Cardiff and Vale University Health Board is improving outpatient pathways as part of Safe Care Collaborative

The Shaping Change team at Cardiff and Vale University Health Board (UHB) is introducing a new approach to follow-up appointments to improve patient experience and relieve pressure on clinical teams.

The project, which forms part of the Safe Care Collaborative’s community workstream is working to increase the number of outpatients placed on to See-on-Symptoms (SOS) and Patient-Initiated Follow-up (PIFU) pathways.

SOS and PIFU pathways empower appropriate patients with short- and long-term conditions to initiate their own follow-up appointments as and when they need them, instead of being seen routinely in appointments they may not necessarily need.

The change in approach releases time for clinicians to manage their caseloads and waiting lists, enabling them to see complex patients and those awaiting an initial appointment.

Feedback shows that the SOS and PIFU models of care also lead to improved outcomes and experiences for patients, with shorter waiting lists and increased access to their specialist team outside of the usual routine follow-ups. They also have a positive impact on levels of ‘did not attend’ (DNA) rates.

Shaping Change, the health board’s improvement and innovation team has been working since autumn 2021 following their attendance at the Spread and Scale Academy. Since spring this year, the team has been undertaking a sprint to accelerate the implementation of SOS and PIFU across the organisation. To date there are over 27,000 patients on an SOS pathway and over 2,500 patients on PIFU pathways across the organisation, an increase of about 4,500 patients in total since the start of Shaping Change’s sprint.

Cardiff and Vale University Health Board estimates that the sprint and the additional patients added to SOS and PIFU pathways has saved around £1.3m in avoided unnecessary appointments, allowing that valuable clinical time to be used to see patients who need it most. Additionally, this has saved an estimated 18.3 tonnes of carbon from a reduction in patient journeys to and from the UHB’s secondary care sites.

As part of their efforts, the team has worked alongside digital colleagues at Cardiff and Vale UHB to set up an internal SOS and PIFU dashboard enabling clinicians to track their patients on these pathways, and visually present an overview of the progress being made in individual specialities and across the health board.

The team has further ambitions to spread the models of care across Wales, and has worked with Welsh Government to develop the Outpatients.wales national website for clinical teams working across all Welsh health boards to access a range of resources to help them implement and effectively use the SOS and PIFU pathways in their areas, including criteria for identifying suitable patients, template letters, flow diagrams and more.

Vicki Burrell, the project lead at Cardiff and Vale UHB has also chaired the national SOS and PIFU development group for Wales since spring 2022.

Vicki said: “Being part of the Safe Care Collaborative has been valuable for the team, giving the opportunity to share their learning of the implementation of the SOS and PIFU pathways with colleagues across NHS Wales as part of our ambitions for Wales-wide spread of the pathways.

“The collaborative has also provided the team with insight, feedback and challenge from colleagues across the country within a supportive structure, enabling them to consider different perspectives as part of their work.”

Dominique Bird, Deputy Director and Head of Quality Improvement at Improvement Cymru, said: “The great work by the Cardiff and Vale UHB team to embed SOS and PIFU pathways is an excellent example of how implementing improvement can have a significant positive impact on patients, clinicians and resources.  

“I’m delighted to see that the Safe Care Collaborative has given impetus to the SOS and PIFU work at Cardiff and Vale UHB, which is in turn providing valuable learning opportunities to teams delivering improvements right across Wales.”

For more detail on the Safe Care Collaborative, visit our webpages, here.