Ann R Coll Surg Engl 2009; 91: 305-309 305Out-patient practice in the UK NHS and many other public funded health systems is under extreme pressure. The current system suits no-one: patients often wait weeks to be seen by a specialist and then even straightforward problems can take several visits to hospital over several more weeks to resolve. This is bad for patients as it is clinically dangerous; bad for hospital managers who are forced to spend far too much time managing the degree of failure and inadequacy rather than putting in place better systems of care; and bad for doctors who respond by overloading clinics, rushing consultations, and engaging in activity to 'beat the system' on a patient's behalf. These activities, although well-intentioned, are often flawed and inevitably fail many other patients.The problems seem to be endemic and previous attempts to deal with them have failed to deliver really significant improvements. Simply working harder seems unlikely to be the answer since lack of commitment is not the problem. Recruitment of extra consultants and nurses has made little impact since the processes of diagnosis and clinical management to which they have been recruited are so inefficient. In addition, waiting-list initiatives and the appointment of locums to see new referrals make little impact. In fact, it could even be argued that they generally Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple outpatient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes.
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