time. The key recommendations and flow chart of the patient journey are summarised below:
RECOMMENDATION 1: In order for care to be optimal, patients must be signposted to the correct pathway from the outset – which may include remote, face to face or asynchronous consultations (defined as a consultation where the patient and clinician interaction occurs at different times)
RECOMMENDATION 2: Enhanced triaging with all the prerequisite information is used to signpost the patient to the correct pathway
RECOMMENDATION 3: Doctors undertaking remote consultations should ensure that they have read and are familiar with GMC guidance
RECOMMENDATION 4: Face to face (F2F) consultations remain essential for particular situations. It should be recognised that there will be some patients who do not have access to a telephone or appropriate information technology and will require F2F consults
RECOMMENDATION 5: Remote consultations should be seen as equivalent to F2F consultations in terms of the remuneration process by commissioners
RECOMMENDATION 6: In order to introduce successful remote consultations there needs to be appropriate information technology (IT) support. Infrastructure varies between hospitals but following COVID-19 it is now essential that all NHS trusts and Boards should be able to provide a level of service that is reliable and sufficient to facilitate and encourage remote consultations
RECOMMENDATION 7: Providing the appropriate skill mix of staff, including specialist nurses, allied health professionals and non-clinical administrative staff, is essential if redesigned outpatient services are to function efficiently and productivity is to be improved
RECOMMENDATION 8: Job planning, including the recognition of flexible working, is key to ensuring that remote consultations are successfully implemented, especially outside standard working hours
RECOMMENDATION 9: Remote consultations will evolve over time. It is essential that accessibility to remote consultations is monitored to ensure that equality and diversity legislation is met. Patient satisfaction and evidence of efficacy is needed through audit and quality improvement projects. These innovative ways of working lend themselves to further clinical research
Andy Douds, CSSC Chair
Rupert Ransford, CSSC Deputy Chair
Tony Tham, CSSC Immediate past Chair
John Thomson, Digital Health Lead for the Modern Patient Pathways Program of the Scottish Government
Bev Oates, Training Committee Chair
Alastair McKinlay, BSG President