‘No longer fit for purpose’: Royal College of Physicians unveils long-term vision to transform ‘disjointed and ineffective’ NHS outpatient care
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In partnership with the Patients Association, the Royal College of
Physicians (RCP) has today launched ‘Prescription for outpatients:
reimagining planned specialist care', setting out its vision for
reformed outpatient care. The current model of
outpatient care is outdated, inefficient, and in need of reform.
Over 135 million outpatient appointments in 2023–24 were often
associated with delays, poor communication, and confusion caused by
trying to navigate...Request free trial
In partnership with the Patients Association, the Royal College of Physicians (RCP) has today launched ‘Prescription for outpatients: reimagining planned specialist care', setting out its vision for reformed outpatient care. The current model of outpatient care is outdated, inefficient, and in need of reform. Over 135 million outpatient appointments in 2023–24 were often associated with delays, poor communication, and confusion caused by trying to navigate services. Following extensive engagement with patients, healthcare professionals and NHS England, the RCP is now calling on the UK government to put outpatient reform at the centre of the 10-Year Health Plan, with the funding and resource to make the system work for patients and clinicians. Outpatient care is a vital part of the NHS, where patients will receive planned clinical investigations and tests, treatment and potentially life-changing diagnoses. The RCP's call for outpatient reform comes in response to Lord Darzi's 2024 independent review which highlighted rising NHS waiting times for planned care. The need for care through outpatient services has grown year on year – a trend that is predicted to continue as the population ages and more people live with multiple health conditions. These trends have contributed to growing waiting lists, with the majority of people currently on NHS waiting lists in England needing an outpatient appointment rather than an operation. Senior doctors are now advocating for a shift towards prevention and early intervention, timely care closer to home and flexible, multidisciplinary integrated care pathways working across the healthcare system. The RCP vision sets out five ambitions for outpatient care:
In a 2025 snapshot survey of RCP members, 57% said they did not have adequate resource to deliver outpatient activity remotely. More than two thirds (66.8%) of physicians said their ability to deliver outpatient care was limited by the availability of rooms, while fewer than a third (31.2%) of respondents said they have the time and information needed to prioritise patients on follow up waitlists based on their risk. Dr Theresa Barnes, RCP clinical lead for outpatients, said: "NHS outpatient care is fundamentally no longer fit for purpose. It is archaic, disjointed and ultimately ineffective for both patients and staff. "It has remained largely unchanged for decades, despite advances in technology. Most people on NHS waiting lists are waiting for an outpatient appointment, patient care is increasingly complex, and the medical workforce is frustrated and desperate for change. "Our new report, Prescription for outpatients, draws on the ideas and expertise of doctors and patients to embrace a new way of doing things – prioritising people, rather than the system. We need a significant shift in the way we deliver planned specialist care. Getting this right is integral to bringing down NHS waiting lists and delivering the government's three shifts. Now is the time to be radical." Outpatient care has historically been used to describe care delivery in a particular setting or location, where patients consult doctors who give specialist advice and treatments. The RCP's new report redefines the full extent of NHS outpatient, or planned specialist care, describing eight transformational shifts in the way it is delivered – including moving from a ‘one size fits all' approach to personalised care; from siloed teams to integrated pathways; and from activity-counting to outcome-focused care – underpinned by five enablers:
Rachel Power, chief executive of the Patients Association said: "Too many patients tell us that outpatient care feels like an uphill battle, with delays, confusion, and a lack of joined-up communication that leaves them feeling powerless. Our joint report with the Royal College of Physicians marks an important step towards the kind of reform patients have long been calling for. Planned specialist care must be built around the needs of real people, not rigid systems. "With the upcoming implementation of the 10-year health plan, the use of technology to improve access, reduce inequalities, and support people to manage their own care is vital. Outpatient services should implement our six key principles of patient partnership, to ensure it works with patients. This vision lays out a roadmap to get us there." People living with multiple health conditions also use outpatient services more. A patient with four or more health conditions will need more than three times as many outpatient appointments as someone with only one health condition. With almost 1 in 5 (17%) people over the age of 65 expected to live with four or more long-term health conditions by 2035, the RCP says that reform of planned specialist care is vital to reduce waiting lists and must be part of the government's 10-year plan for health. Prescription for outpatients provides a 10-year roadmap with over 40 recommendations for patients, clinicians, governments, charities, professional bodies and the NHS. To successfully deliver reformed planned specialist care, the RCP is calling on government and the NHS to expand the specialist workforce, increase medical school and postgraduate training capacity and ensure that doctors and healthcare professionals are supported with adequate administrative support and digital infrastructure. Dr Muhammad Karamat, RCP regional adviser for West Midlands, said: "The outpatient system generally works well in my local area, though there are concerns about patient access to services. To help address this problem locally, physicians, GPs and community teams have been delivering clinics and case discussions in the community, making it easier for patients to access care closer to where they live. For planned clinical activity, we have also incorporated video and tele clinic appointments, which has worked particularly well for some of the more complex muti-site clinics like transplant assessment clinics. "Where patients in our service have access to newer technologies such as Hybrid Closed Loop systems, they can use patient-initiated follow-up which means that clinicians' time can be used elsewhere for other patients – but sadly financial constraints mean that these novel therapies are not accessible for all." Dr Andrew Lansdown, RCP regional adviser for Wales, said: "As an endocrinologist in Cardiff, the introduction of an electronic referral service has made a significant positive difference in managing our waiting list for new patients. It allows me to triage referrals, give advice to referrers and suggest pre-clinic investigations, such as blood tests, making our outpatient service more efficient. “However, compared to other specialties, we have been slower to adopt Patient-Initiated Follow-Up (PIFU) pathways, which allow patients to contact their clinician when they feel they need an appointment. This means that many of our follow-up appointments, which might not be clinically necessary, are adding further pressure to our already stretched outpatient service and limiting clinicians' capacity to teach the next generation of physicians and other health professionals.” Dr Sam Rice, RCP regional adviser for Wales, said: "Delivering specialist outpatient work remains a challenge. Many of our remote areas have struggled to find clinicians with the right skill set. We're working across the region to make sure appointments in specialist centres ensure our rural population have equitable access to high-quality care. "In my experience in Wales, outpatient clinics are already operating at maximum efficiency. The solutions to improved outpatient care are multifaceted and require a whole system approach – an increase in capacity must complement any transformation of outpatient services."
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