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appointment that suits them best by using a mobile app in the beginning, rather than having an appointment arranged for them and being notified by letter. People who are not happy with smartphones can have their appointments made for them by other people who are, be they family members or members of an NHS support team. The technology would also enable entirely new features for smartphone users. Our phones might detect that we are out shopping on the high street already and offer an earlier appointment if one opens. This would save the patient time and mean a clinician’s time was more fully used. We would all be spared the costly paper chase of letters and phone calls. Analogue appointments are a mammoth task. Across England there were nigh- on 125 million outpatient appointments in 2020, up by 66% over the decade.9 Just one large hospital, like Guy’s and St Thomas’ in London, schedules over 2 million appointments per year, yet around 13% of outpatients do not show up.10
Each appointment will need one or two letters, each costing £2 to print and stuff in an envelope. This is not even including the typing, administration and the cost of any rescheduling. This could all be done for as little as 40p per appointment on a paperless app, slashing the carbon footprint and offering a huge saving.
Efficient healthcare depends on bringing patients together with the clinicians and specialist equipment at the right time and the right place. New technology allows our time and place to be more efficiently interlinked. In healthcare, this will benefit patients and all without a single piece of paper or envelope.
Rolling it out Following Manchester’s lead and expanding high street healthcare more widely could help ease the growing burden on the NHS. Hospitals could focus more on what they excel at while high street healthcare tackles what it does best at outpatient clinics. Beyond ARMD this could include day case procedures, non-acute diagnostic tests, physical therapy and help tackle substance
These circumstances may be little more than a fortunate coincidence, but it is nevertheless a golden opportunity to pioneer a model of healthcare that would make the NHS a world leader.
References 1 National Eye Institute. Age-Related Macular Degeneration (AMD) Data and Statistics [Accessed 23rd September, 2021]
2 King’s Fund. What are health inequalities? What are health inequalities? The King’s Fund (
kingsfund.org. uk) [Accessed 23rd September, 2021]
3 Optometry Today, 3rd June 2019. High Street eye clinics in Manchester deliver over 10,000 appointments in first year (
aop.org.uk) [Accessed 23rd September, 2021]
use and mental health issues. The new hubs would also be freed from the often eye-watering inefficiency of paper-based hospital appointment systems, replacing them with a patient- centred “Uberised” self-serving system. As in Manchester these health hubs would also help restore the economic health of struggling town centres by bringing back footfall, which e-commerce has often reduced to critically low levels. Health centres would generate a new set of customers for drinks, food, for pharmacies, health food shops, gyms and groceries. Town centre working is likely to be far preferable for healthcare professionals than in a giant hospital complex on the remote fringes of town. Improving the wellbeing and job satisfaction of those working in healthcare will help recruit and retain the best staff and enable them to deliver to the best of their ability. Publicly-funded health services can reasonably be expected to play an active role in the “levelling-up” agenda. The NHS is under pressure to identify problems earlier if not prevent them and to treat health problems, like mental health, that have been neglected in the past. It needs to treat 380,000 more patients in 2021 just to stop the current waiting list from growing even longer.
The local economies of the places in which the centres are created also benefit.
4 Nuffield Trust. Elective (planned) treatment waiting times Elective (planned) treatment waiting times, The Nuffield Trust [Accessed 24th September, 2021]
5 BBC News report / NHS England data. 4.7 million waiting for operations in England, BBC News [Accessed 23rd September, 2021]
6 Royal College of Surgeons, 15th April 2021. More than 200,000 patients waiting over a year for hospital treatment, Royal College of Surgeons (
rcseng.ac.uk) [Accessed 24th September, 2021)
7 Office for National Statistics National population projections [Accessed 23rd September, 2021]
8 British Retail Consortium. April 30, 2021 Empty shop fronts continue to soar [Accessed 23rd September, 2021]
9 NHS Digital Hospital Outpatient Activity 2019- 20, NHS Digital. October 2020 [Accessed 24th September, 2021]
10 NHS England NHS inpatient admission and outpatient referrals and attendances. February 2018
CSJ
About the author
Kelvin Moulding is divisional director of Health Spaces, based in Peterborough. Health Spaces is a UK healthcare construction company dedicated to NHS design and build, including turnkey solutions for new build or repurposing projects.
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