Home > Knowledge Hub > Service Success Stories > Establishing F3 Clinical Fellow Clinics Improves Waiting Times, is Cost Effective and is Acceptable to Patients

Establishing F3 Clinical Fellow Clinics Improves Waiting Times, is Cost Effective and is Acceptable to Patients

Updated on: 30 Nov 2021   First published on 30 Nov 2021

BSG CSSC Service Development Prize Submission from Dr Tim Jobson, Dr Angus Kitchin, Dr Katharine Hutchison, and Dr Emma Wesley.


What was the challenge? 

Prior to the COVID pandemic, routine gastroenterology patients were facing long waits. Whilst this was consistent with the national picture, waits in excess of 30 weeks created additional workload and a poor patient experience. At the end of the first wave of the COVID 19 pandemic, the Gastroenterology Department at Somerset Foundation Trust faced an even more significant backlog of outpatients waiting for new patient appointments in clinic, which was exacerbated by 2 consultants retiring. This is consistent with the national picture where long waiting times for clinic appointments have become the norm. Funding was available for the recruitment of more consultants, but candidates were in short supply. We therefore decided to try a different approach.  

How did we overcome the challenge? 

The department produced a Gastroenterology and Endoscopy Recovery Plan which included a number of measures including the recruitment of two F3 level clinical fellows to help reduce the backlog. This was achieved using the existing unspent budget available due to consultant vacancies.  

The clinical fellows have a varied role including clinics, endoscopy training, and time set aside for research and teaching. The role has evolved during the year and the job plans adjusted to meet the service needs of the department. They initially saw 4 new patients in each of the 4 telephone clinics a week (2 per fellow). The cases were discussed in detail at a later date with a consultant gastroenterologist who agreed the management plan (including investigations and follow up plan). This was communicated to the patient and referring health care professional in a clinic letter and by a follow up phone call if required. 1 PA of consultant time was job planned for the supervision.  

Outcomes – patients seen 

From August 2021, 286 patients were booked into the F3 telephone new patient clinics (36 week period). This represented 36% of the new patients seen by the whole gastroenterology department during this time period.  261 patients (91.3%) attended their appointment.  

54 (20.7%) were discharged without the need for investigations. 109 (41.8%) had investigations arranged and were subsequently discharged. 71 (27.2%) still have investigations pending.  

84 patients (32.2%) received more than one telephone clinic review by the F3 fellows. 17 patients (6.5%) were subsequently seen face-to-face by the F3 fellows. 25 (9.6%) were subsequently reviewed face-to-face by consultants in clinic. 27 patients (10.3%) were diagnosed with conditions requiring long term clinic follow up. 

Outcomes – waiting times 

There was a considerable improvement in the waiting times for new patient gastroenterology appointments. In August 2021, 386 patients were waiting more than 2 months for a new patient appointment, compared to 45 in April 2021. This represents an 88% reduction. Most of the patients waiting longer needed assessment in specific sub-specialty clinics. The vast majority of all patients referred to the team are now seen within a few weeks. The position is now significantly improved compared to before the pandemic (figure 1). Almost all routine general gastroenterology patients are now seen within 4 weeks of referral. This position has been maintained as referral numbers have increased back to previous levels (figure 2).

Figure 1

 

Figure 2

 

Patient satisfaction 

Postal or email surveys were sent to the whole cohort of patients assessed in the F3 fellow clinics. 

Out of the 261 patients, 73 patients responded (28%). 

F3 clinical fellow phone consultations received positive feedback from 93.0% of patients surveyed, with 63.1% finding them to be more convenient than face-to-face clinics, and 82.2% feeling their expectations from a consultation had been met.  

However, 61.3% of patients said they would have preferred the option of a face-to-face appointment given the choice. 

Conclusions / learning points 

The F3 clinical fellow phone clinics are a cost effective and safe way of assessing new patients referred to general gastroenterology clinics. They form part of a wide-ranging gastroenterology and endoscopy recovery plan which has transformed the delivery of services for our population.

During a time where consultant recruitment wasn’t possible, the service significantly reduced waiting times and hence delays to investigation and treatment. 

Although patients preferred face-to-face appointments, on the whole the vast majority of them were satisfied with the service they received. 

In the future, as the COVID situation becomes more certain, we will look into moving the clinics to face-to-face or allowing patient choice as to the type of new clinic they are assessed in.


Login to your BSG member account to read and post comments on this page